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]

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Overview

The natural history of thymoma certainly illustrates the tendency for local mediastinal recurrence and pleural ‘‘droplet’’ recurrence presumably caused by mediastinal pleural invasion after resection. Local recurrences have been noted in the surgical incision used to completely remove a thymoma.

Natural history

Thymic malignancies are generally considered indolent tumours due to long recurrence intervals (median of 68 months). Overall, for patients diagnosed with a resectable thymic tumor, 16% of them will recur after radical resection, either locally with pleural or ganglionar recurrence or with distant metastases. The most common sites of distant recurrence are lung, liver, bone, kidney, brain and bone marrow.

Prognosis

Prognosis is much worse for stage III or IV thymomas as compared with stage I and II tumors. Invasive thymomas uncommonly can also metastasize, generally to pleura, bones, liver or brain in approximately 7% of cases.

Patients with stage III and IV tumors may nonetheless survive for several years with appropriate oncological management.

Patients who have undergone thymectomy for thymoma should be warned of possible severe side effects after yellow fever vaccination. This is probably caused by inadequate T-cell response to live attenuated yellow fever vaccine. Deaths have been reported.

The prognosis of thymoma depends on the following:

• The location of the tumor.
• The stage of the tumor.
• Whether the tumor can be removed completely by surgery.
• The patient's general health.
• Whether the cancer has just been diagnosed or has recurred.

References

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