I have an appointment this Wednesday with a surgeon to discuss possible thymectomy.

He is a cardio thoracic surgeon and the director of the robotics program at one of our local hospitals and I am hoping he can do it this way.

My CT scan report says: "4cm anterior mediastinal soft tissue mass. The differential includes thymoma and lymphoma."

What kind of questions should I be asking him? I've read on some threads the word hyperplastic in reference to thymoma. What's that?

I was diagnosed with MG in July 09 and currently it is just ocular. My neuro started me out on prednisone and mestinon, but now I am just taking mestinon (30mg X 3) which is controlling the double vision and eyelid droop.

Thanks in advance.

Hi Kathy,

Hyperplastic Thymus is simply over-active thymus tissue. The thymoma is a cancer of the thymus - they are two different things.

There are pros of going with the robotic surgery (less invasive, shorter recovery time, etc.) There are cons (chance of not getting all of the tissue, apparently it is quite a bit more painful in the short term than transternal based on what my sister in law tells me (she's a nursing instructor)).

There are pros of going with transternal (better visibility to the area, surgeon can get all of the thymus when he's in there etc.) There are cons ...

I'd be asking about the thymoma - can he be sure to get it all with the plan of attack? what are the chances you're going to need radiation therapy for it (probably pretty small, yours sounds like it is fairly small.) Are there other concerns about the lymphoma? or is this the same object that they're talking about and they're not sure if it is a lymphnode or thymoma until they get in there?

Best of luck

Cheers!

Brian.

Hey Kathy,

If it's a thymoma, or any other cancerous type of lesion, they should probably do a transternal cut (the vertical cut down the chest). There's also a cut that they can do which is under the breasts. My surgeon offered this to me because it's better in terms of the scar (no need to wear high-collar shirts after the surgery). I opted to go with the transternal cut because he said that the recovery time is less painful.

I think that the cut under the breasts is fairly 'new.' I'm not sure if all surgeons offer this.

The reason that they should do this type of cut as opposed to the small one which I think is done in the throat (not sure)? is because there's less visibility, as Brennan said, and there's a chance that some thymus/thymoma might be left in your chest, which is risky in terms of re-occurence, and decreases the chances of remission from the MG.

Something I learned recently from a post that Brennan had written is that if your thymus is hyperplastic and contains a thymoma, there's a higher chance of a drug-free remission after surgery. If the thymus contains a thymoma only, but is not hyperplastic, then drug-free remission is unlikely. So I guess that a good question would be to see if your thymus is also hyperplastic. Sometimes, a hyperplastic thymus can masquerade as a thymoma too. They'll know for sure once the pathologist checks everything out. You could also ask them what type of thymoma they think it is based on the Masaoka rating system. My docs. were able to tell me this too.

My surgeons were right on the money based on my CT scan only, although they thought it was slightly more invasive than it actually was. Mine was about 4.5/5cm as well (the thymoma). It was encapsulated micro- and macroscopically, but the CT scan image made it look like it had broken through to the fat surrounding my thymus.

Good luck!