Thymoma natural history

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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]

Overview

If left untreated, thymoma may progress to invade the mediastinum and the surrounding structures.
Depending on the stage of the tumor at the time of diagnosis, the prognosis may vary.
The prognosis is generally regarded as good.
Common complications of thymoma include the pressure effect of the mass itself, autoimmune diseases, and rarely, progression to malignancy.

One-third of patients have their thymomas discovered because of an associated autoimmune disorder. The most common of those conditions is myasthenia gravis: 10–15% of patients with myasthenia gravis have thymoma. Conversely, 30–45% of patients with thymomas have myasthenia gravis.
Patients with thymoma demonstrate a tendency for local mediastinal recurrence and plural ‘‘droplet’’ recurrence presumably caused by mediastinal plural invasion after resection.^[1]

Complications associated with thymoma may include:

Pressure effect associated with thymoma (sometimes presented as superior vena cava syndrome)
Autoimmune diseases associated with thymoma (e.g. myasthenia gravis, pure red cell aplasia)
Thymic malignancy of unknown etiology
Rarely (approximately 7% of cases), metastasis to pleura, bones, liver or brain^[2]

The most common complications of radiotherapy are:^[1]

The most common complications of thymectomy are:

Complications of the procedure such as bleeding, infection, damage to other organs, nerve injuries (bilateral phrenic nerve injury), and respiratory failure.
Recurrence has been described 10 to 20 years after removal of the primary lesion, so long-term follow up is very important.
Live attenuated vaccines such as yellow fever vaccine may have adverse effects after thymectomy due to an inadequate T-cell response.

The complications of thymic biopsy include:

The prognosis of thymoma depends on the following:

The prognosis is much worse for stage III or IV thymomas as compared with stage I and II tumors.
Patients with stage III and IV tumors may nonetheless survive for several years with appropriate oncological management.

Resectability of the tumor
Patient's general health
Primary diagnosis vs. recurrence
Histologic type (mixed histologic type is associated with the worst prognosis)^[1]