Figure 9 Thymoma with vascular invasion in a 63-year-old woman with facial swelling. Computed tomography and pathologic correlations of thymic lesions, Computed tomography of the anterior mediastinum in myasthenia gravis: a radiologic-pathologic correlative study, Using the World Health Organization classification of thymic epithelial neoplasms to describe CT findings, Thymic epithelial tumors: comparison of CT and MR imaging findings of low-risk thymomas, high-risk thymomas, and thymic carcinomas, Computed tomographic findings and prognosis in thymic epithelial tumor patients, Invasive and noninvasive thymoma: distinctive CT features, Computed tomography and thymoma: distinctive findings in invasive and noninvasive thymoma and predictive features of recurrence, Computed tomography findings predicting invasiveness of thymoma, Imaging findings of expansile lesions of the thymus, Differential diagnosis between thymoma and non-thymoma by dynamic MR imaging, Octreotide alone or with prednisone in patients with advanced thymoma and thymic carcinoma: an Eastern Cooperative Oncology Group Phase II Trial, Utility of 18FDG-PET for differentiating the grade of malignancy in thymic epithelial tumors, 18F-FDG PET/CT of thymic epithelial tumors: usefulness for distinguishing and staging tumor subgroups, Thymoma: a comparative study of clinical stages, histologic features, and survival in 200 cases, Open in Image
Anderson Cancer Center, 31 patients with thymoma underwent FDG PET/CT prior to surgery. (a) Contrast material–enhanced chest CT scan obtained prior to the initiation of chemotherapy shows the triangular morphology of the normal thymus (arrow). Since no chest wall muscles are cut with this incision, postoperative pain is modest, and recovery is not prolonged. Although CT is superior to MR imaging in the depiction of calcification within thymomas, MR imaging can occasionally reveal fibrous septa within the mass, as well as permit better evaluation of the tumor capsule. Treatment of stage IVa thymomas is similar to that of stage III lesions. policies and procedures for surgeons and pathologists of resection specimens of thymic malignancy, Thymoma: a multivariate analysis of factors predicting survival, Thymoma: a clinicopathologic study based on the new World Health Organization classification, Predictors of recurrence in thymic tumors: importance of invasion, World Health Organization histology, and size, Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report, Thymic epithelial neoplasia: a study of 58 cases, Chemotherapy and operation for invasive thymoma, Long-term outcome after multimodality treatment for stage III thymic tumors, Multimodality treatment of thymoma: a prospective study, Results of re-resection for recurrent thymomas, Tumor recurrence and survival in patients treated for thymomas and thymic squamous cell carcinomas: a retrospective analysis, Thymus in myasthenia gravis: comparison of CT and pathologic findings and clinical outcome after thymectomy, Thymic hyperplasia and thymus gland tumors: differentiation with chemical shift MR imaging, Characterization of the normal and hyperplastic thymus on chemical-shift MR imaging, Thymomas presenting as pleural tumors: report of eight cases. 3, 15 December 2015 | European Journal of Cardio-Thoracic Surgery, Vol. Thymoma is a rare mediastinal neoplasm but is the most common primary neoplasm of the anterior mediastinum. (a) Transverse in-phase T1-weighted MR image shows diffuse enlargement of the thymus without preservation of its normal triangular morphology (arrow). Moore AV, Korobkin M, Powers B, Olanow W, Ravin CE, Putman CE, Breiman RS, Ram PC. (c) Contrast-enhanced multiplanar double-inversion-recovery short-axis MR image demonstrates tumor invasion of the pericardium (arrow) and epicardial fat (arrowhead), findings that were confirmed at thymectomy and pericardial resection. In 1999, the World Health Organization (WHO) Consensus Committee published a histologic classification scheme for tumors of the thymus. Unable to load your collection due to an error, Unable to load your delegates due to an error. Note.—Adapted, with permission, from references 17 and 18. Thymic enlargement should be determined because most enlarged thymus glands visualized on CT … Thymomas may result in vascular invasion (Fig 9), pleural involvement, or pericardial dissemination. 2, Seminars in Ultrasound, CT and MRI, Vol. Conclusion: In this article, we discuss and illustrate t… Malignant germ cell neoplasms almost exclusively affect men and are more common in patients younger than 40 years of age. 2 Chest CT film at recurrence showed a clearly defined mass in the anterior mediastinum and dis seminated tumors in the left pleura. 