pituitrin and Thymus-Neoplasms

Patients with thymoma are likely to present with associated autoimmunologic disorders. The occurrence of syndrome of inappropriate antidiuretic hormone (SIADH) attributable to thymoma is extremely rare. We herein present an extremely rare case of a 59-year-old man patient who was discovered to have malignant thymoma associated with myasthenia gravis, Graves' disease, and SIADH. He was admitted for evaluation and treatment of hyponatremia (Na 125 mEq/l). SIADH was diagnosed, and thymoma was identified as its cause. The patient was also found to have both Graves' disease and myasthenia gravis. The hyponatremia was normalized with water restriction and 3% saline therapy before thymectomy. The thymic tumor was a Masaoka stage III thymoma that resulted in direct invasion to the wall of the innominate vein, but there was no finding of invasion to other mediastinal organs. Complete thymectomy with innominate vein graft was performed. Microscopic histopathology findings corresponded to those of a mixed-type thymoma and type B2. However, immunohistochemical stain for antidiuretic hormone was negative in the tumor cells. Adjuvant radiation therapy was employed postoperatively, and the patient's postoperative recovery was uneventful. He subsequently reached a euthyroid state. And the reversal to normal sodium and osmolality levels was continued after the tumor removal without any further management for hyponatremia. The observation of this interesting case and a literature review provided us with the opportunity to explore the pathogenesis and clinical aspects of thymoma-related autoimmune and/or endocrine disorders which must be suspected in patients with thymoma.

Topics: Graves Disease; Humans; Immunohistochemistry; Inappropriate ADH Syndrome; Male; Middle Aged; Myasthenia Gravis; Thymectomy; Thymoma; Thymus Neoplasms; Vasopressins

Topics: Adrenocorticotropic Hormone; Bronchial Neoplasms; Carcinoid Tumor; Cushing Syndrome; Endocrine System Diseases; Female; Gonadotropins; Hormones, Ectopic; Humans; Islets of Langerhans; Male; Neoplasms; Parathyroid Hormone; Thymus Neoplasms; Thyroid Neoplasms; Vasopressins

Thymic neuroendocrine tumours are rare anterior mediastinal neoplasms often associated with paraneoplastic syndromes. A patient presented with intractable hyponatraemia and a DOTATATE-avid mediastinal mass. Following medical optimization, she underwent thoracoscopic thymectomy with en bloc thymic small-cell carcinoma resection. Her symptoms resolved and her sodium levels normalized. In localized disease, curative-intent, minimally invasive thymic neuroendocrine tumour resection is safe and effective following preoperative staging and paraneoplastic syndrome management.

Topics: Carcinoma, Small Cell; Female; Humans; Paraneoplastic Syndromes; Positron-Emission Tomography; Radionuclide Imaging; Thymoma; Thymus Neoplasms; Vasopressins

We describe a rare case of thymic neuroblastoma with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). A 60-year-old male patient was admitted to our hospital for further examination and treatment of anterior mediastinal tumor found at a regular health check-up. On examination there was hyponatremia, decrease in plasma osmolarity and elevation of plasma antidiuretic hormone (ADH) level. Thus, he underwent total thymectomy under the diagnosis of thymoma with SIADH. The tumor was located in the right lobe of the thymus and the final diagnosis was thymic neuroblastoma. To our knowledge, this is the first reported case of thymic neuroblastoma in which production of ADH by tumor cells is demonstrated immunohistochemically. This case highlights the need to consider functional activity of thymic neuroblastoma and complete resection of the tumor is warranted for treatment.

