Revisando un órgano olvidado: Evaluación del timo en PET-CT / Revisiting a Forgotten Organ: Thymus Evaluation in PET-CT

Resumen La pesquisa incidental de lesiones tímicas ha aumentado. Una adecuada aproximación a esas lesiones en la tomografía computada por emisión de positrones (PET-CT) es fundamental, pues se usa como parte de la mayoría de los procedimientos de planificación oncológica. Se han seleccionado casos representativos respecto de los aspectos más importantes de las imágenes de timo en PET-CT y cómo esa técnica puede contribuir a un diagnóstico preciso o a la planificación del tratamiento. Específicamente, presentamos una descripción general de las lesiones tímicas comunes y los imitadores de enfermedad, con énfasis en los hallazgos en PET-CT, incorporando también ejemplos de resonancia magnética (RM).

Abstract Incidental thymic lesion findings have increased. An adequate characterization of these lesions in positron emission computed tomography (PET-CT) is essential, since it is used as part of most oncological planning procedures. Representative cases have been selected regarding the most important aspects of thymus imaging in PET-CT and how this technique can contribute to an accurate diagnosis or treatment planning. Specifically, we present a general description of common thymic lesions and disease mimics, with an emphasis on PET-CT findings, also incorporating examples of magnetic resonance imaging.

Nephrotic Syndrome Associated with Thymic Neuroendocrine Tumor; Case Report and Review of Literature / 대한신장학회지

We report a case of nephrotic syndrome with thymic neuroendocrine tumor. A 50-year-old woman was admitted with generalized edema. 24-hour urine collection revealed proteinuria of 20 gram daily and creatinine clearance of 28 mL/min. During examination, a thymic mass was found, which is unresectable due to metastasis to the lung. Biopsy of the thymus and the kidney revealed large cell neuroendocrine carcinoma of thymus origin and minimal change disease, respectively. Despite high dose steroid therapy, massive proteinuria continued for about 30 days. However, when the patient was given a chemotherapy (cyclophosphamide, adriamycin, vincristine), proteinuria began to decrease dramatically. The carcinoma showed the partial response after six cycles of chemotherapy. This is the first report on remission of malignancy-related nephrotic syndrome after chemotherapy, especially for thymic neuroendocrine tumor.

An Intraluminal Cardiac Growth Identified as a Spreading Thymus Cancer in a Patient with Dyspnea

A 72-year-old man presented with aggravating dyspnea and swelling of the face due to thymic carcinoma, which was diagnosed based on a transfemoral biopsy specimen. Chest computed tomography and transthoracic echocardiogram showed a mediastinal mass that invaded the superior vena cava and the right atrium. The patient underwent successful chemotherapy with multimodal regimens including cyclophosphamide, vincristine and the dyspnea, facial edema improved. Here, we present a case of spreading thymic carcinoma identified as an intraluminal growth spreading from the mediastinum into the superior vena cava and cardiac cavity.

An Intraluminal Cardiac Growth Identified as a Spreading Thymus Cancer in a Patient with Dyspnea

A 72-year-old man presented with aggravating dyspnea and swelling of the face due to thymic carcinoma, which was diagnosed based on a transfemoral biopsy specimen. Chest computed tomography and transthoracic echocardiogram showed a mediastinal mass that invaded the superior vena cava and the right atrium. The patient underwent successful chemotherapy with multimodal regimens including cyclophosphamide, vincristine and the dyspnea, facial edema improved. Here, we present a case of spreading thymic carcinoma identified as an intraluminal growth spreading from the mediastinum into the superior vena cava and cardiac cavity.

Prognostic Factors of Thymic Carcinoma / 대한흉부외과학회지

BACKGROUND: Thymic carcinoma is a rare malignant disease with sparse data for treatment and prognosis. We intended to investigate the prognostic factors of thymic carcinoma. MATERIAL AND METHOD: Data of 42 patients, who were diagnosed and treated for thymic carcinoma from January of 1986 to August of 2003 were reviewed retrospectively. Influences of characteristics of patients, Masaoka stage, histologic grade, completeness of resection and adjuvant treatment on survival were evaluated. RESULT: There were 30 male and 12 female patients and their mean age was 52.0+/-15.7 years old. There were 28 patients with low-grade histology and 13 patients with high- grade histology. Clinical stage according to Masaoka stage were I in 2, II in 2, III in 15 (35.7%), IVa in 10 (23.8%), and IVb in 13 (31%) patients. Surgical resection was done in 22 patients. Complete resection was possible in 13 patients and incomplete resection was done in 9 patients. Among 20 patients without resection, 8 patients received chemotherapy, 7 patients received radiotherapy and 5 patients received combined therapy. Median survival time was 31.7+/-6.1 months and 5 year survival rate was 28.6%. High grade histology (hazard ratio=3.009, 95% confidence interval=1.178~7.685, p=0.021) and incompleteness of resection (hazard ratio=3.605, 95% confidence interval=1.154~11.580, p=0.023) were the prognostic factors of thymic carcinoma. CONCLUSION: In thymic carcinoma, low grade histology is a good prognostic factor and complete resection can prolong the survival of patients.

