National Research Council, Dept. Biomorphological Funct. Sci., University Federico II, Naples, Italy Department of Radiology, University Federico II, Via S Pansini 5, I-80131 Naples, Italy
Riferimenti:
Sone, S., Higashihara, T., Morimoto, S., Yokota, K., Ikezoe, J., Masaoka, A., Normal anatomy of thymus and anterior mediastinum by pneumomediastinography (1980) AJR Am J Roentgenol, 134, pp. 81-8
Schackelford, G.D., McAlister, W.H., The aberrantly positioned thymus: A cause of mediastinal and neck masses in children (1974) AJR Am J Roentgenol, 120, pp. 291-296
Hadden, J.W., Thymic endocrinology (1998) Ann N Y Acad Sci, 840, pp. 352-358
Baron, R.L., Lee, J.K.T., Sagel, S.S., Peterson, R.R., Computed tomography of the normal thymus (1982) Radiology, 142, pp. 121-125
Francis, I.R., Glazer, G.M., Brookstein, F.L., Gross, B.H., The thymus: Reexamination of age-related changes in size and shape (1985) AJR Am J Roentgenol, 145, pp. 249-254
Sprent, J., Kishimoto, H., T cell tolerance and the thymus (1998) Ann N Y Acad Sci, 841, pp. 236-245
Baron, R.L., Levitt, R.G., Sagel, S.S., Stanley, R.J., Computed tomography in the evaluation of mediastinal widening (1981) Radiology, 138, pp. 107-113
Moore, A.V., Korobkin, M., Olanow, W., Heaston, D.K., Ram, P.C., Dunnick, N.R., Age-related changes in the thymus gland: CT-pathologic correlation (1983) AJR Am J Roentgenol, 141, pp. 241-246
Geer, G., Webb, R., Gamsu, G., Normal thymus: Assessment with MR and CT (1986) Radiology, 158, pp. 313-317
Rosai, J., Levine, G.D., Tumors of the thymus (1976) Atlas of Tumor Pathology. 2nd Edn., pp. 133-137. , Washington, DC: Armed Forces Institute of Pathology
Lopate, G., Pestronk, A., Autoimmune myasthenia gravis (1993) Hosp Pract, 115, pp. 109-131
Fraser, R.S., Paré, J.A.P., Fraser, R.G., Paré, P.D., (1994) Diseases of the Chest, pp. 118-156. , Philadelphia: WB Saunders
Nicolaou, S., Müller, N.L., Li, D.K.B., Oger, J.J.F., Thymus in myasthenia gravis: Comparison of CT and pathological findings and clinical outcome after thymectomy (1996) Radiology, 201, pp. 471-474
Ellis, K., Austin, J.H.M., Jaretzki, A., Radiologic detection of thymoma in patients with myasthenia gravis (1988) AJR Am J Roentgenol, 151, pp. 873-881
Charles, R.J., Sabo, K.M., Kidd, P.G., Abkowitz, J.L., The pathophysiology of pure red cell aplasia: Implications for therapy (1996) Blood, 87, pp. 4831-4838
Urshel, J.D., Grewal, R.P., Thymectomy for myasthenia gravis (1998) Postgrad Med J, 74, pp. 139-144
Lewis, J.E., Wick, M.R., Scheithauer, B.W., Bernartz, P.E., Taylor, W.E., Thymoma: A clinicopathologic review (1987) Cancer, 60, pp. 2727-2743
Chen, J., Weisbrod, G.L., Herman, S.J., Computed tomography and pathologic correlations of thymic lesions (1988) J Thorac Imaging, 3, pp. 61-65
Masaoka, A., Monden, Y., Nakahara, K., Tanioka, T., Follow-up study of thymomas with special reference to their clinical stages (1981) Cancer, 48, pp. 2485-2489
Scatarige, J.C., Fishman, E.K., Zerhouni, E.A., Siegelman, S.S., Transdiaphragmatic extension of invasive thymoma (1985) AJR Am J Roentgenol, 144, pp. 31-35
Do, Y.S., Im, J.G., Lee, B.H., Kim, K.H., Oh, Y.W., Chin, S.Y., CT findings in malignant tumors of thymic epithelium (1995) J Comput Assist Tomogr, 19, pp. 192-197
Molina, P.L., Siegel, M.J., Glazer, H.S., Thymic masses on MR imaging (1990) AJR Am J Roentgenol, 155, pp. 495-500
Sakai, F., Sone, S., Kiyono, K., Kawai, T., Maruyama, A., Ueda, H., MR imaging of thymoma: Radiologic-pathologic correlation (1992) AJR Am J Roentgenol, 158, pp. 751-756
Batra, P., Herrmann, C., Mulder, D., Mediastinal imaging in myasthenia gravis: Correlation of chest radiography, CT, MR, and surgical findings (1987) AJR Am J Roentgenol, 148, pp. 515-519
Schackelford, G. D., McAlister, W. H., The aberrantly positioned thymus: A cause of mediastinal and neck masses in children (1974) AJR Am J Roentgenol, 120, pp. 291-296
Hadden, J. W., Thymic endocrinology (1998) Ann N Y Acad Sci, 840, pp. 352-358
Baron, R. L., Lee, J. K. T., Sagel, S. S., Peterson, R. R., Computed tomography of the normal thymus (1982) Radiology, 142, pp. 121-125
Francis, I. R., Glazer, G. M., Brookstein, F. L., Gross, B. H., The thymus: Reexamination of age-related changes in size and shape (1985) AJR Am J Roentgenol, 145, pp. 249-254
Baron, R. L., Levitt, R. G., Sagel, S. S., Stanley, R. J., Computed tomography in the evaluation of mediastinal widening (1981) Radiology, 138, pp. 107-113
Moore, A. V., Korobkin, M., Olanow, W., Heaston, D. K., Ram, P. C., Dunnick, N. R., Age-related changes in the thymus gland: CT-pathologic correlation (1983) AJR Am J Roentgenol, 141, pp. 241-246
Fraser, R. S., Par, J. A. P., Fraser, R. G., Par, P. D., (1994) Diseases of the Chest, pp. 118-156. , Philadelphia: WB Saunders
Nicolaou, S., M ller, N. L., Li, D. K. B., Oger, J. J. F., Thymus in myasthenia gravis: Comparison of CT and pathological findings and clinical outcome after thymectomy (1996) Radiology, 201, pp. 471-474
Charles, R. J., Sabo, K. M., Kidd, P. G., Abkowitz, J. L., The pathophysiology of pure red cell aplasia: Implications for therapy (1996) Blood, 87, pp. 4831-4838
Urshel, J. D., Grewal, R. P., Thymectomy for myasthenia gravis (1998) Postgrad Med J, 74, pp. 139-144
Lewis, J. E., Wick, M. R., Scheithauer, B. W., Bernartz, P. E., Taylor, W. E., Thymoma: A clinicopathologic review (1987) Cancer, 60, pp. 2727-2743
Scatarige, J. C., Fishman, E. K., Zerhouni, E. A., Siegelman, S. S., Transdiaphragmatic extension of invasive thymoma (1985) AJR Am J Roentgenol, 144, pp. 31-35
Do, Y. S., Im, J. G., Lee, B. H., Kim, K. H., Oh, Y. W., Chin, S. Y., CT findings in malignant tumors of thymic epithelium (1995) J Comput Assist Tomogr, 19, pp. 192-197
Molina, P. L., Siegel, M. J., Glazer, H. S., Thymic masses on MR imaging (1990) AJR Am J Roentgenol, 155, pp. 495-500
The thymus is a bilobed lymphoid organ the morphology of which varies considerably with age as a result of a process of fatty infiltration occurring after puberty. Although several diseases can arise in the thymic parenchyma, including germ cell and neuroendocrine tumours, primitive epithelial neoplasms (thymomas) are the most common neoplasms and account for almost 10% of mediastinal masses. Thymomas are usually benign but can be locally invasive. Up to 30% of patients with a thymoma have myasthenia gravis, which is more commonly associated with thymic hyperplasia. The latter results in a symmetric diffuse enlargement of the thymus. However, thymic hyperplasia can be histologically found in up to 50% of normal-sized thymuses on computed tomography (CT). CT is much more accurate in detecting thymomas than it is in detecting thymic hyperplasia, although CT findings may be unspecific. C-T can be exhaustive in the case of an encapsulated thymoma (65% of all thymomas), which appear as a solid homogeneous mass with a slight contrast enhancement and a well-defined surrounding fat plane. These tumours rarely recur after surgery, CT can also accurately detect a spread through the capsule into the adjacent mediastinal fat, which characterizes invasive thymomas (35%). These, however, are best evaluated by magnetic resonance imaging (MRI). On T1-weighted MR scans the thymus is well delineated against the mediastinal fat, whereas marked inhomogeneity of the signal may appear on T2-weighted images as a result of areas of cystic degeneration in the tumour mass. The superior contrast resolution of MRI and the multiplanar images that can be produced with it are well suited for documenting the mediastinal spread of invasive thymomas. MRI depicts accurately pleural and/or pericardial implants as well as the involvement of great vessels, offering considerable aid in the planning of surgery.
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