Thymoma differential diagnosis: Difference between revisions

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__NOTOC__
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{{Thymoma}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Thymoma]]
{{CMG}}; {{AE}} {{AM}}
{{CMG}} {{AE}} {{AM}} {{AAM}}  [[User:K.Nouman|Khuram Nouman, M.D. [4]]]
==Overview==
Thymoma must be differentiated from [[thymic carcinoma]], [[mediastinal germ cell tumor]], [[Thymus|thymic]] masses, [[lymphoma]], and sub-[[Sternum|sternal]] [[Thyroid disease|thyroid]].


==Differential Diagnosis==
==Differentiating Thymoma from other Diseases==
Differential diagnosis of thymomas types A, AB, B and [[Thymic cancer|thymic carcinomas]].<ref>{{Cite web  | last =  | first =  | title = http://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb10/BB10.pdf | url = http://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb10/BB10.pdf | publisher =  | date =  | accessdate = }}</ref>
{|
{|
| [[File:diff.png|800px|thumb]]
|+
|}
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
!Site
! colspan="3" |Clinical Features
| colspan="3" |'''Pathology'''
|'''Labs'''
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Mediastinal Part
!Systemic Symptoms
!Obstructive Symptoms
!Additional Features
!Cell Organization
!Tumor Cells
!Lymphoid Cells
!Additional Tests
|-
! style="background: #DCDCDC; padding: 5px; text-align: left;" |[[Mediastinal germ cell tumor|Mediastinal Germ Cell Tumor]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Anatomical terms of location|Anterior]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Chest pain, cough and dyspnea|Chest pain]],
*[[Cough]]
*[[Dyspnea|Difficulty breathing]]
*[[Weight loss]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Superior vena cava syndrome]]
| style="background: #F5F5F5; padding: 5px;" |
*Post-obstructive [[pneumonia]]
| style="background: #F5F5F5; padding: 5px;" |
* Non-adhesive
| style="background: #F5F5F5; padding: 5px;" |
*[[Cell (biology)|Cells]] with large [[Cell nucleus|nuclei]] and prominent [[Nucleolus|nucleoli]]
| style="background: #F5F5F5; padding: 5px;" |
*Mature looking
*Small
| style="background: #F5F5F5; padding: 5px;" |
*[[Placental alkaline phosphatase|PLAP]]+
*[[Serum]] [[Alpha-fetoprotein|AFP]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: left;" |[[Thymus|Thymic]] masses


'''Thymoma must be differentiated from other diseases such as:'''
* Thymoma
* Cyst 
* Thymic carcinoma
* Thymolipoma
* Parathyroid hyperplasia)
| style="background: #F5F5F5; padding: 5px;" |
* [[Anatomical terms of location|Anterior]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Fever and cough|Fever]]
*[[Night sweats]]
*[[Weight loss]] (depending on the type of mass)
| style="background: #F5F5F5; padding: 5px;" |
*[[Stridor]]
*[[Superior vena cava syndrome]]
*[[Face|Facial]] [[swelling]]
*[[Odynophagia|Painful swallowing]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Horner syndrome]] due to [[Mass effect (medicine)|mass effect]]
| style="background: #F5F5F5; padding: 5px;" |
* Varies
| style="background: #F5F5F5; padding: 5px;" |
*Varies with type
| style="background: #F5F5F5; padding: 5px;" |
*Varies with type
| style="background: #F5F5F5; padding: 5px;" |
*Varies with type
*[[Serum]] [[Parathyroid hormone|PTH]]
*[[Complete blood count|CBC]]
*[[Thyroid-stimulating hormone|TSH]], [[Triiodothyronine|T3]], [[Thyroxine|T4]]
*[[Human chorionic gonadotropin|beta-HCG]]
*[[Serum]] [[Alpha-fetoprotein|AFP]]
*Gamma [[Globulin|Globulins]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: left;" |[[Lymphoma]]
* [[Non-Hodgkin Lymphoma|Non-Hodgkin lymphoma]]
* [[Hodgkin's lymphoma]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Anterior mediastinum|Anterior]]
* [[Middle mediastinum|Middle]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Fever and cough|Fever]]
*[[Weight loss]]
*[[Night sweats]]
*[[Shortness of breath while lying down|Shortness of breath]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Phrenic nerve]] [[palsy]]
*[[Hoarseness]]
*[[Superior vena cava syndrome]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Pleural effusion]]
*[[Pericardial effusion]]
| style="background: #F5F5F5; padding: 5px;" |
* Non-adhesive
| style="background: #F5F5F5; padding: 5px;" |
*Immature [[Lymphoid cell|lymphoid cells]] ([[Non-Hodgkin lymphoma]])


