lymphoreticular

Question 1

where is the thymus located?

Answer 1

in the mediastinum between the lungs

Question 2

what quadrant is the spleen located in ?

Answer 2

located in the upper left quadrant of the abdomen

Question 3

what T levels does the spleen abut?

Answer 3

T9-12

Question 4

spleen functions

Answer 4

filters blood especially RBC and platelets
fights off bacteria and viruses
stores RBC, platlets and WBC

Question 5

thymus functions

Answer 5

produces progenitor cells which becomes T cells which fight off tumour cells and infections

Question 6

thymoma symptoms symptomatic vs myasthenia gravis symptoms

Answer 6

30% present with symptomatic symptoms and the rest present with myasthenia graves symptoms

Question 7

symptomatic thymoma symptoms

Answer 7

most are related to an impingement in the thoracic cavity

cough, chest pain , dypsnea, hoarsness , superior vena cava obstruction and tumor hemmorhage

Question 8

myasthenia gravis symptoms

Answer 8

Presence of antibodies that react with nicotinic acetylcholine receptors in muscle and distrupt transmission at the neuromuscular junction
Weakness
Fatigability of skeletal muscles
In the worst cases it can even affect respiration

Question 9

how myasthenia gravis is diagnosed

Answer 9

Routine blood work is done to rule out other associated medical conditions
Serum a fetoprotein and beta-human chorionic gonadotropin in men to rule out germ cell tumors

Question 10

how is thymus cancer diagnosed ?

what biopsies are performed and when?

Answer 10

when thymus cancer is small it is diagnosed clinically
when thymus cancer is large it is diagnosed with a biopsy
Biopsies are: fine needle aspiration, bronchoscopy, mediastinoscopy , video -assisted thoracoscopy or even open biopsy
Diagnostic imaging includes: CT, MRI, PET and octeoride scanning

Question 11

thymomas benign vs malignant

Answer 11

1/3-1/2 is malignant and the rest are benign

Question 12

how commonly are thymomas asymptomatic

Answer 12

1/3

Question 13

most important prognostic indicator and treatment indicator in thymoma

Answer 13

whether myasthenia graves is present or not or if the tumour is encapsulated or invasive (stage)

Question 14

how common is mets in thymomas, invasive thymomas?

Answer 14

5% in thymomas in general, 25% in invasive thymomas

Question 15

common mets in thymomas

Answer 15

supraclav LN, liver, bone and lung

Question 16

combined treatment modality of choice in thymomas

Answer 16

Preoperative cisplatinum based chemotherapy, then surgery and postoperative radiation therapy is optimal

Question 17

Adjuvant XRT in thymoma

Answer 17

Is used adjuvantly after surgery for patients with stage 2 and 3 disease
Adjuvant therapy can also be used after incomplete resection

Question 18

neoadjuvant XRT in thymoma

Answer 18

when the tumour is close to critical structures to make it easier to remove in surgery

Question 19

coverage thymoma XRT

Answer 19

The entire mediastinum and both hila should be encompassed within the irradiated volume
The supraclavicular area should also be included of adenopathy is present
Prophylactic irradiation of one or both supraclavicular fossa can be recommended

Question 20

Surgery of choice in thymoma

Answer 20

A complete en-bloc resection is the treatment of choice for all thymomas regardless of invasiveness except in the case of intrathoracic and extrathoracic metastasis however the majority are localized (90-95%)

Question 21

what stage of thymomas are usually resectable

Answer 21

Encapsulated (stage I) and minimally invasive (stage II) thymomas are virtually always resectable
~20% of obviously invasive (stage III) thymomas are unresectable

Question 22

chemo agents used to treat thymomas

Answer 22

cyclophosphamide, doxorubicin, cisplatin and prednisone

Question 23

thymomas are chemo____________.

Answer 23

chemosensitive

Question 24

chemo in thymomas should be used ________.

Answer 24

neoadjuvantl

Question 25

thymus tumours pathology

Answer 25

90% are thymomas , <5% are thymic carcinoid

Question 26

thymus staging

Answer 26

Stage I: macroscopically completely encapsulated; no microscopic capsular invasion
Stage II: Microscopic invasion into capsule; macroscopic invasion into surrounding fatty tissue or mediastinal pleura
Stage III: Macroscopic invasion into neighboring organs
Stage IVA: pleural or pericardial implants
Stage IVB: lymphogenous or hematogenous metastasis

Question 27

treatment spleen

Answer 27

The usual boost doses to the spleen, given in conjunction with TBI for marrow or stem cell transplantation vary considerably from a high of 10 Gy in one fraction to a low of 2.5 Gy in five fractions