Timoma: discussão sobre tratamento e prognóstico

Abstract

ObjetivoLocalizado em sua porção anterior, é o tumor mais freqüente desse compartimento, compreendendo aproximadamente de 20 a 30% das massas mediastinais em adultos (1) . Os pacientes com timoma podem apresentar quadro clínico não muito específico: tosse, dispnéia, dor torácica, perda de peso, queda do estado geral. Porém, alguns pacientes são diagnosticados por radiografias de tórax em exames de rotina -que mostram opacidade homogênea no mediastino ântero-superior -ou por apresentar miastenia gravis associada (2) . Grande parte dos pacientes que apresentam timoma é de portadores de outras doenças auto-imunes ou endócrinas. Cerca de 27% dos pacientes com miastenia gravis apresentam timoma -83% dos homens com miastenia gravis entre 50 e 60 anos possuem timoma (3) -e 20-40% dos pacientes com timoma apresentam miastenia gravis. Artrite reumatóide, miosite e aplasia por células vermelhas puras são outras síndromes que podem vir associadas ao timoma (4) . O timoma está mais presente nas 5 a e 6 a décadas de vida, sendo menos freqüente em pacientes abaixo de 40 INTRODUÇÃO Timoma, um tumor infreqüente e de crescimento lento, é usualmente confinado localmente ao mediastino.

Bócio de tireóide intratorácico e timoma invasivo: apresentação simultânea incomum

“…(10)(11)(12) In a study involving 104 patients, of which 85.6% were submitted to complete resection and 25% received adjuvant treatment, 2 patients were treated with chemotherapy, 19 with radiotherapy and 5 received a combination of the two treatments. (13) In another study, the authors evaluated a sample of 100 patients and found the ten-year survival rates to be 92%, 87%, 60% and 35%, respectively, for those with stage I, II, III and IV tumors. (14) The mean interval of recurrence for patients with stage I tumors is ten years, compared with five years for patients with stage II, III or IV tumors.…”

Tratamento cirúrgico da síndrome da veia cava superior causado por timoma invasivo

“…The SVC syndrome is usually associated with malignancy and poor prognosis [5]. These cases include lung cancer in advanced stages (57%), mediastinal tumors (20%), and solid metastases (5%) [4].…”

“…There are discrepancies in the literature regarding the best methods for staging and classifying the disease. The most important methods are of Masaoka et al, which determines the degree of involvement of the disease, clinically and pathologically, and the French Study Group on Thymic Tumors (GETT system), which is based on surgical and pathological aspects of the tumor [5].…”

“…Complete resection followed by radiotherapy is the treatment of choice for all thymomas, except in stage IA tumors (of Masaoka) [5], which can be treated only with surgery. Although thymoma is radiosensitive, there is controversy regarding the use of radiotherapy in patients with invasive thymoma.…”

<![CDATA[<B>Middle mediastinal thymoma</B>: <B>case report</B>]]>

“…In Brazil, patients with benign tumors present 10-year survival rates of 82.6% and with malignant tumors the mean 5-year survival rate is 33.5% [8].…”