Thymic tumor

Last reviewed: 1 Sep 2023
Last updated: 12 Aug 2022



History and exam

Key diagnostic factors

  • myasthenia gravis
  • muscle weakness
  • facial and upper extremity edema
  • facial plethora
  • distended veins in the neck, chest and/or abdominal wall
  • left-arm swelling
More key diagnostic factors

Other diagnostic factors

  • cough
  • dyspnea
  • fever and/or weight loss
Other diagnostic factors

Risk factors

  • history of myasthenia gravis
  • age >45 years
More risk factors

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • chest CT with intravenous contrast medium
More 1st investigations to order

Investigations to consider

  • chest MRI
  • tissue biopsy
  • acetylcholine receptor antibodies
  • CBC
  • PET/CT scan
  • serum alpha-fetoprotein (AFP)
  • serum beta-human chorionic gonadotrophin (beta-hCG)
More investigations to consider

Treatment algorithm


resectable tumor

locally advanced tumor


recurrent tumor



Douglas Z. Liou, MD

Clinical Assistant Professor of Cardiothoracic Surgery

Division of Thoracic Surgery

Stanford University School of Medicine / Stanford Cancer Institute




DZL declares that he has no competing interests.

Joseph B. Shrager, MD

Professor of Cardiothoracic Surgery

Chief, Division of Thoracic Surgery

Medical Director, Thoracic Oncology CCP

Stanford University School of Medicine / Stanford Cancer Institute




JBS declares that he has no competing interests.


Dr Douglas Z. Liou and Dr Joseph B. Shrager would like to gratefully acknowledge Dr Tracey Evans, Dr Nicholas Choong, Dr Mario Gasparri, and Dr Cameron Wright, previous contributors to this topic.


TE has received consultancy fees from Genentech and Celgene. She is a board member of Wissahickon Hospice. Educational events include an annual thoracic educational series sponsored by Imedex. NC and MG declare that they have no competing interests. CW is an author of a number of references cited in this topic.

Peer reviewers

Enrico Ruffini, MD

Associate Professor

Thoracic Surgery

University of Torino




ER is an author of a reference cited in this topic.

James R. Jett, MD

Emeritus Professor of Medicine

National Jewish Health




JRJ is co-editor of the section on thymoma in Up To Date. He is also co-chief medical officer for Biodesix Inc.

  • Thymic tumor images
  • Differentials

    • Lymphoma
    • Malignant mediastinal germ cell tumour: seminoma
    • Malignant mediastinal germ cell tumour: nonseminoma
    More Differentials
  • Guidelines

    • NCCN clinical practice guidelines in oncology: thymomas and thymic carcinomas
    • Surgical, radiation, and systemic treatments of patients with thymic epithelial tumours
    More Guidelines
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