1/6. Malignant melanoma presenting as an intrathymic tumor: a primary thymic melanoma?The identification of malignant melanoma in a visceral organ of nonepidermal origin is not an uncommon occurrence. Frequently, these cases are solitary metastases that present years after a thin epidermal melanoma has been diagnosed (and sometimes forgotten). However, primary visceral melanomas have been reported that have not been preceded by an epidermal lesion. We describe herein a unique case of melanoma presenting as a primary intrathymic tumor. The patient had no previous history of epidermal melanoma, and extensive workup did not reveal evidence for an alternative primary site. The tumor exhibited histologic features characteristic of melanoma, including an abundance of large pleomorphic cells with eosinophilic cytoplasm, prominent nucleoli, and S100 protein and ultrastructural analysis revealed stage II and stage III melanosomes. The patient remained free of disease until intrathoracic recurrence was detected on a computed tomographic scan 14 months later. The lack of clinical history and physical findings of melanoma at presentation, the intrathymic location of the tumor, and the pattern of recurrence suggest that this case likely represents a primary thymic melanoma, a previously unreported entity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Gigantic thymolipoma.A 48-year-old woman with an abnormal shadow in chest radiography during an annual physical examination was found by chest computed tomography to have a large fatty mass lesion found to be diagnosed as a gigantic lipoma. Histopathological diagnosis was found to be benign thymolipoma consisting of mature fatty tissue and hyperplastic thymic tissue structures with Hassall,s corpuscles. Although the diagnosis is supported by imaging studies that demonstrate fat and soft tissue within the tumor, variations occur in computed tomography appearance. We suggest that surgical excision be considered when a gigantic intrathoracic lipomatous mass is in scanning as in this case.- - - - - - - - - - ranking = 13.890540544865keywords = physical examination, physical (Clic here for more details about this article) |
3/6. An unusual localization of thymoma.A 41-year-old man with myasthenia gravis was referred to our clinic to undergo a thymectomy by video-assisted thoracic surgery. After physical examination of the thorax and evaluation by computed tomography, a mass lesion was noticed in the neck and thymectomy was performed by partial sternotomy combined with a cervical incision. The cervical thymoma was discontinuous with the thymus. thymoma in the neck has rarely been reported. In this case report we emphasize the possible presence of thymoma in the neck and the importance of neck evaluation in patients with myasthenia gravis.- - - - - - - - - - ranking = 13.890540544865keywords = physical examination, physical (Clic here for more details about this article) |
4/6. Symptomatic cervical thymic cyst in a neonate.Thymic cysts are unusual neck masses in adults and children and are rarely differentiated from other neck masses by physical examination. This is a case report of a thymic cyst producing airway obstruction in a neonate. The embryogenesis and differential diagnosis of thymic cysts are reviewed.- - - - - - - - - - ranking = 13.890540544865keywords = physical examination, physical (Clic here for more details about this article) |
5/6. The pathophysiology of pure red cell aplasia: implications for therapy.To determine the utility of marrow culture in defining the natural history and therapeutic response of pure red cell aplasia we have studied 37 patients. patients were evaluated at the University of washington before specific therapies (n = 21) or at the time of treatment failure in = 16). Evaluation included a medical and drug exposure history, a physical examination, a chest x-ray or computed tomography to rule out thymoma, lymphocyte immunophenotype studies, anti-nuclear antibody and rheumatoid factor determinations, marrow cytogenetics, and marrow progenitor cell cultures. Retrospective Southern analyses to detect human parvovirus B19 was performed in the 27 patients for whom sera was stored. Clinical follow-up was obtained to document therapeutic responses. Normal burst forming unit-erythroid (BFU-E) growth (>30 bursts/10(5) marrow mononuclear cells [MMNC]) in culture proved an outstanding predictor of clinical response, as 27 of 29 individuals with normal frequencies of erythroid bursts in culture responded to immunomodulating therapies (sensitivity 96%, specificity 78%, predictive value 93%, P = .0001 with two-tailed chi square analysis). overall, 28 patients responded to either immunomodulating therapies or drug withdrawal. Twenty-four patients obtained a normal hematocrit (complete response [CR] and 4 additional patients became transfusion independent (partial response). Although responding patients often required several therapies, 20 of 24 (83%) patients who obtained a CR have sustained a normal hematocrit without maintenance therapy at the time of last follow-up (median 5 years). In contrast, of 8 patients with poor in vitro BFU-E growth (<6 bursts/10(5) MMNC), 7 failed to respond to any therapy and all died (median survival time 17 months). Our data suggest that in individuals, from whom BFU-E mature appropriately in culture, immunosuppressive drugs should be used sequentially until a CR is obtained and a durable remission is the expected outcome.- - - - - - - - - - ranking = 13.890540544865keywords = physical examination, physical (Clic here for more details about this article) |
6/6. T-cell lymphocytosis associated with lymphocyte-rich thymoma.BACKGROUND: Peripheral T-cell lymphocytosis is found on very rare occasions in patients with thymomas. The immunophenotypic features and clonality of the lymphocytes in tumor and peripheral blood now are elucidating this enigmatic phenomenon. methods: The author presents what is believed to be the seventh case of peripheral T-cell lymphocytosis associated with thymoma and reviews the previous six cases. The pathology slides of the thymoma were reviewed with a pathologist who confirmed the presence of neoplastic thymic epithelium with cytokeratin stains. immunophenotyping by flow cytometry was performed at Dianon Systems, Inc., on both the thymoma cells and cells in the peripheral blood. In addition, gene rearrangement analysis was performed on the peripheral lymphocytes using the previously described Southern blot analysis technique with immunoglobulin probes (heavy chain, kappa light chain, and lambda light chain) and T-cell receptor gene probes (beta and gamma chains). RESULTS: Analyses of the T cells within the thymoma and the peripheral blood confirm that the peripheral T cells are both polyclonal and more mature than those populating the thymoma. Clearly the peripheral T cells are not themselves neoplastic, and yet they represent more than physical "spillover" of the immature tumor-related T cells. CONCLUSIONS: Peripheral T-cell lymphocytosis occurs rarely with locally aggressive, lymphocytic thymomas. Although it is clear that these cells are not neoplastic, as they are in other T-cell proliferative disorders, the etiology of this unusual phenomenon remains obscure and may reflect the perturbation of systemic immunoregulation that accompanies thymic neoplasia. It is important to differentiate this condition from T-cell lymphomas or leukemia to treat affected patients appropriately.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |