How to clinically differentiate thymic hyperplasia and thymoma? - USMLE Forums
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Old 10-11-2011
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Question How to clinically differentiate thymic hyperplasia and thymoma?

How to clinically differentiate thymic hyperplasia and thymoma?
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Old 10-13-2011
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Default thymic hyperplasia

True Thymic HyperplasiaClinical Features
Seen in children and occasionally in adults after chemotherapy for malignancy

May be associated with hyperthyroidism, myasthenia gravis, or other autoimmune disease



Gross Pathology
Thymic enlargement with increase in volume and normal weight of the gland


Histopathology
Normal lobular architecture with normal distribution of lymphocytes and epithelial cells
Preservation of corticomedullary differentiation


Special Stains and Immunohistochemistry
Noncontributory


Other Techniques for Diagnosis
Noncontributory


Differential Diagnosis Thymoma Differentiation into cortex and medulla is usually absent
If areas resembling cortex and medulla are present, they are not arranged normally and do not display the normal lobulation

Thymic follicular hyperplasia Well-formed lymphoid follicles with germinal centers
CD20-positive B lymphocytes are present within germinal centers

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Old 10-13-2011
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Default thymoma

Clinical Features
Most commonly found in adults; peak incidence in the fifth decade
Most common solid primary neoplasm of the mediastinum
Typically in anterior-superior mediastinum; may also occur in thymic tissue rests: pleura, pulmonary hilum, pericardium, and thyroid
Radiograph shows a lobulated mass that is occasionally calcified
Clinical associations
Myasthenia gravis (thymic follicular hyperplasia and thymoma)
Acquired hypogammaglobulinemia
Pure red cell aplasia
Hypogammaglobulinemia

Other associations
Systemic lupus erythematosus
Rheumatoid arthritis
Scleroderma
Polymyositis
Prognosis and staging: thymomas exhibit a range of biologic behavior from noninvasive, encapsulated tumors to aggressive infiltrative tumors
Most noninvasive tumors are cured by surgical resection
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Endocrinology-, Internal-Medicine-, Oncology-

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