Thymic neoplasm: a rare disease with a complex clinical presentation

Abstract

Thymic neoplasms constitute a broad category of rare lesions with a wide spectrum of pathologic characteristics and clinical presentations which therefore require a high index of suspicion to diagnose. The natural history of the disease is seldom predictable, anywhere from an indolent to an aggressively malignant course. Although the classification and staging of these lesions are complex and controversial, complete radical surgical resection remains the gold standard of therapy. Radiation and chemotherapy are important elements of the multimodality approach to treating these patients and it is important for thoracic surgeons to work closely with their colleagues in other disciplines in the management of and future research endeavors in thymic neoplasm. In this review, we discuss the evaluation of the patient with an anterior mediastinal mass, the classification and staging of thymic neoplasms, the role of surgery, radiation and chemotherapy in treating this disease, as well as future directions in research for novel targeted therapies.

Keywords: Thymic neoplasm; thymic carcinoma; thymoma.

Figure 1

A. Chest CT angiogram demonstrates an anterior mediastinal mass with calcifications (arrow); B. Chest CT scan demonstrates enlarged mass adjacent to the right atrium suspicious for metastatic spread versus contiguous extension (arrow).

Figure 2

The surgical field after radical complete thymectomy via median sternotomy.

Figure 3

A. The gross surgical specimen demonstrating the thymic neoplasm resected en bloc with all the adjacent fat; B. The gross cross section demonstrates the mass was resected with surrounding fat tissue.