Mediastinal neoplasms in patients with Graves disease: a possible link between sustained hyperthyroidism and thymic neoplasia?

Abstract

BackgroundAnterior mediastinal masses are a rare but well documented finding in Graves disease. The vast majority of these lesions represents benign thymic hypertrophy and regress after treatment of the hyperthyroidism. A small percentage of these cases however represent neoplastic/malignant diseases which require further treatment.Cases12 year old boy with one year history of refractory Graves disease was found to have an anterior mediastinal mass and underwent curative thyroidectomy for sustained hyperthyroidism. Cervical lymphadenopathy was detected during the procedure and biopsy was obtained. A 23 year old woman who presented with a one month history of hyperthyroid symptoms, was diagnosed with Graves disease and also was found to have an anterior mediastinal mass on imaging. Biopsy of the anterior mediastinal mass was obtained and subsequently the patient underwent robotic thymectomy. Histologic examination and immunophenotyping of the cervical lymph node in a 12 year old boy revealed neoplastic proliferation of T lymphoblasts diagnostic of T lymphoblastic leukemia/lymphoma. Examination of the anterior mediastinal mass biopsy in the 23 year old woman revealed type B1 thymoma which was confirmed after examination of the subsequent robotic thymectomy specimen.ConclusionThis is the first reported case of T cell lymphoblastic lymphoma and the third reported case of thymoma associated with sustained hyperthyroidism due to Graves disease. These cases indicate that an anterior mediastinal mass in a patient with active Graves disease may be due to a neoplastic cause, which may require definitive treatment. Caution should be exercised when dismissing a mediastinal mass as benign thymic hyperplasia in patients with active Graves disease.

Thymic hyperplasia in patients with Graves’ disease

“…In addition to the 92 cases discussed by Deforges-Bullet et al [9], we found another 15 case reports of thymic enlargements associated with GD published to date [12][13][14][15][16][17][18][19][20][21][22]. Only 4 of these 107 cases in all were diagnosed as thymic malignancies (three thymomas and one T lymphoblastic lymphoma/leukemia [19][20][21]), while TH was confirmed in all the other cases.…”

“…Only 4 of these 107 cases in all were diagnosed as thymic malignancies (three thymomas and one T lymphoblastic lymphoma/leukemia [19][20][21]), while TH was confirmed in all the other cases.…”

Analysis of ICU Treatment on Resection of Giant Tumors in the Mediastinum of the Thoracic Cavity

“…Along with hematosis, controlled hypertension was needed to decrease postoperative errhysis in patients with hypertension. In conclusion, advancements were gained in maintaining postoperative circulatory stability (Boyd et al, 2012;Sirotkina et al, 2012;Tantisattamo et al, 2012).…”

“…Long-term application of ventilators can easily add difficulties for removing ventilators because of ventilator-relevant pulmonary infection or adopt second application due to respiratory failure after forced remove of the machine (Cardillo et al, 2008;Ipek et al, 2012). It is also effective in COPD combined with acute respiratory failure.…”

Μελέτη Της Συσχέτισης Μεταξύ Των Νοσημάτων Του Θυρεοειδούς Και Των Αιματολογικών Παραμέτρων Με Έμφαση Στα Ουδετερόφιλα Κοκκιοκύτταρα

“…Πρόσφατα, οι Boyd and Juskevicius παρουσίασαν την τρίτη περίπτωση θυμώματος που συνυπήρχε ταυτόχρονα με νόσο Graves' σε μια ασθενή ηλικίας 23 ετών, καθώς και το πρώτο περιστατικό Τ-λεμφoβλαστικού λεμφώματος/λευχαιμίας, η οποία εκδηλώθηκε σε έδαφος από έτους διαγνωσμένης, ανθεκτικής στη θεραπεία νόσου Graves σε έναν ασθενή ηλικίας 12 ετών. Και στις δύο περιπτώσεις βρέθηκε τραχηλική λεμφαδενοπάθεια στην κλινική εξέταση και μάζα πρόσθιου μεσοθωρακίου στο παρακλινικό έλεγχο (Boyd and Juskevicius, 2012). Τα περιστατικά αυτά υποδεικνύουν πως μια μάζα πρόσθιου μεσοθωρακίου σε ασθενή με ενεργό νόσο Graves μπορεί να οφείλονται σε νεοπλασματική αιτία που μπορεί να απαιτεί ριζική θεραπεία.…”