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 structure. 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 the thymoma include the pressure effect of the mass itself, autoimmune diseases, and rarely, malignancy.
Natural History, Complications and Prognosis
Natural history
The natural history of thymoma certainly illustrates the tendency for local mediastinal recurrence and plural ‘‘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.[1]
Complications
the complication associated with thymoma may inculde:
- 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
Complications of Radiotherapy
The most common complications with radiotherapy are: pulmonary fibrosis, pericarditis and myelitis. IMRT, a new technique of radiotherapy will hopefully have less toxicities.[1]
Complications of Surgery
- The complications of the procedure are rare but they should be considered. 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
In some rare cases pneumothorax or mediastinitis may occur.
Prognosis
The 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.[2]
Patients with stage III and IV tumors may nonetheless survive for several years with appropriate oncological management.
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
- The main prognostic factors for recurrence and survival are the stage at diagnosis and whether a complete resection has been achieved. Other prognostic factors with less impact on prognosis are the histological subtype, tumour size at diagnosis, age, gender and the presence or absence of myasthenia gravis.[1]
- The prognostic significance of the histologic type is somewhat variable because of the subjectivity of the classification into 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]
References
- ↑ 1.0 1.1 1.2 1.3 "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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