lymphoreticular Flashcards
(27 cards)
where is the thymus located?
in the mediastinum between the lungs
what quadrant is the spleen located in ?
located in the upper left quadrant of the abdomen
what T levels does the spleen abut?
T9-12
spleen functions
filters blood especially RBC and platelets
fights off bacteria and viruses
stores RBC, platlets and WBC
thymus functions
produces progenitor cells which becomes T cells which fight off tumour cells and infections
thymoma symptoms symptomatic vs myasthenia gravis symptoms
30% present with symptomatic symptoms and the rest present with myasthenia graves symptoms
symptomatic thymoma symptoms
most are related to an impingement in the thoracic cavity
cough, chest pain , dypsnea, hoarsness , superior vena cava obstruction and tumor hemmorhage
myasthenia gravis symptoms
Presence of antibodies that react with nicotinic acetylcholine receptors in muscle and distrupt transmission at the neuromuscular junction
Weakness
Fatigability of skeletal muscles
In the worst cases it can even affect respiration
how myasthenia gravis is diagnosed
Routine blood work is done to rule out other associated medical conditions
Serum a fetoprotein and beta-human chorionic gonadotropin in men to rule out germ cell tumors
how is thymus cancer diagnosed ?
what biopsies are performed and when?
when thymus cancer is small it is diagnosed clinically
when thymus cancer is large it is diagnosed with a biopsy
Biopsies are: fine needle aspiration, bronchoscopy, mediastinoscopy , video -assisted thoracoscopy or even open biopsy
Diagnostic imaging includes: CT, MRI, PET and octeoride scanning
thymomas benign vs malignant
1/3-1/2 is malignant and the rest are benign
how commonly are thymomas asymptomatic
1/3
most important prognostic indicator and treatment indicator in thymoma
whether myasthenia graves is present or not or if the tumour is encapsulated or invasive (stage)
how common is mets in thymomas, invasive thymomas?
5% in thymomas in general, 25% in invasive thymomas
common mets in thymomas
supraclav LN, liver, bone and lung
combined treatment modality of choice in thymomas
Preoperative cisplatinum based chemotherapy, then surgery and postoperative radiation therapy is optimal
Adjuvant XRT in thymoma
Is used adjuvantly after surgery for patients with stage 2 and 3 disease
Adjuvant therapy can also be used after incomplete resection
neoadjuvant XRT in thymoma
when the tumour is close to critical structures to make it easier to remove in surgery
coverage thymoma XRT
The entire mediastinum and both hila should be encompassed within the irradiated volume
The supraclavicular area should also be included of adenopathy is present
Prophylactic irradiation of one or both supraclavicular fossa can be recommended
Surgery of choice in thymoma
A complete en-bloc resection is the treatment of choice for all thymomas regardless of invasiveness except in the case of intrathoracic and extrathoracic metastasis however the majority are localized (90-95%)
what stage of thymomas are usually resectable
Encapsulated (stage I) and minimally invasive (stage II) thymomas are virtually always resectable
~20% of obviously invasive (stage III) thymomas are unresectable
chemo agents used to treat thymomas
cyclophosphamide, doxorubicin, cisplatin and prednisone
thymomas are chemo____________.
chemosensitive
chemo in thymomas should be used ________.
neoadjuvantl
