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  • • Rare variant of thymic lesions (< 15%)

    • Biologically different from malignant thymoma

    • Tend to be very invasive and aggressive

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Epidemiology

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  • • Young men (< 50-years-old, typically)

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Symptoms and Signs

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  • • 50% of asymptomatic cases identified on chest film

    • Chest pain dysphagia, dyspnea, or superior vena cava syndrome most common if symptomatic

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Imaging Findings

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  • Chest film: Anterior mediastinal mass

    CT scan: Useful in assessing extent of lesion

    MRI: Can assess vascular invasion

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  • Definitive diagnosis: Histologic tissue analysis

    • Do not biopsy small, well-encapsulated mediastinal masses-

    • Do complete excision, otherwise risk tumor seeding

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Rule Out

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  • • Lymphoma

    • -Can be difficult to differentiate histologically from thymoma

    • Thymoma

    • -Very aggressive variant of thymic lesions

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  • • Chest CT

    • Biopsy

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  • • Attempt complete resection

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Medications

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  • • Induction chemotherapy

    • Postoperative chemoradiation

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Prognosis

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  • • High recurrence locally and at distant sites

    • After thymectomy, 75% with myasthenia gravis are improved; 30% complete remission

    • Younger patients (< 40 years) do better after thymectomy

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References

Rea F et al. Chemotherapy and operation for invasive thymoma. J Thorac Cardiovasc Surg. 1993;106:543.  [PubMed: 8361199]
Toker et al: Comparison of early postoperative results of thymectomy: partial sternotomy vs. videothoracoscopy. Thorac Cardiovasc Surg 2005;53:110.  [PubMed: 15786010]

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Practice Guidelines

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