37, No. Imaging plays an essential role in the diagnosis, staging, and follow-up of thymoma, and CT is the cross-sectional imaging modality of choice. Epub 2020 Feb 11. Patient age and gender, tissue composition as assessed at CT, ancillary CT findings, and evidence of tumor invasiveness are helpful in developing the differential diagnosis for anterior mediastinal masses. Does CT of thymic epithelial tumors enable us to differentiate histologic subtypes and predict prognosis? Results: Jung W, Cho S, Yum S, Lee YK, Kim K, Jheon S. J Thorac Dis. Although thymic hyperplasia and thymoma, which are present in 75% of patients with myasthenia gravis, are less likely in MuSK autoantibody receptor-positive disease, these disorders should first be ruled out with a chest CT For example, a cystic anterior mediastinal mass with intrinsic fat attenuation typically represents a mature teratoma. At surgery, a thymoma was found in 26 … 2021 Jan;31(1):423-435. doi: 10.1007/s00330-020-07100-4. 15, No. 31, No. Associations between computed tomography features of thymomas and their pathological classification. Thymoma typically arises in 1 of the thymic lobes, which accounts … Harris K, Elsayegh D, Azab B, Alkaied H, Chalhoub M. World J Surg Oncol. This site needs JavaScript to work properly. 2, 1 January 2015 | Polish Journal of Radiology, Vol. Those with the strongest correlation and most frequently encountered include: 1. myasthenia gravis: most common association 5 1.1. (Fig 3 courtesy of Loren Ketai, MD, Department of Radiology, University of New Mexico, Albuquerque, NM.). Currently, FDG PET/CT may highlight metastatic disease (Figs 17, 18), but its exact role in the management of thymoma has not yet been defined. The normal adult thymus is not visible at chest radiography but has a triangular shape at CT and magnetic resonance (MR) imaging and is best visualized at the level of the aortic arch. Myasthenia gravis (MG) is an autoimmune disease that often is associated with thymic abnormalities. Figure 10 Pleural dissemination in a 36-year-old woman with myasthenia gravis and acute chest pain. A cystic lesion in the anterior mediastinum was found on chest CT … Epub 2020 Aug 5. Note.—Adapted, with permission, from reference 3. Figure 7 Pleural metastases in a 36-year-old woman with chest discomfort. Contrast-enhanced chest CT scan shows an anterior mediastinal mass (M) with a drop metastasis to the right pleura (arrow). Privacy, Help Chen X, Feng B, Li C, Duan X, Chen Y, Li Z, Liu Z, Zhang C, Long W. Oncol Rep. 2020 Apr;43(4):1256-1266. doi: 10.3892/or.2020.7497. (b) Follow-up contrast-enhanced chest CT scan obtained 2 years later shows increased diaphragmatic pleural thickening (arrow). Thymoma is the most common primary neoplasm of the anterior mediastinum (1). Subsequent PET scan demonstrated locally invasive thymoma without distant … 59, No. Viewer, Case 261: Thymoma Embedded in Thymus with Pleural Implant in Myasthenia Gravis Lambert-Eaton Overlap Syndrome, Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings. ITMIG follow-up recommendations suggest that, at a minimum, chest CT should be performed annually for 5 years after surgical resection, and then alternated with annual chest radiograp… ), Department of Pathology (C.A.M. The reported average time to recurrence of a completely resected thymoma is approximately 5 years (range, 3–7 years) (16). ), University of Texas M.D. 96, No. Currently, both CT and MR images of the chest are more typically obtained on deep inspiration. Table 2 Thymoma Treatment Options according to the Masaoka-Koga Staging System. At 7-month follow-up PET/CT, the uptake had resolved, a finding consistent with thymic hyperplasia. Invited Commentary
See discussion on this article by Ketai. Epub 2009 Dec 16. The mass was diagnosed as a lymphocyte-rich WHO type B1 thymoma at resection. Cystic changes and intratumoral necrosis manifest with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Fig. Differentiating thymoma from thymic cyst in anterior mediastinal abnormalities smaller than 3 cm. The mass is cystic but has solid enhancing components, so we are worried about lymphoma, germ cell tumor and cystic thymoma. Invasive thymomas were more likely to have lobulated (16/27, 59%) or irregular (6/27, 22%) contours than noninvasive thymomas (8/23, 35% and 1.5/23, 6%, respectively) (p < 0.05). Other financial activities: consultant for GlaxoSmithKline. (a) Postoperative baseline CT scan shows normal right basilar pleura adjacent to the attachment of the diaphragm to the chest wall (arrow). Method: 