Summary
Definition
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
Other diagnostic factors
- cough
- dyspnea
- fever and/or weight loss
Risk factors
- history of myasthenia gravis
- age >45 years
Diagnostic investigations
1st investigations to order
- chest x-ray
- chest CT with intravenous contrast medium
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)
Treatment algorithm
resectable tumor
locally advanced tumor
recurrent tumor
Contributors
Authors
Douglas Z. Liou, MD
Clinical Assistant Professor of Cardiothoracic Surgery
Division of Thoracic Surgery
Stanford University School of Medicine / Stanford Cancer Institute
Stanford
CA
Disclosures
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
Stanford
CA
Disclosures
JBS declares that he has no competing interests.
Acknowledgements
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.
Disclosures
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
Torino
Italy
Disclosures
ER is an author of a reference cited in this topic.
James R. Jett, MD
Emeritus Professor of Medicine
National Jewish Health
Denver
CO
Disclosures
JRJ is co-editor of the section on thymoma in Up To Date. He is also co-chief medical officer for Biodesix Inc.
Differentials
- Lymphoma
- Malignant mediastinal germ cell tumour: seminoma
- Malignant mediastinal germ cell tumour: nonseminoma
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: thymomas and thymic carcinomas
- Surgical, radiation, and systemic treatments of patients with thymic epithelial tumours
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