IS case 532: Thymoma

Alok Bhatt, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-09-11


Patient is a 75-year-old female incidentally found to have an anterior mediastinal mass on chest radiograph.


PA and lateral views of the chest demonstrated a smooth, lobulated anterior mediastinal mass that projects over the right hilum. There was no significant tracheal deviation or compression. Calcified granulomas within the right lower lobe were also noted.




Familiarly, thymomas are part of the mnemonic, "the 4 T's" -- tumors that are found in the anterior mediastinum -- with the other three entities being: thyroid, teratoma, and "terrible" lymphoma.

In actuality, a large variety of tumors can arise in the the anterior mediastinum, not just limited to the 4T's. However, lymphoma and thymomas comprise the top two most common anterior mediastinal masses, so the mnemonic is certainly useful.

The term thymoma refers to a spectrum of thymic epithelial neoplasms, which possess different proportions of epithelial cells and lymphocytes. In terms of invasiveness and anaplasia, they can range from benign encapsulated thymomas (Class A) to thymic carcinomas (Class C). The latter tend to demonstrate more irregular margins, heterogeneity, necrosis, and calcifications, but benign thymomas may also exhibit these characteristics.

The clinical presentation of thymomas may be related to impingement of mediastinal structures, or occasionally to the development of various autoimmune conditions. About 30-50% of thymoma cases are associated with myasthenia gravis. Grave's disease, hypogammaglobulinemia, Sjogren's syndrome, dermatomyositis/polymyositis, and Cushing's disease have also been reported.


  1. Brant WE, Helms CA, eds. Fundamentals of Diagnostic Radiology, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2007, vol. 2, pp. 389-397.
  2. Kumar V, Abbas A, Fausto N. Robbins and Cotran Pathologic Basis of Disease, 7th ed. Saunders, 2005: 706-708.

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