Tumor tímico

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 14 Sep 2025

Last updated: 23 Feb 2024

Os timomas são responsáveis pela grande maioria das neoplasias malignas tímicas e costumam estar associados a síndromes autoimunes ou neurológicas, mais comumente miastenia gravis.

Cerca de um terço dos timomas são assintomáticos e identificados como um achado radiográfico incidental. Uma tomografia computadorizada (TC) do tórax com contraste intravenoso no grupo demográfico apropriado pode ser altamente sugestiva de timoma.

Pequenos tumores encapsulados são removidos para diagnóstico patológico e tratamento. Para tumores do mediastino anterior com probabilidade substancial de representar um linfoma, recomenda-se a biópsia percutânea com agulha grossa. A tomografia por emissão de pósitrons (PET)/CT pode ser muito útil na diferenciação do timoma do linfoma antes da biópsia, pois o linfoma tem um valor padronizado de captação máximo (SUVmáx) mais alto em comparação ao timoma.

Neoplasias malignas tímicas que estejam localmente avançadas na apresentação são geralmente tratadas com terapia neoadjuvante (quimioterapia ± radioterapia) seguida por reavaliação para cirurgia. Pacientes com miastenia gravis devem ter os sintomas miastênicos otimizados antes da cirurgia.

Timomas são tumores relativamente indolentes com altas taxas de cura; no entanto, todos os timomas são considerados malignos. O prognóstico depende em grande parte da integridade da ressecção, do estádio e da histologia da OMS. Os carcinomas tímicos e os tumores neuroendócrinos do timo (NETT) são geralmente mais agressivos.

O tratamento para tumores localmente avançados e metastáticos deve envolver uma equipe multidisciplinar de oncologistas clínicos, cirurgiões torácicos, rádio-oncologistas, patologistas e radiologistas com experiência e especialização em neoplasias malignas tímicas.

Definition

Tumores tímicos são raros, embora sejam os tumores do mediastino anterior mais comuns em adultos.[1][2] Timomas são responsáveis pela maioria das neoplasias tímicas. Embora os tumores menores sejam tipicamente assintomáticos e identificados incidentalmente no exame de imagem (a menos que estejam associados à miastenia gravis), tumores grandes podem se apresentar com desconforto torácico, tosse e/ou dispneia, com ou sem sintomas de miastenia gravis.[3] Cerca de um terço dos timomas são diagnosticados como um achado incidental.

O manejo profundo da miastenia gravis extrapola o escopo deste tópico. Consulte Miastenia gravis.

History and exam

Key diagnostic factors

miastenia gravis
fraqueza muscular
edema facial e de membros superiores
pletora facial
veias dilatadas no pescoço e parede torácica e/ou abdominal
edema no braço esquerdo

Full details

Other diagnostic factors

tosse
dispneia
febre e/ou perda de peso

Full details

Risk factors

história de miastenia gravis
idade >45 anos

Full details

Diagnostic tests

1st tests to order

radiografia torácica
tomografia computadorizada (TC) do tórax com meio de contraste intravenoso

Full details

Tests to consider

ressonância nuclear magnética (RNM) do tórax
biópsia tecidual
anticorpos contra o receptor da acetilcolina
Hemograma completo
tomografia por emissão de pósitrons/tomografia computadorizada (PET/TC)
alfafetoproteína sérica (AFP)
gonadotrofina coriônica humana beta sérica (beta-hCG)

Full details

Treatment algorithm

ACUTE

tumor ressecável

tumor localmente avançado

ONGOING

tumor recorrente

Contributors

Authors

Douglas Z. Liou, MD

Clinical Associate Professor of Cardiothoracic Surgery

Division of Thoracic Surgery

Stanford University School of Medicine / Stanford Cancer Institute

Stanford

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

Declarações

JBS declares that he has no competing interests.

Nathaniel J. Myall, MD

Clinical Assistant Professor of Medical Oncology

Stanford University School of Medicine / Stanford Cancer Institute

Stanford

Declarações

NJM declares that he has no competing interests.

Kavitha Ramchandran, MD

Professor of Medical Oncology

Stanford University School of Medicine / Stanford Cancer Institute

Stanford

Declarações

KR has been compensated for consulting services by Varian Medical Systems and Curio Bioscience. She has served on the advisory council for Group Well and Pathomiq and has received honorarium from the Binaytara Foundation for speaking at a conference.

Lucas Kas Vitzthum, MD

Clinical Assistant Professor of Radiation Oncology

Department of Radiation Oncology

Stanford University School of Medicine

Stanford

Declarações

LKV has received research funding from RefleXion Medical.

Agradecimentos

Dr Douglas Z. Liou, Dr Joseph B. Shrager, Dr Nathaniel J. Myall, Dr Kavitha Ramchandran, and Dr Lucas Kas Vitzthum 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

Disclosures

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

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Girard N, Ruffini E, Marx A, et al. Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(suppl 5):v40-v55.Full text Abstract

Phan AT, Öberg K, Choi J, et al. NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the thorax (includes lung and thymus). Pancreas. 2010;39:784-98.Full text Abstract

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: thymomas and thymic carcinomas [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Linfoma
- Tumor mediastinal maligno de células germinativas: seminoma
- Tumor mediastinal de células germinativas: não seminoma
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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Tumor tímico

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

tumor ressecável

tumor localmente avançado

tumor recorrente

Contributors

Authors

Douglas Z. Liou, MD

Disclosures

Joseph B. Shrager, MD

Declarações

Nathaniel J. Myall, MD

Declarações

Kavitha Ramchandran, MD

Declarações

Lucas Kas Vitzthum, MD

Declarações

Agradecimentos

Disclosures

Peer reviewers

Enrico Ruffini, MD

Disclosures

James R. Jett, MD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice