Thymoma differential diagnosis: Difference between revisions

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Revision as of 18:52, 1 August 2018

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] Nouman M.K, M.D.[4]

Overview

Thymoma must be differentiated from other diseases such as thymic carcinoma, mediastinal germ cell tumor,thymic masses,lymphoma and substernal thyroid.

Differential Diagnosis

Thymoma must be differentiated from other diseases as^[1]:

Diseases	Site	Histology Findings and Lab Tests				Clinical Features
Diseases	Mediastinal Part	Cell Organization	Tumor Cells	Lymphoid Cells	Additional Tests	General Symptoms	Obstructive symptoms	Additional Features
Mediastinal Germ Cell Tumor	Anterior	Non-adhesive	Cell with large nuclei and prominent nucleoli	Mature looking,small	PLAP+ Serum AFP	Chest pain, Cough Difficulty breathing Weight loss	Superior vena cava syndrome	Post obstructive pneumonia
Thymic masses	Anterior	Varies	Depend on mass type	Varies with type	Depend on type	Fever Night sweats Weight loss(depend on mass type)	Stridor Superior vena cava syndrome Facial Swelling Odynophagia	Obstructive effect can cause Horner syndrome
Lymphoma	Anterior,middle	Non-adhesive	Immature lymphoid cells(Non-Hodgkin Lymphoma), Classical Reed Sternberg Cell and its variant(Hodgkin Lymphoma)	Immature(Non-Hodgkin lymphoma) Mature,small(Hodgkin lymphoma)	LCA+, Light chain restriction in B-NHL, CD15+,CD30+ in Hodgkin Lymphoma	Fever Weight loss Night sweats Shortness of breath	Phrenic nerve palsy Hoarseness Superior vena cava syndrome	Pleural Effusion Pericardial effusion
Thyroid	Anterior	Varies	Hurtle cells,prominent nucleoli,abundant cytoplasm	Non-Hodgkin type is more common in Thyroid lymphoma	Antithyroid peroxidase antibodies, Antithyroglobulin antibodies	Symptoms of hypothyroidism(cold intolerance,weight gain,constipation etc) or Hyperthyroidism (heat intolerance,weight loss,diarrhea etc)	Positional dyspnea Choking sensation Wheezing Superior vena cava syndrome	Vocal cord palsy Horner Syndrome

The following table shows the important differences between thymomas and thymic carcinomas:

Differential diagnosis of thymomas types A, AB, B and thymic carcinomas.

Other differentials

Thymoma must be differentiated from other similar conditions which lead to multiple endocrine disorders such as autoimmune polyendocrine syndrome, POEMS syndrome, Hirata 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	Hypoparathyroidism Candidiasis Hypogonadism
APS type 2	+	+	+	Hypogonadism Malabsorption
APS type 3	-	+	+	Malabsorption
Thymoma	+	-	+	Myasthenia gravis Cushing syndrome
Chromosomal abnormalities (Turner syndrome, Down's syndrome)	-	+	+	Cardiac dysfunction
Kearns–Sayre syndrome	-	+	-	Myopathy Hypoparathyroidism Hypogonadism
Wolfram syndrome	-	+	-	Diabetes insipidus Optic atrophy Deafness
POEMS syndrome	-	+	-	Polyneuropathy Hypogonadism Plasma cell dyscrasias

References

↑ Desai F, Shah M, Patel S, Shukla SN (2008). "Fine needle aspiration cytology of anterior mediastinal masses". Indian J Pathol Microbiol. 51 (1): 88–90. PMID 18417872.

Template:WikiDoc Sources

[pmid18417872-1] Desai F, Shah M, Patel S, Shukla SN (2008). "Fine needle aspiration cytology of anterior mediastinal masses". Indian J Pathol Microbiol. 51 (1): 88–90. PMID 18417872.

