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 pathology of thymic carcinomas, the initial approach to patients with an anterior mediastinal mass, and diagnosis and management of thymic neuroendocrine tumors is discussed separately. (See "Pathology of mediastinal tumors", section on 'Thymoma' and "Pathology of mediastinal tumors", section on 'Thymic carcinoma' and "Approach to the adult patient with a mediastinal mass" and "Thymic neuroendocrine (carcinoid) tumors".)
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.
Thymomas and thymic carcinomas typically present in one of three major ways:
●As an incidental finding identified on imaging in an asymptomatic patient (image 1)
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- CLINICAL PRESENTATION
- - Thoracic manifestations
- - Paraneoplastic disorders
- Thymic carcinoma
- INITIAL EVALUATION, DIAGNOSIS, AND STAGING
- Diagnostic evaluation
- General approach
- - Resectable disease
- - Potentially resectable disease
- Special considerations for involvement of the phrenic nerve
- - Unresectable disease
- - Recurrent disease
- Postoperative RT
- Chemotherapy indications and regimens
- SURVEILLANCE AFTER TREATMENT
- SUMMARY AND RECOMMENDATIONS