Thymoma natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Amr Marawan, M.D. [2] Ahmad Al Maradni, M.D. [3]
Overview
If left untreated, thymoma may progress to invade the mediastinum and the surrounding structures. Depending on the stage of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good. Common complications of thymoma include the pressure effect of the mass itself, autoimmune diseases, and rarely, progression to malignancy.
Natural History, Complications and Prognosis
Natural history
One-third of patients have their thymomas discovered because of associated autoimmune disorder. The most common of those conditions is myasthenia gravis, 10–15% of patients with myasthenia gravis have thymoma. Conversely, 30–45% of patients with thymomas have myasthenia gravis. Patients with tymothma certainly illustrates the tendency for local mediastinal recurrence and plural ‘‘droplet’’ recurrence presumably caused by mediastinal plural invasion after resection.[1]
Complications
the complication associated with thymoma may include:
- Pressure effect associated with thymoma (sometimes presented as superior vena cava syndrome)
- Autoimmune diseases associated with thymoma (e.g. myasthenia gravis, pure red cell aplasia)
- Thymomic malignancy of unknown etiology may arise
- Thymomas rarely metastasize to pleura, bones, liver or brain in approximately 7% of cases.[2]
Complications of Radiotherapy
The most common complications of radiotherapy are:
The new technique of radiotherapy will hopefully has less toxicity.[1]
Complications of Surgery
The most common complications of thymectomy are:
- The complications of the procedure such as bleeding, infection, damage to other organs, nerve injuries(biateral phrenic nerve injury) and respiratory failure.
- Recurrence was described 10-20 years after removal of the primary lesion, so long term follow up is very important.
- Live attenuated vaccines such as yellow fever vaccine may have adverse side effect after thymectomy due to inadequate T-cell response.
Complications of Thymic Biopsy
The complications of the biopsy are:
Prognosis
The prognosis of thymoma depends on the following:
- The location of the tumor
- The stage of the tumor
- The Prognosis is much worse for stage III or IV thymomas as compared with stage I and II tumors.
- Patients with stage III and IV tumors may nonetheless survive for several years with appropriate oncological management.
- Whether the tumor can be removed completely by surgery
- The patient's general health
- Whether the cancer has just been diagnosed or has recurred.
- The histologic types include lymphocyte predominant, epithelial predominant, and mixed. The mixed histologic type was associated with the worst prognosis.
- the presence of myasthenia gravis at diagnosis is of less prognostic significance today.[1]
- The stage and the surgical excision of thymoma at the diagnosis are important prognostic factors for recurrence and survival.
References
- ↑ 1.0 1.1 1.2 "Results of surgical treatment for t... [J Thorac Cardiovasc Surg. 1984] - PubMed - NCBI".
- ↑ Thomas CR, Wright CD, Loehrer PJ (1999). "Thymoma: state of the art". Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 17 (7): 2280–9. PMID 10561285. Text "accessdate" ignored (help); Unknown parameter
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