[1]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Thymoma}}
-{{CMG}} {{AE}} {{AM}} {{AAM}}
+{{CMG}} {{AE}} {{AM}} {{AAM}} Nouman M.K, M.D.[4]
 ==Overview==
-Thymoma must be differentiated from other diseases such as [[thymic carcinoma]], thymic [[cyst]], thymic [[hyperplasia]] and [[germ cell tumors]].
+Thymoma must be differentiated from other diseases such as [[thymic carcinoma]], [[mediastinal germ cell tumor]],thymic masses,[[lymphoma]] and substernal [[Thyroid disease|thyroid]].
 ==Differential Diagnosis==
-Thymoma must be differentiated from other diseases such as:
+Thymoma must be differentiated from other diseases as<ref name="pmid18417872">{{cite journal| author=Desai F, Shah M, Patel S, Shukla SN| title=Fine needle aspiration cytology of anterior mediastinal masses. | journal=Indian J Pathol Microbiol | year= 2008 | volume= 51 | issue= 1 | pages= 88-90 | pmid=18417872 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18417872  }}</ref>:
-* '''Thymic masses'''
+{|
-:* ''[[Cyst|Thymic cyst]]'': It is an incidental mass that may be congenital or acquired. It might contain [[parathyroid]] or salivary tissue, as they have a common embryological origin.
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-:* ''Thymic [[hyperplasia]]'': Resected only if associated [[paraneoplastic syndrome]].
+! rowspan="2" |Diseases
-:* ''Thymolipoma'': Increased thymic size with mixed [[adipose tissue]].
+!Site
-:* ''[[Thymic cancer|Thymic carcinoma]]'': Rare thymic tumor, poor survival rate, high rate of recurrence. Sometimes called type C thymoma.
+! colspan="4" |Histology Findings and Lab Tests
-:* ''Thymic [[carcinoid]]'': Also called thymic neuroendocrine tumor, uncommon and presents as a mass in the anterior mediastinum.
+! colspan="3" |Clinical Features
-:* ''Ectopic [[parathyroid]] tissue''
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+!Mediastinal Part
+!Cell Organization
+!Tumor Cells
+!Lymphoid Cells
+!Additional Tests
+!General Symptoms
+!Obstructive symptoms
+!Additional Features
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mediastinal germ cell tumor|Mediastinal Germ Cell Tumor]]
+|Anterior
+| style="background: #F5F5F5; padding: 5px;" |Non-adhesive
+| style="background: #F5F5F5; padding: 5px;" |
+* Cell with large nuclei and prominent nucleoli
+| style="background: #F5F5F5; padding: 5px;" |
+* Mature looking,small
+| style="background: #F5F5F5; padding: 5px;" |
+* PLAP+
+* Serum AFP
+| 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: #DCDCDC; padding: 5px; text-align: center;" |[[Thymic masses]]
+|Anterior
+| style="background: #F5F5F5; padding: 5px;" |Varies
+| style="background: #F5F5F5; padding: 5px;" |
+* Depend on mass type
+| style="background: #F5F5F5; padding: 5px;" |
+* Varies with type
+| style="background: #F5F5F5; padding: 5px;" |
+* Depend on type
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Fever and cough|Fever]]
+* [[Night sweats]]
+* Weight loss(depend on mass type)
+| style="background: #F5F5F5; padding: 5px;" |
+* Stridor
+* Superior vena cava syndrome
+* Facial Swelling
+* [[Odynophagia]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Obstructive effect can cause [[Horner syndrome]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lymphoma]]
+|Anterior,middle
+| style="background: #F5F5F5; padding: 5px;" |Non-adhesive
+| style="background: #F5F5F5; padding: 5px;" |
+* Immature lymphoid cells([[Non-Hodgkin lymphoma|Non-Hodgkin Lymphoma]]),
-* '''Germ cell tumors'''
+* Classical Reed Sternberg Cell and its variant(Hodgkin Lymphoma)
-:*The most common site of extragonadal [[germ cell tumors]] is the mediastinum.
+| style="background: #F5F5F5; padding: 5px;" |
-:* Germ cell tumors include:
+* Immature([[Non-Hodgkin lymphoma]])
-::* ''[[Teratoma]]s'': Represents two thirds of mediastinal germ cell tumors. Usually benign, but when malignant, it's very aggressive and has a very poor prognosis.
+* Mature,small(Hodgkin lymphoma)
-::* ''[[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>
+| style="background: #F5F5F5; padding: 5px;" |
-::* ''Malignant germ cell tumor'': 90% of malignant mediastinal germ cell tumors occur in males. A full physical examination and scrotal ultrasound is required.
+* LCA+,
-::* ''Seminomas'': Slightly more common, grows slowly but might reach large sizes.
+* Light chain restriction in B-NHL,
-::* ''Non-seminomatous germ cell tumor'': Consists of [[yolk sac tumor]]s, embryonal cell carcinoma, and/or [[choriocarcinoma]]. Commonly occurs between 20 and 40 years of age.
+* CD15+,CD30+ in Hodgkin Lymphoma
+| style="background: #F5F5F5; padding: 5px;" |
-* '''Lymphoma''' (anterior mediatinal lymphoma, also known as terrible lymphoma, may be middle or posterior mediastinal)
+* [[Fever and cough|Fever]]
-:*''Nodular sclerosing [[Hodgkin’s lymphoma]]'' and ''primary mediastinal [[B-cell lymphoma]]'' are the two common types that present in the mediastinum.
+* [[Weight loss]]
-:*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]].
+* [[Night sweats]]
+* [[Shortness of breath while lying down|Shortness of breath]]
-* '''Thyroid''' (intrathyroid [[goiter]])
+| style="background: #F5F5F5; padding: 5px;" |
-:*''[[Grave's disease]]'' and ''[[Hashimoto's thyroiditis]]'' are usually associated with [[goiter]].
+* Phrenic nerve palsy
-:*Presents with [[shortness of breath]] or [[dysphagia]].
+* [[Hoarseness]]
+* Superior vena cava syndrome
+| style="background: #F5F5F5; padding: 5px;" |
+* Pleural Effusion
+* [[Pericardial effusion]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Thyroid]]
+|Anterior
+| style="background: #F5F5F5; padding: 5px;" |Varies
+| style="background: #F5F5F5; padding: 5px;" |
+* Hurtle cells,prominent 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;" |
+* Antithyroid peroxidase antibodies,
+* Antithyroglobulin antibodies
+| style="background: #F5F5F5; padding: 5px;" |
+* Symptoms of [[hypothyroidism]](cold intolerance,weight gain,constipation etc) or
+* [[Hyperthyroidism]] (heat intolerance,weight loss,diarrhea etc)
+| style="background: #F5F5F5; padding: 5px;" |
+* Positional dyspnea
+* Choking sensation
+* [[Wheezing]]
+* Superior vena cava syndrome
+| style="background: #F5F5F5; padding: 5px;" |
+* Vocal cord palsy
+* Horner Syndrome
+|}
+* The following table shows the important differences between thymomas and thymic carcinomas:
 {|
-| [[File:diff.png|800px|thumb|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|Differential diagnosis of thymomas types A, AB, B and [[Thymic cancer|thymic carcinomas]].]]
 |}
 ==Other differentials==
-Thymoma must be differentiated from other similar conditions which lead to multiple endocrine disorders such as [[autoimmune polyendocrine syndrome]], [[POEMS syndrome]], Hirata syndrome, [[Kearns–Sayre syndrome]] and [[Wolfram syndrome|Wolfram syndromes]].<ref name="pmid21533467">{{cite journal |vauthors=Sherer Y, Bardayan Y, Shoenfeld Y |title=Thymoma, thymic hyperplasia, thymectomy and autoimmune diseases (Review) |journal=Int. J. Oncol. |volume=10 |issue=5 |pages=939–43 |year=1997 |pmid=21533467 |doi= |url=}}</ref><ref name="Nozza2017">{{cite journal|last1=Nozza|first1=Andrea|title=POEMS SYNDROME: AN UPDATE|journal=Mediterranean Journal of Hematology and Infectious Diseases|volume=9|issue=1|year=2017|pages=e2017051|issn=2035-3006|doi=10.4084/mjhid.2017.051}}</ref><ref name="pmid17342029">{{cite journal |vauthors=Maceluch JA, Niedziela M |title=The clinical diagnosis and molecular genetics of kearns-sayre syndrome: a complex mitochondrial encephalomyopathy |journal=Pediatr Endocrinol Rev |volume=4 |issue=2 |pages=117–37 |year=2006 |pmid=17342029 |doi= |url=}}</ref><ref name="pmid22790102">{{cite journal |vauthors=Rigoli L, Di Bella C |title=Wolfram syndrome 1 and Wolfram syndrome 2 |journal=Curr. Opin. Pediatr. |volume=24 |issue=4 |pages=512–7 |year=2012 |pmid=22790102 |doi=10.1097/MOP.0b013e328354ccdf |url=}}</ref><ref name="HusebyeAnderson2010">{{cite journal|last1=Husebye|first1=Eystein S.|last2=Anderson|first2=Mark S.|title=Autoimmune Polyendocrine Syndromes: Clues to Type 1 Diabetes Pathogenesis|journal=Immunity|volume=32|issue=4|year=2010|pages=479–487|issn=10747613|doi=10.1016/j.immuni.2010.03.016}}</ref>
+Thymoma must be differentiated from other similar conditions which lead to multiple endocrine disorders such as [[autoimmune polyendocrine syndrome]], [[POEMS syndrome]], Hirata syndrome, [[Kearns–Sayre syndrome]] and [[Wolfram syndrome|Wolfram syndromes]].
 {| class="wikitable"
@@ Line 96: / Line 179: @@
 ==References==
-{{Reflist|2}}
+<references />
 [[Category:Types of cancer]]
 [[Category:Rare diseases]]