Thymoma - a kind of tumor lesions preferentially localized in the thymus, which has a benign course and a tendency to malignancy.In connection with the specific localization of the tumor lesion, the pathology in oncology classification has formulated as a "mediastinal thymoma."
in pathogenetic mechanisms of occurrence of this disease factor of gender and age of the patient does not matter, but according to global statistics, thymoma in children is classified as a rare disease.Risk for the disease are elderly people suffering from myasthenia gravis.
In situations where the tumor substrate includes not only the elements of the thymus, and fat tissue, the conditions for the development of lipotimomy characterized asymptomatic.
thymoma Thymoma thymus gland, usually a tumor volume with all the signs of purity, that is, it has a relatively small settings, is surrounded by a dense shell of surrounding tissue and is characterized by sluggish flow.
In some cases, the signs of
pathomorphological features of this type of tumor is the presence of multiple foci of necrosis and hemorrhage, subsequently resolved by the formation of cystic structures sclerotic component.
This pathology belongs to the category polisimptomaticheskih diseases, since even under the same conditions of its occurrence in different patients may have individual clinical picture.In an era of rapid technological development in the field of diagnostic studies of certain diseases, the conditions for the early detection of thymoma, which is in the initial stages of development of a particular has no clear symptoms.
Typical complaints arise in a patient suffering from thymoma, to achieve large-sized tumors, putting pressure on other structures of the upper floors of the mediastinum.During this period, the patient may observe discomfort in the belly, wearing a permanent nature and has nothing to do with pain.
When compression of the cartilaginous structures of the trachea, the patient marked respiratory disorders of varying degrees of intensity, until the onset of apnea.In the primary objective examination of a patient with thymoma, drew the attention of some blueness of the skin, pasty upper body and swelling of the veins in the neck.
In some cases, thymoma may show uncharacteristic symptoms that occur as a result of its development compared to other diseases, such as - myasthenia gravis, agammaglobulinemia and Cushing's syndrome.
all morphological variations Tim have a single version of the disease, which is divided into two phases: asymptomatic phase and expressed clinical and morphological manifestations.
for the duration of the latent period during which the patient does not feel the changes in their health and in most cases not even aware of the presence of thymoma, is influenced by a number of factors, namely: the location and the metric parameters of tumors, the intensity of the proliferation of tumor substrate positional relationship withother structures related to the mediastinum.
All clinical manifestations of thymoma can be attributed to a particular syndrome:
- compartment syndrome mediastinal structures;
- specific symptom characteristic of the tumors of different localization;
- non-specific general symptoms of cancer.
most common complaint of patients with signs of thymoma is a feeling of discomfort and sometimes severe pain syndrome, caused tumor germination substrate into the surrounding tissue with nerve endings.Pain often have no clear localization and prone to irradiation in the neck and upper limbs on the affected side.Malignant thymoma with evidence of metastasis to bone may be accompanied by a pretty intense bone pain.
Due to the close anatomical location of the tumor with the structures vagosympathetic trunk, with its compression characteristic symptoms appear in the form of unilateral upper eyelid ptosis, pupil dilation while enophthalmos, local temperature changes of the skin and expressed dermographism.
Compression compression of the nerve innervating the larynx and vocal cords, the patient provokes hoarseness and loss of the phrenic nerve is accompanied by the unilateral elevation of the diaphragm.
In the projection of the upper floors of the mediastinum, which is usually localized thymoma, there are many structures and vessels, so when you put pressure on the walls of the large veins, there is symptom disorders of blood flow from the venous reservoirs of the upper half of the body.The patient noted persistent headache squeezing and pulsing character, dizziness, growing at sharp movements, pastoznost soft tissues of the head and neck.
In some situations, the patient has to consult a doctor about difficulty swallowing both solids and liquid food resulting from the massive proliferation of thymoma tumor substrate, squeezing the lumen of the esophagus.
symptoms that are observed in all patients with a tumor of a particular location, are marked weakness and a sharp decline in disability, short-term fever, is not stopped taking antipyretics, progressive weight loss.In the terminal stages of thymoma, the patient is increasing symptoms related to intoxication syndrome, namely arrhythmias, arthralgia, infectious-inflammatory complications with localization in the skin and joints.
Due to the fact that the thymus is an important structure to the regulator of immunity, the slightest change in the gland leads to a decrease in the protective properties of the body and increase exposure to the emergence of infectious diseases in severe form.
Despite the diversity of clinical manifestations that characterize the damage of the thymus, most of them non-specificity does not allow the diagnosis at an early stage of the disease, so a major role in this situation have a ray diagnostic techniques.
in oncology practice classification of thymoma is used to determine the required amount of remedial measures, and in accordance with this division is divided into four main stages.
first (1) stage of thymoma is a tumor substrate on all sides enclosed in a tight capsule and this tumor volume is small.Thymoma in the early stages of development can be successfully treated by the use of corticosteroid therapy and operational benefits.
In a situation where the elements are defined in the substrate of the tumor surrounding adipose tissue and perikapsulyarnoy region, one should speak of a second (2) the stage of thymoma.The only effective treatment neoplasms in asymptomatic stage unfolded is surgical resection and radiotherapy dosage.
further course of the disease with invasion of the tumor to nearby elements of structure of the upper anterior mediastinum shows the progression of thymoma to three (3) stages of the disease.The main practical way to treat this level is surgical resection of the patient's pre-treatment with chemotherapy.
fourth (4) the stage accompanied by the proliferation of thymoma tumor cell substrate with a current of lymph and blood, that is, there are distant metastases.Therapeutic measures in this case is limited to courses chemoradiation therapy.
Among diagnostic procedures, allowing to determine not only the fact of thymoma, but also specify the size of tumors, its structure and the degree of malignancy, the most informative are instrumental ray methods.In most cases, a standard X-rays to diagnose the large size of tumors, and tumors of small size only visualized during a CT scan.
Treatment of thymoma
In determining the tactics of the patient and the use of appropriate method of treatment, the attending physician should be based on the general condition of the patient, presence of contraindications to one or another method of therapy, the prevalence of cancer.
most effective way to eliminate the tumor lesion is considered to be surgical, but the positive results of treatment can be expected only in the early stages of thymoma.In this case it is possible complete removal of a tumor volume, since it has a clearly defined border.Operational allowance is performed via a midline sternal access and apart from radical removal of a thymoma recommended the implementation of a sectoral resection of surrounding structures of the upper floors of the mediastinum to prevent the recurrence of tumor growth.
If you have any signs of infiltrative tumor growth with damage to nearby organs, thymoma resection is considered inappropriate.Dedicated operational access substrate is necessarily exposed to tumor histological study method to determine the signs of malignancy of tumor, and the confirmation of malignancy in the postoperative period the patient is shown passing the course of radiation or chemotherapy.
early postoperative phase is dangerous because in this period the patient may experience signs of myasthenic crisis who need the application of urgent measures (tracheotomy, long-term mechanical ventilation, detoxification therapy).
Imagistic when thymoma is used not only as diagnostic but also therapeutic measures.In order to eliminate cancerous cells using high-energy X-ray ionizing radiation.Radiation therapy techniques are used as an adjunct to surgery and in the postoperative period have a greater efficiency in the case of a combination with chemotherapy drugs.Note that this method of treatment does not belong to the category of sparing the patient's health, and in some cases, its use may be accompanied by the development of adverse reactions in the form of violations of the functioning of the digestive tract, fatigue and skin reactions.In most cases, side reactions do not require the application of a specific treatment and independently leveled after cessation of radiation therapy.The field of application of radiotherapy only considered cases of thymoma in an elderly patient population subject to the availability of contraindications to surgery.
as palliative measures in thymoma medication used drugs group cholinesterase inhibitors (1% solution of 1 ml of galantamine, neostigmine 0.05% solution of 1 ml subcutaneously).
In the majority of cases subcapsular thymoma, a combination of operational and cytostatic therapy method gives 90% positive results due to the use of the latest minimally invasive surgical techniques.The inadequate research, however, has a pronounced positive effect on the prevention of recurrence of tumor treatment is considered to photodynamic therapy.