27, No. Method: The CT scans … When differentiation between nonneoplastic thymic enlargement and thymoma cannot be achieved at CT or conventional MR imaging, chemical shift MR imaging with in-phase and out-of-phase gradient-echo sequences can be helpful. Tumors that are encapsulated and are amenable to complete resection have a good prognosis, whereas invasive and unresectable tumors have a poor prognosis regardless of their histologic characteristics. Systemic complaints and paraneoplastic syndromes are typically due to the secretion of hormones, antibodies, or cytokines by the tumor. (a) Axial T1-weighted MR image shows a rounded intermediate-signal-intensity mass (M) in the anterior mediastinum. When one or more of these findings are seen, a diagnosis other than thymoma is more likely. (b) Axial fat-suppressed T2-weighted MR image demonstrates a 6-cm anterior mediastinal mass (M) with high signal intensity at the level of the ascending aorta (Ao). Chemotherapy is not recommended for stage II disease (17). Up to one-third of patients with thymoma have chest pain, dyspnea, or cough (5). Computed tomography (CT) scan of the chest revealed a 5.3‐ × 3.0‐cm … We describe a case of a 60 year-old woman with a cystic thymoma studied with advanced tomographic imaging stydies.CT… For example, thymoma rarely manifests with lymphadenopathy, pleural effusions, or extrathoracic metastases. S.G.S. As such, they can present with venous obstruction, dysphagia or stridor. The FDG uptake as assessed on the basis of maximum standardized uptake value was variable and could not help distinguish early-stage (stages I and II) from advanced-stage (stages III and IV) disease (P = 0.66). Epub 2016 Jul 20. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Radiology, Saint Luke's Hospital of Kansas City, Kansas City, Mo (M.L.R.d.C. Recipient of a Cum Laude award for an education exhibit at the 2010 RSNA Annual Meeting. Heterogeneous signal intensity is present in tumors with necrosis, hemorrhage, or cystic change. 34, No. 42, No. However, lobulated or irregular contours, cystic or necrotic regions within the tumor, and multifocal calcifications were more suggestive of invasive thymoma at univariable analysis. Contrast-enhanced chest CT scan shows a 4-cm round left anterior mediastinal mass (M). (b) Contrast-enhanced chest CT scan obtained 3 months after completion of chemotherapy shows diffuse enlargement of the thymus with preservation of its triangular shape (arrow), findings that are consistent with thymic hyperplasia. *For stage III or IVa tumors, adjuvant chemotherapy may be considered, but data are insufficient to routinely recommend its use after complete resection. CT scans were assessed for the location, size (short and long axes), shape, marginal characteristics, homogeneity, attenuation (compared with chest wall muscle), and degree of tumor enhancement. In this article, we describe the epidemiologic, pathologic, and clinical features of thymoma and discuss this disease entity in terms of classification, staging, treatment, imaging evaluation, differential diagnosis, and recurrence and follow-up. Currently, the histologic classification of thymoma has no clinical implications, and management decisions rest primarily on the stage of disease and the completeness of resection. From the Division of Diagnostic Imaging (M.F.K.B., B.S.S., E.M.M. Souma T, Maruyama Y, Hirono T, Yamato Y, Yoshiya K, Nakayama K, Tsuchida M, Eguchi S. Contemp Oncol (Pozn). 1, Singapore Medical Journal, Vol. Chest CT demonstrate a small soft tissue mass at the anterior mediastinum, pathologically proven thymoma, axial. Figure 6 Surgically proved phrenic nerve involvement in a 60-year-old man who presented with cough. This is why careful handling and identification of resection specimens by the surgeon and proper communication with the pathologist are essential, so that areas of concern can be identified for the planning of radiation therapy. Tumors with a favorable outcome are those that are encapsulated and amenable to complete resection. 体，抗DNA抗体 … 1, Radiologic Clinics of North America, Vol. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Radiologists are key members of the multidisciplinary team required to evaluate patients with thymoma and must be aware of the imaging findings that impact treatment. One study suggested a correlation with tumor stage and showed a mean time to recurrence of 10 years in patients with stage I thymoma, compared with 3 years in patients with stages II–IV thymoma (52). Thymoma An encapsulated thymoma (mixed lymphocytic and epithelial type) Specialty Oncology, cardiothoracic surgery Usual onset Adulthood Treatment surgical removal, chemotherapy (in … Several CT studies have correlated CT appearance with WHO histologic classification. The CT shows a mass located in the anterior mediastinum. CT guided biopsy was consistent with thymoma B1 subtype. Figure 10 Pleural dissemination in a 36-year-old woman with myasthenia gravis and acute chest pain. Thymoma in a 54-year-old woman with facial swelling. Computed tomography and thymoma: distinctive findings in invasive and noninvasive thymoma and predictive features of recurrence. 2, Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie, Vol. Contrast-enhanced chest CT scan demonstrates a right anterior mediastinal mass (M) with invasion of the superior vena cava (*). The presence and distribution of various CT findings were independently analyzed. A White Paper of the ACR Incidental Findings Committee, Comparison of Interobserver Agreement and Diagnostic Accuracy for IASLC/ITMIG Thymic Epithelial Tumor Staging Among Co-registered FDG-PET/MRI, Whole-body MRI, Integrated FDG-PET/CT, and Conventional Imaging Examination with and without Contrast Media Administrations, Usefulness of Volume Perfusion Computed Tomography in Differentiating Histologic Subtypes of Thymic Epithelial Tumors, Iodine Quantification Using Dual-Energy Computed Tomography for Differentiating Thymic Tumors, Evaluation of metabolic response with 18F-FDG PET-CT in patients with advanced or recurrent thymic epithelial tumors, Doubling time of thymic epithelial tumours on CT: correlation with histological subtype, Therapie von Thymomen und Thymuskarzinomen, ITMIG Classification of Mediastinal Compartments and Multidisciplinary Approach to Mediastinal Masses, Radiologic Features of Mediastinal Lesions, Pediatric Mediastinal Tumors and Tumor-Like Lesions, State of the art: diagnostic tools and innovative therapies for treatment of advanced thymoma and thymic carcinoma, An Evaluation of Performance Characteristics of Primary Display Devices, Perplexing Histologic Classification of Thymic Epithelial Tumor, Value of Computerized 3D Shape Analysis in Differentiating Encapsulated from Invasive Thymomas, Correlative Imaging in a Patient with Cystic Thymoma: CT, MR and PET/CT Comparison, Multimodality Imaging for Characterization, Classification, and Staging of Malignant Pleural Mesothelioma, Diffusion-weighted MR Imaging in Thymic Epithelial Tumors: Correlation with World Health Organization Classification and Clinical Staging, Approaching the Patient with an Anterior Mediastinal Mass: A Guide for Radiologists, Imaging of invasive thymoma in the costophrenic recess presenting as thickening of arcuate ligaments of the diaphragm, Imaging of thymus in myasthenia gravis: From thymic hyperplasia to thymic tumor, Ectopic pancreas in the anterior mediastinum: A report of two cases and review of the literature, Imaging Characteristics of Pathologically Proven Thymic Hyperplasia: Identifying Features That Can Differentiate True From Lymphoid Hyperplasia, Thymus and aging: morphological, radiological, and functional overview, The IASLC/ITMIG Thymic Malignancies Staging Project: Development of a Stage Classification for Thymic Malignancies, Thymoma Originating in a Giant Thymolipoma: A Rare Intrathoracic Lesion, New era of radiotherapy: An update in radiation-induced lung disease, Computed tomography characterization of neuroendocrine tumors of the thymus can aid identification and treatment, Unlocking the Mystery of Thymus Gland: Imaging Holds the key to the Chest, Thymic Imaging of Adults: The Spectrum of Image Manifestation of Normal and Abnormal Thymus, Clinical and Radiologic Review of the Normal and Abnormal Thymus: Pearls and Pitfalls, The Neglected Adult Thymus: Variants, Pathology and Mimics, Differentiation of Rebound and Lymphoid Thymic Hyperplasia from Anterior Mediastinal Tumors with Dual-Echo Chemical-Shift MR Imaging in Adulthood: Reliability of the Chemical-Shift Ratio and Signal Intensity Index. Sakai et al (48) studied 31 patients with thymoma using dynamic MR imaging and showed that mean peak time was delayed in advanced-stage thymomas (stage III) compared with earlier-stage tumors. 7, No. Contrast-enhanced chest CT scan shows an anterior mediastinal mass (M) with a drop metastasis to the right pleura (arrow). The appearance of hemorrhage may vary according to its age. Chest CT was performed at the onset (C), and at 3 months (D) and 9 months (E) after the treatment of the tumor. Nonneoplastic thymic enlargement must not be confused with thymoma. There have been only a few published reports assessing this disease. The purpose of this work was to evaluate the CT features of thymoma and to determine the most helpful findings in differentiating invasive from noninvasive thymoma. WHO classification, type B1 invasive thymoma. The differential diagnosis for anterior mediastinal tumors includes other primary thymic malignancies (eg, thymic carcinoma, thymic carcinoid tumor), nonthymic tumors (eg, lymphoma, germ cell tumor, small-cell lung cancer), and mediastinal metastasis. 