Friday, 11 March 2016

The answer to last weeks case!


Clinical scenario:
          A 24 yr old female presented with left lower limb soft tissue  mass and was diagnosed as sarcoma .She was operated and later received chemotherapy and radiotherapy as well .On follow up  the  CT scan of chest showed   mediastinum  mass as is shown below Fig 1 .
What is your diagnosis ?


Fig 1 Mediastinal mass 
The answer is  :  THYMOMA 

        Thymoma originates within the epithelial cells of the thymus, a lymphoid organ located in the anterior mediastinum. Located behind the sternum in front of the great vessels; it reaches its maximum weight at puberty and undergoes involution thereafter.
In early life, the thymus is responsible for the development and maturation of cell-mediated immunologic functions. The thymus is composed predominantly of epithelial cells and lymphocytes. Precursor cells migrate to the thymus and differentiate into lymphocytes. Most of these lymphocytes are destroyed, with the remainder of these cells migrating to tissues to become T cells.
A relation between myasthenia gravis (MG) and thymomas was determined incidentally in 1939, when Blalock et al reported the first excision of a thymic cyst in a 19-year-old girl with MG.This patient achieved long-term remission; therefore, thymectomy became the definitive therapy for treatment of generalized MG. The index case had no features of Myasthenia  gravis
No clear histologic distinction between benign and malignant thymomas exists. The propensity of a thymoma to be malignant is determined by the invasiveness of the thymoma. Malignant thymomas can invade the vasculature, lymphatics, and adjacent structures within the mediastinum. The 15-year survival rate is 12.5% for a person with an invasive thymoma and 47% for a person with a noninvasive thymoma. Death usually occurs from cardiac tamponade or other cardiorespiratory complications in such cases.
 Further reading  : Click to continue reading Thymoma
TEACHING MESSAGE :  Mass lesion found on imaging   in a case of malignancy on follow up is a  secondary  , but keep an eye on a different  pathology as well 

Case was contributed by


This case was contributed by :
Dr. Majed Al-Mourgi .FRCS,FCCP,FACS
Consultant Thoracic surgeon &
Head of Surgery dept 
College of Medicine Taif University KSA

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