Topics: Biomarkers; Biopsy; Humans; Hyponatremia; Immunohistochemistry; Inappropriate ADH Syndrome; Magnetic Resonance Imaging; Male; Middle Aged; Neuroblastoma; Osmolar Concentration; Thymectomy; Thymus Neoplasms; Tomography, X-Ray Computed; Treatment Outcome; Up-Regulation; Vasopressins

A 61-year-old woman was admitted to the hospital because of general fatigue. Laboratory examinations showed hyponatremia, plasma hypo-osmolarity, and inappropriate increased concentration of the plasma antidiuretic hormone (ADH) in the presence of concentrated urine. Magnetic resonance imaging revealed a mass lesion in the anterior mediastinum. An extended thymectomy was performed under the diagnosis of thymoma with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Histologically the tumor was located in the thymic tissue and was diagnosed as ganglioneuroblastoma. Immunohistochemical studies showed the existence of ADH in the tumor cells. To the knowledge of the authors, this is the first case of ganglioneuroblastoma of the thymus with SIADH.

Topics: Female; Ganglioneuroblastoma; Humans; Inappropriate ADH Syndrome; Microscopy, Electron; Middle Aged; Thymus Neoplasms; Vasopressins

Different hormones (thymulin, thymosin alpha 1, vasopressin), antigenic markers of cortical and subcapsular/medullary thymic areas and tumour associated antigens were studied on paraffin or frozen section and cultures of human epithelial thymic tumours ('thymomas'). Thymulin, thymosin alpha 1 and for the first time vasopressin are found in most tumours. The epithelial cells of five 'thymomas' had markers of both cortical (TE3) and subcapsular/medullary thymic regions (A2B5 and/or TE4 and/or anti-p19). Leu-7, a marker of subcapsular epithelial cells was positive only in two tumours. The histological classification into cortical and medullary tumours does not correspond to our immunofluorescence results. The presence of these markers does not support the theory of different embryologic origin of the cortical and subcapsular/medullary epithelial cells. Transferrin receptors were detected on only some epithelial cells of thymic 'carcinomas'. Adenocarcinoma related antigen and carcino embryonic antigen only stained a few epithelial cells of all the tumours. There is no expected correlation between the presence of epidermal growth factor receptors on cell membranes and the number of proliferative cells stained by the anti-Ki67 antibodies. Immunostainings were heterogeneous according to the epithelial thymic tumours, independent of histological classification and not yet useful for prognosis.

Topics: Adult; Aged; Antigens, Neoplasm; ErbB Receptors; Female; Humans; Male; Middle Aged; Staining and Labeling; Thymus Hormones; Thymus Neoplasms; Tumor Cells, Cultured; Vasopressins

Topics: Biopsy; Humans; Hyponatremia; Male; Middle Aged; Osmolar Concentration; Syndrome; Thymoma; Thymus Neoplasms; Vasopressins

Topics: Adrenocorticotropic Hormone; Adult; Cushing Syndrome; Diagnosis, Differential; Female; Follicle Stimulating Hormone; Growth Hormone; Hormones, Ectopic; Humans; Hyperthyroidism; Hypocalcemia; Hypoglycemia; Hyponatremia; Insulin; Luteinizing Hormone; Mediastinal Neoplasms; Middle Aged; Osmolar Concentration; Parathyroid Hormone; Pigmentation Disorders; Syndrome; Thymus Neoplasms; Thyrotropin-Releasing Hormone; Vasopressins

Topics: Adenocarcinoma; Adrenocortical Hyperfunction; Adrenocorticotropic Hormone; Bronchial Neoplasms; Carcinoma; Female; Gastrointestinal Neoplasms; Gonadotropins; Growth Hormone; Hormones, Ectopic; Humans; Hyperparathyroidism; Hyperthyroidism; Lung Neoplasms; Male; Paraneoplastic Endocrine Syndromes; Parathyroid Hormone; Pituitary Hormones; Sex Factors; Thymus Neoplasms; Thyroid Neoplasms; Thyrotropin; Urogenital Neoplasms; Vasopressins

Topics: Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Erythropoietin; Gonadotropins, Pituitary; Growth Hormone; Humans; Insulin; Insulin Secretion; Liver Neoplasms; Lung Neoplasms; Malignant Carcinoid Syndrome; Melanocyte-Stimulating Hormones; Pancreatic Neoplasms; Paraneoplastic Endocrine Syndromes; Prolactin; Serotonin; Thymus Neoplasms; Vasopressins