PDF (5 MB) - Jurnalul de Chirurgie

Lateral & paracardiac thymoma 175Jurnalul de Chirurgie (Iaşi), 2013, Vol. 9, Nr. 2Fig. 4 Case 3: Oval opacity in the lower half of thechest with extension to the right hemithoraxFig. 5 Case 3: Lateral and paracardiac tumorFig. 6 Case 3: Resected specimenDISCUSSIONThymoma, the most common tumor ofthe mediastinum represents 20-25% of allmediastinal tumors and 50% of overallmediastinal masses [5]. Maximum incidenceof thymoma is in the fourth or fifth decadeof life; the patients average age is 52 [5].The incidence is similar in women and inmen [5]. In our study, all cases were womenaveraging 54.33±13.33 years old.Although the development ofthymoma in childhood is rare, the symptomsare more frequent in children than in adults[6].About 50% of patients with thymomaare asymptomatic [7]. Non specificsymptoms are noted like chest pain, coughand dyspnea [7]. More severe symptomssuch as superior vena cava syndrome,phrenic nerve paralysis or recurrentlaryngeal nerve paralysis that causes raucousvoice are rare and most frequently indicatesmalignancy of the lesion [6]. Chest wall orpleural invasion can also occur in the case ofamalignant thymoma, frequentlyaccompanied by persistent pleural effusionand significant local pain [6].Other general signs associated withthymoma are weight loss, fever, fatigabilityand night sweats and were present in 20% ofpatients included [7].Myasthenia gravis is a relatively raredisease and can occur at any age. Womenare affected more frequently than men, withpeak incidence around 30 years old; the peakincidence in men is reached at the age of 50-60 years. Surgical treatment of myasthenia isthe thymectomy. Remission rate increases intime reaching 40-60% at 7-10 years after thesurgery [2].Posteroanterior (PA) and lateral chestX-ray exams can detect most of thymomas.On the PA view, the lesion typically appearsas a smooth mass in the upper half of thechest, overlying the superior portion of thecardiac shadow near the junction of the heartand great vessels. The mass usually projectspredominantly into one of the hemi thoraces.On the right side, the silhouette sign ispresent and the ascending portion of theaortic arch is obliterated. Conversely, if thethymoma is on the left side, the silhouettesign is obscured and the aortic knob isidentified behind the mass [7].CT scan may delineate a mass furtheror detect a smaller tumor missed on