Journal of Association of Pulmonologist of Tamil Nadu

QUIZ
Year
: 2020  |  Volume : 3  |  Issue : 3  |  Page : 147--148

Radiology quiz on mediastinal mass


A Kirubanandam, R Narasimhan 
 Department of Respiratory Medicine, Apollo Main Hospitals, Chennai, Tamil Nadu, India

Correspondence Address:
A Kirubanandam
Apollo Main Hospital, Chennai, Tamil Nadu
India




How to cite this article:
Kirubanandam A, Narasimhan R. Radiology quiz on mediastinal mass.J Assoc Pulmonologist Tamilnadu 2020;3:147-148


How to cite this URL:
Kirubanandam A, Narasimhan R. Radiology quiz on mediastinal mass. J Assoc Pulmonologist Tamilnadu [serial online] 2020 [cited 2021 Oct 27 ];3:147-148
Available from: http://www.japt.com/text.asp?2020/3/3/147/314966


Full Text



 Case Report



A 58-year-old gentleman who is a known case of diabetes mellitus/coronary artery disease/obstructive sleep apnea came with complaints of breathlessness on exertion for the past 20 days with a history of orthopnea, nasal speech, and diplopia. He was hemodynamically stable, SpO2 was 98% on room air, and the chest was clear. Chest X-ray showed upper mediastinal widening. Computed tomography (CT) chest showed soft tissue lesion in the anterior mediastinum [Figure 1] and [Figure 2].{Figure 1}{Figure 2}

 Radiological Image



What is the radiological description?What are the differential diagnoses of this lesion?What is the common condition associated with this lesion?Does tissue biopsy needed in this patient to confirm the diagnosis?

 Answers



CT chest showed a moderately enhancing lobulated left anterior mediastinal massThymoma, lymphoma, germ cell tumorsMyasthenia gravis. Other conditions associated with thymoma are hypogammaglobinemia and pure red cell aplasiaOnce diagnosis of thymoma is suggested, the goal is to proceed directly to resection without biopsy, as these tumors have a predilection for local recurrence once the capsule has been violated

 Discussion



Thymoma is the common anterior mediastinal mass, most commonly occurs between 35 and 70 years of age with a median age of 54 years, and occurs equally on both sexes.[1],[2]

40%–45% of patients present with myasthenia gravis. It is also may be associated with pure red cell aplasia, hypogammaglobinemia, and systemic lupus erythematosus. Presence of paraneoplastic syndrome associated with anterior mediastinal mass essentially clinches the diagnosis.[3]

Antibodies to acetylcholine should be measured. CT scan demonstrates a well-circumscribed solid anterior mediastinal mass without low-density areas. Once diagnosis of thymoma is suggested, the goal is to proceed directly to resection without biopsy, as these tumors have a predilection for local recurrence once the capsule has been violated. If tissue diagnosis is required, image guided core needle biopsy can be done to confirm the diagnosis. If that fails, open surgical biopsy can be done.[4]

Diagnosis of myasthenia gravis requires two confirmatory tests among tensilon test, anti-AchR antibodies, and electromyographic studies.[4]

Masaoka classification system is the most commonly used for thymoma staging. Recently, the WHO proposed a classification system based on histology which is useful to distinguish between thymoma, thymic carcinoma, and thymic carcinoids. Surgical resection is the mainstay of treatment for Stage 1–3 thymoma. For advanced disease, chemotherapy is recommended followed by radiation.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We thank the department of radiology.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Dahal S, Bhandari N, Dhakal P, Karmacharya RM, Singh AK, Tuladhar SM, et al. A case of thymoma in myasthenia gravis: Successful outcome after thymectomy. Int J Surg Case Rep 2019;65:229-32.
2Marx A, Weis CA, Ströbel P. Thymomas. Pathologe 2016;37:412-24.
3Jamilloux Y, Frih H, Bernard C, Broussolle C, Petiot P, Girard N, et al. Thymoma and autoimmune diseases. Rev Med Interne 2018;39:17-26.
4Tomaszek S, Wigle DA, Keshavjee S, Fischer S. Thymomas: Review of current clinical practice. Ann Thorac Surg 2009;87:1973-80.
5Johnson SB, Eng TY, Giaccone G, Thomas CR. Thymoma: Update for the new millennium. Oncologist 2001;6:239-46.