* '''Thymic masses'''
*[[Reed-Sternberg cells]] and variants ([[Hodgkin's lymphoma]])
:* [[Cyst|Thymic Cyst]]: It is incidental mass that may be congenital or acquired. It might contain [[parathyroid]] or salivary tissue, as they has a common embryological origin.
| style="background: #F5F5F5; padding: 5px;" |
:* Thymic [[hyperplasia]]: Resected only if associated [[paraneoplastic syndrome]].
*Immature([[Non-Hodgkin lymphoma]])
:* Thymolipoma: Increased thymic size with mixed [[adipose tissue]].
*Mature, small ([[Hodgkin's lymphoma]])
:* [[Thymic cancer|Thymic carcinoma]]: Rare thymic tumor, poor survival rate, high rate of recurrence. Sometimes called type C thymoma.
| style="background: #F5F5F5; padding: 5px;" |
:* Thymic [[carcinoid]]: Also called thymic neuroendocrine tumors, uncommon and present as a mass in the anterior mediastinum.
*LCA+
:* Ectopic [[parathyroid]] tissue.
*[[Light chain]] restriction in B-[[Non-Hodgkin lymphoma|NHL]]
* '''Germ cell tumors'''
*[[CD15]]+, [[CD30]]+ in [[Hodgkin's lymphoma]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: left;" |Sub-[[Sternum|sternal]] [[goiter]] & [[thyroid]] [[lymphoma]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Anterior mediastinum|Anterior]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Symptom|Symptoms]] of [[hypothyroidism]](cold intolerance, [[weight gain]], and[[constipation]])
*[[Hyperthyroidism]] (heat intolerance, [[weight loss]], and [[diarrhea]])
| style="background: #F5F5F5; padding: 5px;" |
*Positional [[dyspnea]]
*[[Choking]] sensation
*[[Wheezing]]
*[[Superior vena cava syndrome]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Vocal cord]] [[palsy]]
*[[Horner's syndrome]]
| style="background: #F5F5F5; padding: 5px;" |
* Varies
| style="background: #F5F5F5; padding: 5px;" |
*[[Hurthle cells]]
*Prominent [[Nucleolus|nucleoli]]
*Abundant [[cytoplasm]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Non-Hodgkin Lymphoma|Non-Hodgkin]] type is more common in [[thyroid]] [[lymphoma]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Antibodies]] against [[thyroid peroxidase]]  


:*The most common site of extragonadal [[germ cell tumors]] is the mediastinum.
*[[Antibodies]] against [[thyroglobulin]]  
:* [[Teratoma]]s: Represents two thirds of mediastinal germ cell tumor. Usually benign, but when malignant, it's very aggressive and very poor prognosis.
|}
:* [[Dermoid cyst]]s: Very rare tumor, only 118 cases have been reported.<ref name="Ripa-1992">{{Cite journal | last1 = Ripa | first1 = LW. | title = Rinses for the control of dental caries. | journal = Int Dent J | volume = 42 | issue = 4 Suppl 1 | pages = 263-9 | month = Aug | year = 1992 | doi = | PMID = 1399044 }}</ref>
:* Malignant germ cell tumor: 90% of malignant mediastinal germ cell tumor occur in males. Full physical examination and scrotal ultrasound is required.
:* Seminomas: Slightly more common, grow slowly but might reach large sizes.
:* Non-seminomatous germ cell tumor: Consists of [[yolk sac tumor]], embryonal cell carcinoma, and/or [[choriocarcinoma]]. Commonly between 20-40 years of age.


* '''Lymphoma''' (terrible, could be middle or posterior mediastinal too)


:*Nodular sclerosing [[Hodgkin’s lymphoma]] and primary mediastinal [[B-cell lymphoma]] are the two common types that present in the mediastinum.
=== Thymoma Vs Thymic Carcinoma ===
:*Usually has systemic symptoms such as fever, weight loss, and night sweats and may also have other symptoms as [[chest pain]], [[wheezing]], [[dyspnea]] or [[superior vena cava syndrome]].
* The following table highlights the difference between thymoma and thymic carcinoma:
{|
| [[File:diff.png|800px|thumb|Differential diagnosis of thymoma types A, AB, B, and [[Thymic cancer|thymic carcinomas]].]]
|}


* '''Thyroid''' (intrathyroid [[goitre]])
==Other Differential Diagnoses==
:*[[Grave's disease]] and [[Hashimoto's thyroiditis]] are usually associated with [[goitre]]
Thymoma must be differentiated from other similar conditions which lead to multiple [[Endocrine diseases|endocrine disorders]], such as [[autoimmune polyendocrine syndrome]], [[POEMS syndrome]], Hirata's syndrome, [[Kearns–Sayre syndrome]], and [[Wolfram syndrome|Wolfram syndromes]].
:*Presents with [[shortness of breath]] or [[dysphagia]].


{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Addison's Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type 1 Diabetes Mellitus
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hypothyroidism
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other Disorders Present
|-
!APS  type 1
|<nowiki>+</nowiki>
|
* Less common
|
* Less common
|
* [[Hypoparathyroidism]]
* [[Candidiasis]]
* [[Hypogonadism]]
|-
!APS  type 2
| +
| +
| +
|
* [[Hypogonadism]]
* [[Malabsorption]]
|-
!APS  type 3
|<nowiki>-</nowiki>
| +
|<nowiki>+</nowiki>
|
* [[Malabsorption]]
|-
![[Thymoma]]
| +
|<nowiki>-</nowiki>
| +
|
* [[Myasthenia gravis]]
* [[Cushing syndrome]]
|-
![[Chromosomal abnormalities]]<br>([[Turner syndrome]],<br>[[Down's syndrome]])
| -
| +
| +
|
* [[Cardiac dysfunction]]
|-
![[Kearns–Sayre syndrome]]
|<nowiki>-</nowiki>
| +
|<nowiki>-</nowiki>
|
* [[Myopathy]]
* [[Hypoparathyroidism]]
* [[Hypogonadism]]
|-
![[Wolfram syndrome]]
|<nowiki>-</nowiki>
| +
|<nowiki>-</nowiki>
|
* [[Diabetes insipidus]]
* [[Optic atrophy]]
* [[Deafness]]<br>
|-
![[POEMS syndrome]]
|<nowiki>-</nowiki>
| +
|<nowiki>-</nowiki>
|
* [[Polyneuropathy]]
* [[Hypogonadism]]
* [[Plasma cell dyscrasia|Plasma cell dyscrasias]]
|}
==References==
==References==
{{Reflist|2}}
<references />
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Rare diseases]]
[[Category:Rare diseases]]
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Latest revision as of 22:28, 8 August 2019

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] Khuram Nouman, M.D. [4]

Overview

Thymoma must be differentiated from thymic carcinoma, mediastinal germ cell tumor, thymic masses, lymphoma, and sub-sternal thyroid.

Differentiating Thymoma from other Diseases

Diseases Site Clinical Features Pathology Labs
Mediastinal Part Systemic Symptoms Obstructive Symptoms Additional Features Cell Organization Tumor Cells Lymphoid Cells Additional Tests
Mediastinal Germ Cell Tumor
  • Non-adhesive
  • Mature looking
  • Small
Thymic masses
  • Thymoma
  • Cyst
  • Thymic carcinoma
  • Thymolipoma
  • Parathyroid hyperplasia)
  • Varies
  • Varies with type
  • Varies with type
Lymphoma
  • Non-adhesive
Sub-sternal goiter & thyroid lymphoma
  • Varies


Thymoma Vs Thymic Carcinoma

  • The following table highlights the difference between thymoma and thymic carcinoma:
Differential diagnosis of thymoma types A, AB, B, and thymic carcinomas.

Other Differential Diagnoses

Thymoma must be differentiated from other similar conditions which lead to multiple endocrine disorders, such as autoimmune polyendocrine syndrome, POEMS syndrome, Hirata's syndrome, Kearns–Sayre syndrome, and Wolfram syndromes.

Disease Addison's Disease Type 1 Diabetes Mellitus Hypothyroidism Other Disorders Present
APS type 1 +
  • Less common
  • Less common
APS type 2 + + +
APS type 3 - + +
Thymoma + - +
Chromosomal abnormalities
(Turner syndrome,
Down's syndrome)
- + +
Kearns–Sayre syndrome - + -
Wolfram syndrome - + -
POEMS syndrome - + -

References


Template:WikiDoc Sources