Thymoma differential diagnosis

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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] 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 Anterior
  • Post obstructive pneumonia
Non-adhesive
  • Cell with large nuclei and prominent nucleoli
  • Mature looking,small
  • PLAP+
  • Serum AFP
Thymic masses(Thymoma Cyst,Thymic Carcinoma,Thymolipoma,parathyroid hyperplasia) Anterior
  • Stridor
  • Superior vena cava syndrome
  • Facial Swelling
  • Odynophagia
Varies
  • Depend on mass type
  • Varies with type
  • Depend on type
  • Serum PTH
  • CBC
  • TSH,T3,T4
  • beta-HCG
  • Serum AFP
  • Gamma Globulins
Lymphoma(Non-Hodgkin Lymphoma & Hodgkin Lymphoma) Anterior,middle
  • Phrenic nerve palsy
  • Hoarseness
  • Superior vena cava syndrome
Non-adhesive
  • Classical Reed Sternberg Cell and its variant(Hodgkin Lymphoma)
  • LCA+,
  • Light chain restriction in B-NHL,
  • CD15+,CD30+ in Hodgkin Lymphoma
Substernal Goiter & Thyroid Lymphoma Anterior
  • Positional dyspnea
  • Choking sensation
  • Wheezing
  • Superior vena cava syndrome
  • Vocal cord palsy
  • Horner Syndrome
Varies
  • Hurtle cells,prominent nucleoli,abundant cytoplasm
  • Antithyroid peroxidase antibodies,
  • Antithyroglobulin antibodies


Thymomas Vs Thymic Carcinomas:

  • 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


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