Two Cases of Ectopic Cervical Thymic Tumors Mimicking as Thyroid Tumors / 대한이비인후과학회지

The thymus arises from the ventral wings of the third and fourth branchial pouches in the embryo. Subsequently, the thymus passes down to the mediastinum by the sixth week of gestation. Several unusual conditions such as remnants of the thymus and incomplete descent may occur along the path of descent. Therefore, thymic diseases such as thymoma, thymic hyperplasia, and thymic cyst can be found in the neck. Thymoma is the most common anterior mediastinal mass in adult. Rarely, it is presented as an anterior neck mass, commonly located in the anterolateral aspect of the neck or adjacent to the thyroid. Cervical thymic cyst is uncommon and usually occurs in the first and second decades. Cervical thymic cyst after the third decade is so rare that it is very difficult to diagnose preoperatively. We experienced two cases of cervical thymic neoplasm in the lower anterior neck in an adult. Here, we present the cases with a review of the related literatures.

Treatment of Bilateral Diaphragmatic Paralysis after Resection of Thymic Carcinoma: One case report / 대한흉부외과학회지

Bilateral diaphragmatic paralysis is a rare disease. It is caused by trauma, cardiothoracic surgery, neuromuscular disorders, cervical spondylosis, and infection. A 60 year-old male patient developed bilateral diaphragmatic paralysis after an en-bloc resection of thymic carcinoma which invaded the right upper lobe, pericardium, superior vena cava and innominate vein. Severe respiratory difficulty developed and ventilator weaning was impossible. We performed bilateral diaphragmatic plication. After the operation, satisfactorily ventilator weaning and sleeping in supine position were possible; therefore, we report this case.

Clinical Analysis for Thymic Carcinoma / 대한흉부외과학회지

BACKGROUND: Thymic carcinoma is a very rare disease and treatment modality is not standardized. So, we report our experience of management of thymic carcinoma. MATERIAL AND METHOD: Between 1984 and 1998, eight patients with thymic carcinoma were treated at Keimyung University Dongsan Medical center. RESULT: The median age was 46 years with a range of 23 to 67 years. Chief complaint was a anterior chest pain. Histologic subtypes included two lymphoepithelioma-like carcinoma, two squamous cell carcinoma, one basaloid carcinoma, and three mixed type. Clinical staging was classified to stage I in 2, stage II in 4, stage III in 1, and stage IVA in 1 according to the modified Masaoka staging system. Four patients underwent complete resection and three patients were found to have incomplete resection by histologic evaluation. One patient underwent only biopsy due to pericardial dissemination and invasion of adjacent organ. All patients had adjuvant chemotherapy, radiation therapy was administered to five patients for positive resection margin and above stage III. The median follow up period was 55.3+/-64.6 months, three patiants died and four patients are alive without recurrence. One patient in recurrence had two times re-operations and adjuvant chemoradiotherapy. He is still alive. CONCLUSION: We concluded that completely surgical resection and adequate adjuvant chemoradiotherapy after early diagnosis are useful to management of thymic carcinoma.

Thymic Carcinoid Tumor: 1 Case report / 대한흉부외과학회지

Thymic carcinoid tumor is a rare mediastinal tumor, which was firstly described by Rosai and Higa in 1972. A carcinoid tumor of the thymus has recently been regarded as a distinct tumor from thymoma, and is probably Kultschizky cell origin. The pathologic diagnosis of thymic carcinoid is made from findings from light microscopy, immunohistochemical studies and electron microscopy. About 50% of thymic carcinoids were seen with endocrinopathies. Recurrences and extrathoracic metastasis are characteristics of thymic carcinoids. Surgical removal of the intial and tumor recurred are considered to be the most effective treatment today. However, the role of the adjuvant radiotherapy and the chemotherapy is still uncertain. Herein we report a case of thymic carcinoid tumor, which was confirmed by operation and pathologic study.