86, Journal of Community Hospital Internal Medicine Perspectives, Vol. Thymoma. Many different staging systems for thymoma have been proposed (12–15). Ten percent of patients with a thymoma have hypogammaglobulinemia, whereas 5% have pure red cell aplasia (7). An invasive thymoma with vascular and pericardial involvement (stage III) was diagnosed at surgery.Figure 9Download as PowerPointOpen in Image
Thymic hyperplasia in a 23-year-old woman with Ewing sarcoma. The thymus gland is in the chest, between the lungs and behind the breastbone.It makes white blood cells called T lymphocytes. 12, Seminars in Roentgenology, Vol. Thymoma is the most common primary tumor of anterior mediastinum and accounts for 20% of all mediastinal tumors. Chest CT … 10-20% of patients with myasthenia gravis have a thymoma 1.… Purpose: 4, Journal of the American College of Radiology, Vol. At MR imaging, thymomas manifest with low to intermediate signal intensity on T1-weighted images, and with high signal intensity on T2-weighted images (Fig 14) that may approach the signal intensity of fat (46,47). Thymic carcinoma is a more aggressive disease that is often diagnosed with needle biopsy before treatment planning; it has been discussed elsewhere (3). Diagnosis of thymoma and thymic carcinoma can happen unintentionally when a patient has a chest x-ray or CT scan performed for another reason. However, when the intravenous administration of iodinated contrast material is contraindicated, MR imaging is used for the assessment of local tumor invasiveness (Fig 13). However, because of the rarity of thymoma, there are few published series assessing this disease, many of which are single-institution studies spanning several decades, which may lead to potentially misleading conclusions related to diagnosis, staging, and treatment. ), and Department of Thoracic and Cardiovascular Surgery (S.G.S. Pleural nodularity is indicative of pleural metastases (stage IVa disease) (Fig 7). 60, No. In an internal review at M.D. :Related financial activities: none. Thymic neoplasms are rare tumors that account for less than 1% of all adult malignancies, with reported incidences of one to five cases per 1 million people per year (2). Visualization of the capsule and of septa within a tumor has been shown to be associated with a less aggressive histologic appearance (41). (a) Contrast-enhanced chest CT scan demonstrates a left anterior mediastinal mass with infiltration of surrounding fat (arrow). 2011 Aug 23;9:95. doi: 10.1186/1477-7819-9-95. Because completeness of resection is a major prognostic factor (20–22), surgical resection is the cornerstone of treatment of patients with thymoma (18). Chest CT is the imaging procedure of choice in patients with myasthenia gravis (MG). Myasthenia gravis associated with thymoma occurs most frequently in women. Patients with resected stage III or IVa thymoma, thymic carcinoma, incomplete resection, or other high-risk tumors should undergo CT every 6 months for 3 years. CT chest revealed an anterior mediastinal mass. 48, No. The radiologist's main role is to distinguish early disease (stages I and II) from advanced disease (stages III and IV), since postoperative Masaoka-Koga staging cannot be used to guide decisions about neoadjuvant therapy (13,14). Recent reports suggest that neoadjuvant therapy provides a survival advantage compared with adjuvant therapy in patients with stage III thymomas (26–28). Posteroanterior chest radiograph shows an anterior mediastinal mass with elevation of the right hemidiaphragm. The CT characteristics that showed a significant association with stage III and IV disease at multivariable analysis were a primary tumor 7 cm or larger (Fig 11), infiltration of the fat surrounding the tumor (Fig 12), and lobulated tumor contours.Figure 11 Stage III thymoma in an asymptomatic 41-year-old man. :Related financial activities: none. (c) Axial fused FDG PET/CT image shows FDG-avid pleural recurrence (arrow). The precise role of computed tomography (CT… In an attempt to distinguish between patients who require neoadjuvant therapy before surgery (ie, those with stage III or IV disease) and those who do not (ie, those with stage I or II disease), the authors of a third study comparing the CT findings in 99 patients with thymoma found that CT was useful in making this distinction (45). The radiologist must be familiar with (a) the advantages and disadvantages of each imaging modality, and (b) the information it may offer with respect to thymoma staging and treatment planning. Magnetic resonance imaging characteristics of thymoma in Vietnamese patients with myasthenia gravis in relation to histopathological type and disease staging. 