Clinical presentation and management of thymoma and thymic carcinoma
- Avedis Meneshian, MD
Avedis Meneshian, MD
- Assistant Professor of Surgery
- Division of Thoracic Surgery
- Johns Hopkins Hospital
- Thoracic Surgeon
- Anne Arundel Medical Center
- Giuseppe Giaccone, MD, PhD
Giuseppe Giaccone, MD, PhD
- Professor of Medical Oncology and Pharmacology
- Lombardi Comprehensive Cancer Center, Georgetown University
- Kenneth R Olivier, MD
Kenneth R Olivier, MD
- Associate Professor
- Mayo Clinic, Rochester, MN
- Section Editors
- Joseph S Friedberg, MD
Joseph S Friedberg, MD
- Section Editor — Thoracic Surgery
- Charles Reid Edwards Professor of Surgery
- University of Maryland
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
- Steven E Schild, MD
Steven E Schild, MD
- Section Editor — Radiation Therapy
- Professor of Radiation Oncology
- Mayo Clinic College of Medicine
Thymic tumors are rare neoplasms that arise in the anterior mediastinum. The clinical presentation, diagnosis, staging, and management of thymoma and thymic carcinoma are reviewed here.
The initial approach to patients with an anterior mediastinal mass is discussed separately. (See "Approach to the adult patient with a mediastinal mass".)
The thymus is an anterior mediastinal organ that weighs 12 to 15 grams at birth, reaches its maximum weight of about 40 grams around puberty, and then involutes and persists in an atrophic state into old age.
The thymus is composed of an outer cortex consisting primarily of epithelial cells, degenerated keratinized epithelial cells (Hassall's corpuscles), myoid cells, thymic lymphocytes ("thymocytes"), and B-lymphocytes, which form rare germinal centers. The thymus is primarily involved in the processing and maturation of lymphocytes, which become T-lymphocytes upon release into the circulation.
In adults, thymomas and thymic carcinomas are the most common neoplasms arising in the thymus. Thymomas account for about 20 percent of mediastinal neoplasms (table 1). Most thymoma patients are between 40 and 60 years of age, and there is a similar incidence in men and women . There are no known risk factors, although there is a strong association with myasthenia gravis and other paraneoplastic syndromes.
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- CLINICAL PRESENTATION
- Thoracic manifestations
- - Thymoma
- - Thymic carcinoma
- Paraneoplastic disorders
- - Myasthenia gravis
- - Pure red cell aplasia
- - Immunodeficiency
- - Thymoma-associated multiorgan autoimmunity
- INITIAL EVALUATION AND DIAGNOSIS
- General approach
- Resectable disease
- - Surgery
- - Postoperative RT
- Dose and schedule
- Potentially resectable disease (stages III and IVA)
- - Approach and indications
- - Neoadjuvant chemotherapy
- Recurrent disease
- Unresectable disease (stages III and IV)
- - Approach
- mTOR inhibitors
- Second primary cancers
- SURVEILLANCE AFTER TREATMENT
- SUMMARY AND RECOMMENDATIONS