Difference between revisions of "Thymus Neoplasia"
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==Introduction== | ==Introduction== | ||
| − | Two types of thymic neoplasia occur, the thymoma and the thymic lymphosarcoma ''aka'' [[Lymphoma|mediastinal lymphoma]]. With both tumour types the animal may present with very similar clinical signs, and histopathology may be necessary to confirm diagnosis. It is important to definitively diagnose the tumour as the two tumour types have very different treatments and prognoses. | + | Two types of thymic neoplasia occur, the '''thymoma''' and the '''thymic lymphosarcoma''' ''aka'' [[Lymphoma|mediastinal lymphoma]]. With both tumour types the animal may present with very '''similar clinical signs''', and '''histopathology''' may be necessary to confirm diagnosis. It is important to definitively diagnose the tumour as the two tumour types have very '''different treatments and prognoses'''. |
==Pathology== | ==Pathology== | ||
===Thymoma=== | ===Thymoma=== | ||
| − | Thymomas are benign and localised. They are most commonly seen in cats. | + | Thymomas are '''benign''' and '''localised'''. They are most commonly seen in '''cats'''. |
| − | Their cell type can be either be predominantly epithelial, or predominantly lymphocytic | + | Their cell type can be either be predominantly '''epithelial''', or predominantly '''lymphocytic''' |
===Thymic lymphosarcoma=== | ===Thymic lymphosarcoma=== | ||
| − | Thymic lymphsarcoma is a malignant tumour that often metastasises. Involvement of the lung is unusual. It is also known as [[Lymphoma|mediastinal lymphoma]] - for more information on the disease, click [[Lymphoma|here]]. | + | Thymic lymphsarcoma is a '''malignant''' tumour that often '''metastasises'''. Involvement of the lung is unusual. It is also known as [[Lymphoma|mediastinal lymphoma]] - for more information on the disease, click [[Lymphoma|here]]. |
| − | Normally the mass is poorly encapsulated, and there may be infiltration of the atria and heart base infiltration and the sternal pleura. | + | Normally the mass is '''poorly encapsulated''', and there may be '''infiltration''' of the atria and heart base infiltration and the sternal pleura. |
==Clinical signs== | ==Clinical signs== | ||
| − | Common presenting signs: | + | Common presenting signs are associated with compression of structures in the cranial thorax: |
| − | * Dyspnoea | + | * '''Dyspnoea''' |
| − | * Coughing | + | * '''Coughing''' |
| − | * Tachypnoea | + | * '''Tachypnoea''' |
| − | * Weightloss | + | * '''Weightloss''' |
| − | * Regurgitation | + | * '''Regurgitation''' |
| − | * Loss of compressability of the cranial thorax in cats | + | * '''Loss of compressability of the cranial thorax in cats''' |
| − | * Displacement of heart sounds caudally | + | * '''Displacement of heart sounds caudally''' |
| − | * Decreased lung sounds ventrally | + | * '''Decreased lung sounds ventrally''' |
Other clinical sign that may be present: | Other clinical sign that may be present: | ||
| − | * Swelling of the head and neck due to compression of the vena cava | + | * Swelling of the head and neck due to compression of the cranial vena cava |
* Horners syndrome due to compression of the sympathetic nerves within the mediastinum | * Horners syndrome due to compression of the sympathetic nerves within the mediastinum | ||
| − | * Hypercalcaemia - normally only present in lymphosarcoma in the dog. Signs include PU/PD, [[Vomiting|vomiting]], [[Colonic Impaction - Dog and Cat|constipation]], malaise, bradycardia, muscle tremors and [[Dehydration|dehydration]]. | + | * [[Hypercalcaemia]] - normally only present in lymphosarcoma in the dog. Signs include PU/PD, [[Vomiting|vomiting]], [[Colonic Impaction - Dog and Cat|constipation]], malaise, bradycardia, muscle tremors and [[Dehydration|dehydration]]. |
| − | * [[ | + | * [[Myasthenia Gravis]] - this can be induced by a thymoma |
==Diagnosis== | ==Diagnosis== | ||
| + | [[File:Thymoma B1 (2).JPG|thumb|150px|right|'''Thymoma''' (Wikimedia Commons)]] | ||
Diagnosis of a cranial mediastinal mass may be achieved using imaging modalities such as radiography and ultrasound. | Diagnosis of a cranial mediastinal mass may be achieved using imaging modalities such as radiography and ultrasound. | ||
| − | Radiography will reveal a soft tissue opacity in the cranial thorax, normally with displacement of the heart caudally and the trachea dorsally. The cranial lung fields are normally obscured by the mass. There may be pleural fluid | + | '''Radiography''' will reveal a '''soft tissue opacity''' in the '''cranial thorax''', normally with '''displacement of the heart caudally''' and the '''trachea dorsally'''. The cranial lung fields are normally obscured by the mass. There may be evidence of '''pleural fluid''', which can be confirmed by '''ultrasound'''. |
| − | As the thymoma and mediastinal lymphoma often look the same clinically it is necessary to differentiate them by performing an ultrasound guided fine needle aspiration of either the mass or pleural fluid, and if this proved inconclusive - a surgical biopsy. | + | As the thymoma and mediastinal lymphoma often look the same clinically it is necessary to differentiate them by performing an '''ultrasound guided fine needle aspiration of either the mass or pleural fluid''', and if this proved inconclusive - a '''surgical biopsy'''. |
===Cytology=== | ===Cytology=== | ||
| − | Lymphomas have high numbers of malignant lymphocytes and lymphoblasts. | + | [[File:Primary mediastinal large B-cell lymphoma - very high mag.jpg|thumb|150px|right|'''Mediastinal Lymphoma''' (Wikimedia Commons)]] |
| − | Thymomas usually contain both lymphocytes and epithelial cells. However because lymphocyte numbers can be high in lymphocytic thymomas, unless the epithelial cells in the sample are atypical or suggestive of neoplasia, it can be hard to differentiate thymomas from lymphomas. In this instance a surgical biopsy | + | '''Lymphomas''' have high numbers of '''malignant''' '''[[Lymphocytes|lymphocytes]] and lymphoblasts'''. |
| + | '''Thymomas''' usually contain both '''lymphocytes and [[Epithelial Histology resource|epithelial cells]]'''. However because lymphocyte numbers can be high in lymphocytic thymomas, unless the '''epithelial cells''' in the sample are '''atypical or suggestive of neoplasia''', it can be hard to differentiate thymomas from lymphomas. In this instance a '''surgical biopsy''' and '''histopathology''' are required. | ||
==Treatment== | ==Treatment== | ||
Treatment of the two types of neoplasia is very different: | Treatment of the two types of neoplasia is very different: | ||
| − | * The treatment of choice for a thymoma is complete surgical excision. | + | * The treatment of choice for a '''thymoma is complete surgical excision'''. |
| − | * The treatment of choice for mediastinal lymphoma is chemotherapy. | + | * The treatment of choice for '''mediastinal lymphoma is [[Lymphoma|chemotherapy]]'''. |
==Prognosis== | ==Prognosis== | ||
| − | Prognosis following successful surgical excision of a thymoma is good. Prognosis of mediastinal lymphoma is very poor, with a survival time of weeks if left untreated. | + | Prognosis following successful surgical excision of a '''thymoma''' is '''good'''. Prognosis of mediastinal '''lymphoma''' is very '''poor''', with a survival time of weeks if left untreated. |
| + | |||
| + | {{Learning | ||
| + | |flashcards = [[Feline Medicine Q&A 12]] | ||
| + | }} | ||
==References== | ==References== | ||
| + | Elwood, C (2006) '''Diagnosis and management of canine oesophageal disease and regurgitation''' ''In Practice 2006 28: 14-2'' | ||
| + | |||
| + | Hayes, A (2006) '''Feline lymphoma 2. Specific Disease Presentations''' ''In Practice 2006 28: 578-585'' | ||
| + | Sparks, AH & Caney, SMA (2005) '''Self-Assessment Colour Review Feline Medicine''' ''Manson'' | ||
[[Category:Lymphoreticular and Haemopoietic Diseases]] | [[Category:Lymphoreticular and Haemopoietic Diseases]] | ||
[[Category: To Do - Siobhan Brade]] | [[Category: To Do - Siobhan Brade]] | ||
| + | [[Category:To Do - Manson review]] | ||
Revision as of 10:21, 15 August 2011
Introduction
Two types of thymic neoplasia occur, the thymoma and the thymic lymphosarcoma aka mediastinal lymphoma. With both tumour types the animal may present with very similar clinical signs, and histopathology may be necessary to confirm diagnosis. It is important to definitively diagnose the tumour as the two tumour types have very different treatments and prognoses.
Pathology
Thymoma
Thymomas are benign and localised. They are most commonly seen in cats. Their cell type can be either be predominantly epithelial, or predominantly lymphocytic
Thymic lymphosarcoma
Thymic lymphsarcoma is a malignant tumour that often metastasises. Involvement of the lung is unusual. It is also known as mediastinal lymphoma - for more information on the disease, click here.
Normally the mass is poorly encapsulated, and there may be infiltration of the atria and heart base infiltration and the sternal pleura.
Clinical signs
Common presenting signs are associated with compression of structures in the cranial thorax:
- Dyspnoea
- Coughing
- Tachypnoea
- Weightloss
- Regurgitation
- Loss of compressability of the cranial thorax in cats
- Displacement of heart sounds caudally
- Decreased lung sounds ventrally
Other clinical sign that may be present:
- Swelling of the head and neck due to compression of the cranial vena cava
- Horners syndrome due to compression of the sympathetic nerves within the mediastinum
- Hypercalcaemia - normally only present in lymphosarcoma in the dog. Signs include PU/PD, vomiting, constipation, malaise, bradycardia, muscle tremors and dehydration.
- Myasthenia Gravis - this can be induced by a thymoma
Diagnosis
.JPG)
Diagnosis of a cranial mediastinal mass may be achieved using imaging modalities such as radiography and ultrasound.
Radiography will reveal a soft tissue opacity in the cranial thorax, normally with displacement of the heart caudally and the trachea dorsally. The cranial lung fields are normally obscured by the mass. There may be evidence of pleural fluid, which can be confirmed by ultrasound.
As the thymoma and mediastinal lymphoma often look the same clinically it is necessary to differentiate them by performing an ultrasound guided fine needle aspiration of either the mass or pleural fluid, and if this proved inconclusive - a surgical biopsy.
Cytology
Lymphomas have high numbers of malignant lymphocytes and lymphoblasts. Thymomas usually contain both lymphocytes and epithelial cells. However because lymphocyte numbers can be high in lymphocytic thymomas, unless the epithelial cells in the sample are atypical or suggestive of neoplasia, it can be hard to differentiate thymomas from lymphomas. In this instance a surgical biopsy and histopathology are required.
Treatment
Treatment of the two types of neoplasia is very different:
- The treatment of choice for a thymoma is complete surgical excision.
- The treatment of choice for mediastinal lymphoma is chemotherapy.
Prognosis
Prognosis following successful surgical excision of a thymoma is good. Prognosis of mediastinal lymphoma is very poor, with a survival time of weeks if left untreated.
| Thymus Neoplasia Learning Resources | |
|---|---|
 Test your knowledge using flashcard type questions |
Feline Medicine Q&A 12 |
References
Elwood, C (2006) Diagnosis and management of canine oesophageal disease and regurgitation In Practice 2006 28: 14-2
Hayes, A (2006) Feline lymphoma 2. Specific Disease Presentations In Practice 2006 28: 578-585
Sparks, AH & Caney, SMA (2005) Self-Assessment Colour Review Feline Medicine Manson