3, 8 November 2011 | RadioGraphics, Vol. The presence of lobulated or irregular contour, areas of low attenuation, and multifocal calcification is suggestive of invasive thymoma. If the address matches an existing account you will receive an email with instructions to reset your password. Viewer
Purpose: The purpose of this work was to evaluate the CT features of thymoma and to determine the most helpful findings in differentiating invasive from noninvasive thymoma. ではbcl下2を 強く発現しているが,皮 質型ではbcl下2の 発 現を認 … The mass proved to be rich in epithelial cells (WHO type B3).Figure 11Download as PowerPointOpen in Image
After completing this journal-based CME activity, participants will be able to: Describe the various imaging features of thymoma. For this journal-based CME activity, authors M.L.R.d.C. Figure 15 Cystic thymoma in an asymptomatic 35-year-old woman. Priola AM, Priola SM, Di Franco M, Cataldi A, Durando S, Fava C. Radiol Med. (a) Contrast-enhanced chest CT scan shows thymic enlargement. Thymomas have a typical CT … An updated version of the WHO classification scheme was published in 2004 (2). Epub 2020 Sep 17. [1] A 43-year-old female with myasthenia gravis. The mass proved to be rich in epithelial cells (WHO type B3). Disclosures of Potential Conflicts of Interest.—M.L.R.d.C. In addition, fibrous septa within the tumor and associated nodularity can be seen as low-signal-intensity regions, which help differentiate cystic thymoma from congenital cysts (Fig 15). Jeong YJ, Lee KS, Kim J, Shim YM, Han J, Kwon OJ. Low signal intensity due to hemosiderin deposition may be seen on T1- and T2-weighted images. Relationship Between Computed Tomography Imaging Features and Clinical Characteristics, Masaoka-Koga Stages, and World Health Organization Histological Classifications of Thymoma. 1, 22 March 2017 | European Radiology, Vol. In most patients, thymic histology shows follicular hyperplasia, but 10–20% of patients with MG have thymoma . Risk stratification of thymic epithelial tumors by using a nomogram combined with radiomic features and TNM staging. Tomiyama et al (40) found that type A thymomas were more likely to have smooth contours, but that CT was of limited value in differentiating types AB, B1, B2, and B3. 6, 5 October 2015 | Journal of Digital Imaging, Vol. have disclosed various financial relationships (see “Disclosures of Potential Conflicts of Interest”); all other authors, the editor, and reviewers have no relevant relationships to disclose. Misleading terms such as benign thymoma are no longer acceptable, since all thymomas are malignant tumors and have the potential to metastasize. Stage III thymoma in a 52-year-old man with chest pain and dyspnea. Please enable it to take advantage of the complete set of features! Stage IVa thymoma in a 50-year-old man. CT is the imaging modality of choice for evaluating thymoma and can help distinguish thymoma from other anterior mediastinal abnormalities. Stage II thymoma is also treated with extended thymectomy. … Invasive thymomas had a higher prevalence of low attenuation areas within the tumor (16/27, 60%) than noninvasive thymomas (5/23, 22%) (p < 0.001) as well as foci of calcification (14.5/27, 54% vs. 6/23, 26%; p < 0.01). Thymic hyperplasia characteristically manifests at CT as a diffusely and symmetrically enlarged thymus with smooth borders and preservation of the normal thymic shape (Fig 2). 4, American Journal of Roentgenology, Vol. Although use of MR imaging can help limit radiation dose, its ability to help detect early recurrence compared with CT has not been assessed. Careers. One difficulty is that increased physiologic FDG uptake by a normal or hyperplastic thymus is common, especially in children and in adults younger than 40 years of age (Fig 16). Galen of Pergamum (130–200 ad), who first noted that the thymus was proportionally largest during infancy (,4), referred to the thymus as an “organ of mystery,” a moniker that remained fairly accurate for almost two millennia. 51, No. Patients with locally advanced thymomas typically receive neoadjuvant chemotherapy to allow effective resection (23,24), since complete resection—even of advanced disease—improves survival (20,25).