11. THYMOMA
• SEEN BETWEEN 40 – 60 YRS
• ASSOCIATED WITH PARANEOPLASTIC
SYNDROMES LIKE MYASTHENIA , RED CELL
APLASIA, HYPOGAMMAGLOBLINEMIA, SLE
• 2 STAGINGS – MASAOKA AND WHO
12. Stage I – Completely encapsulated .
Stage II – Capsular invasion.
IIA: Microscopic capsular invasion
IIB: Macroscopic invasion into surrounding fatty
tissue or adherent to but not through the mediastinal
pleura or pericardium
Stage III – Pericardial or lung involvement.
IIIA: Macroscopic invasion into pericardium or lung
without great vessel invasion
IIIB: Macroscopic invasion into pericardium or lung
with great vessel invasion
Stage IV – Disseminated disease.
IVA: Pleural or pericardial dissemination
IVB: Lymphatic or hematogenous metastases
13. TREATMENT :
STAGE 1 AND 2 – COMPLETE RESECTION
STAGE 3 AND 4 – COMPLETE RESECTION +
POST OP RADIATION
POST OP CHEMOTHERAPY – CISPLATIN,
DOXORUBICIN, CYCLOPHOSPHAMIDE
IN UNRESECTABLE TUMOR – PRE OP
CHEMOTHERAPY [OR] RADIOTHERAPY IS DONE .
15. NEUROGENIC TUMORS
• ORIGIN
SYMPATHETIC GANGLIA :–
GANGLIOMA
GANGLIO-NEUROBLASTOMA
NEUROBLASTOMA
NERVE SHEATH :–
NEUROLEMOMA(SCHWANOMA)
NEUROFIBROMA
NEUROSARCOMA
PARAGANGLION CELLS :-
PHEOCHROMOCYTOMA
NEUROBLASTOMA
• CHILDHOOD TUMOR
• COMMONLY SEEN IN ADRENAL MEDULLA
OTHER SITE – SYMPATHETIC CHAIN
• ARISE FROM NEUROBLASTIC CELLS
• C/F – MASS IN LOIN OR CHEST (PRESSURE SYMPTOM)
OTHER MANIFESTATIONS - RACOON EYE SIGN ,
OPSOMYOCLONUS SYNDROME , HYPERTENSION
, FLUSHING , DIARRHOEA (VIP)
• INVESTIGATION – CT OR MRI , VANILYL
MANDELIC ACID (VMA ) , HOMOVANILIC ACID
(HVA) , MIBG( META IODO BEZYL GUANIDINE)
SCAN , BONE MARROW BIOPSY
16. GRADING OF NEUROBLASTOMA
BASED ON AGE , EXTENT OF DISEASE , HISTOLOGY ,
N-MYC ONCOGENE
LOW RISK 90% - SURGICAL EXCISION
INTERMEDIATE RISK 70 % – EXCISION AND
RADIOTHERAPY
HIGH RISK 30 % – DEBULKING , RADIATION AND
CHEMOTHERAPY (CISPLATIN , DOXORUBICIN ,
CYCLOPHOSPHAMIDE ) AND SECOND LOOK
SURGERY
17. NEUROGENIC TUMORS
• ORIGIN
SYMPATHETIC GANGLIA :–
GANGLIOMA
GANGLIO-NEUROBLASTOMA
NEUROBLASTOMA
NERVE SHEATH :–
NEUROLEMOMA(SCHWANOMA)
NEUROFIBROMA
NEUROSARCOMA
PARAGANGLION CELLS :-
PHEOCHROMOCYTOMA
PHEOCHROMOCYTOMA
• TUMOR ARISES FROM CHROMAFFIN CELLS
• SEEN COMMONLY IN ADRENAL MEDULLA
EXTRA ADRENAL ( PARAGANGLIONS )
• THESE TUMOR SECRETES NORADRENALINE AND
ADRENALINE
• RULE OF 10’S :– 10% - MALIGNANT ,
EXTRAADRENAL , BILATREAL , FAMILIAL , MULTIPLE
, NON HYPERTENSIVE
• CLINICAL FEATURES – HEADACHE , PALPITATION ,
FLUSHING , WEAKNESS , HYPERTENSION ,
• ASSOSIATED WITH MEN 2 , VHL , NF TYPE 1 .
18. • INVESTIGATION –
24 HR URINE OR BLOOD SAMPLE - METANEPHRINE &
NORMETANEPHRINE
MRI FOR LOCALISATION
MIBG SCAN
• TREATMENT :–
INTIALLY α- BLOCKER (PHENOXYLBENZAMINE) IS GIVEN
FOR 10 DAYS
THEN START β – BLOCKERS
SURGICAL EXCISION OF TUMOR IS DONE .
MALIGNANT PHEOCHROMOCYTOMA – SURGERY + I-131 MIBG
+ POST OP CHEMOTHERAPY - MITOTANE +
CYCLOPHOSPHAMIDE , VINCRISTINE , DACARBAZINE .
19. NEUROGENIC TUMORS
• ORIGIN
SYMPATHETIC GANGLIA :–
GANGLIOMA
GANGLIO-NEUROBLASTOMA
NEUROBLASTOMA
NERVE SHEATH :–
NEUROLEMOMA(SCHWANOMA)
NEUROFIBROMA
NEUROSARCOMA
PARAGANGLION CELLS :-
PHEOCHROMOCYTOMA
NEUROFIBROMA
•ARISE FROM SCHWANN CELLS AND CONNECTIVE TISSUES
•TYPES – CUTANEOUS – SMALL , HARD , MULTIPLE NODULES
PLEXIFORM – LARGE , HARD MASS
NON TENDER , PARAESTHESIA ,MOVE PERPENDICULAR TO THE NERVE
•COMMONLY ASSOCIATED WITH NEUROFIBROMATOSIS
TYPE 1 – CHROMOSOME 17 MUTATION , NF-1 GENE .
OTHER FEATURES – AXILLARY FRECKLES , LISCH NODULES,
CAFÉ AU LAIT SPOT .
INVESTIGATION – CT/MRI , SLIT LAMP , MOLECULAR
TESTING .
TREATMENT – SURGICAL EXCISION
20. NEUROGENIC TUMORS
• ORIGIN
SYMPATHETIC GANGLIA :–
GANGLIOMA
GANGLIO-NEUROBLASTOMA
NEUROBLASTOMA
NERVE SHEATH :–
NEUROLEMOMA(SCHWANOMA)
NEUROFIBROMA
NEUROSARCOMA
PARAGANGLION CELLS :-
PHEOCHROMOCYTOMA
SCHWANNOMA
•ARISE FROM SCHWANN CELLS , BENIGN TUMORS
•CAN OCCUR AT ANY SITE
•ASSOCIATED WITH NEUROFIBROMATOSIS TYPE - 2
CAUSING ACOUSTIC NEUROMA .
•C/F – HEARING LOSS , PARAESTHESIA , SOMETIMES
TENDER .
• INVESTIGATION – CT/MRI , AUDIOMETRY .
• TREATMENT – SURGICAL EXCISION