Editing Primary thymic tumours


Most common masses of the anterior mediastinum

== Thymomas ==

* Presentation
** Half present with paraneoplastic syndrome
*** Myaesthenia gravis
*** Red cell aplasia
*** Hypogammaglobulinaemia
** Cough
** Local compressive symptoms
** Incidental
* Imaging
** Well-defined solid or cystic soft tissue mass within the anterior mediastinum. Generally occurs within normal thymic area in upper substernal area.
** CT is diagnostic
** MRI adds clarity, and assesses for invasion
*** If invasion, consider thymic carcinoma (WHO type C thymoma)
*** This patient would need PET scan, biopsy, and neoadjuvant chemoradiotherapy
* Histopathology
** Types of thymic tumours:
*** Thymomas
**** No atypia or mitotic activity
*** Atypical thymomas/well-differentiated thymic carcinomas
*** Thymic carcinomas
**
* Staging
**

*
* 5 year survival based on Masaoka-Koga staging:
** 1: 95%
** 2: 80%
** 3: 65%
** 4a: 50%
** 4b: <50%

* Treatment
** R0 surgical resection is optimal for all thymic tumours
*** Mainstay of treatment for thymoma
*** Excellent long-term outcomes (90% 5 year survival if completely resected)
*** May entail extensive resection of surrounding structures
*** Entire thymus should be resected in continuity with the tumour, along with attached mediastinal fat
** Adjuvant RTX may prevent local recurrence, especially if incomplete resection
* Surgical approach
** Can be either open or minimally-invasive (VATS vs robot)
*** VATS only works with smaller, easily removable tumours
** Transcervical thymectomy is not appropriate for thymic tumours

[[Category:Thoracics]]