Pericardial thymoma
Introduction
Introduction to pericardial thymoma Pericardial thymoma is mostly secondary, caused by metastases of anterior mediastinal thymoma, but found cases of primary pericardial thymoma, so the name of pericardial thymoma, especially the name of primary pericardial thymoma, remains to be international Identity on the top. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: pericardial effusion
Cause
Pericardial thymoma
Causes:
The cause of anterior mediastinal thymoma is unknown. Secondary pericardial thymoma is derived from the metastasis of anterior mediastinal thymoma. In patients with primary pericardial thymoma, there is no pathological change in the anterior mediastinal thymus tissue. The presumed cause is The thymus tissue in the ectopic pericardium is caused by malignant hyperplasia under the long-term biochemical stimulation of the abnormal physiological environment in the pericardium.
Pathogenesis:
The pathological changes of thymoma in the pericardium are basically consistent with the pathological changes of mediastinal thymoma. The pericardial thymoma is grayish white, soft, clear, lobulated, or erosive. It can be divided into lymphocytes and epithelium. Reticulocyte type and mixed cell type, epithelial cells are round or fusiform, varying in size, nuclear round, with vacuoles, ultrastructural epithelial cells are characterized by a complex of tension fibers and desmosomes, tumors may have Necrosis, bleeding.
Prevention
Pericardial thymoma prevention
Because the cause of anterior mediastinal thymoma is unknown, and some pericardial thymoma is derived from the metastasis of anterior mediastinal thymoma, there is no specific preventive measure.
To fully improve the understanding of this disease, in the diagnosis and treatment of heart disease, we must pay attention to the identification of this disease, once suspected of this disease should be further in-depth examination, strive for early diagnosis and treatment to prevent serious complications.
Complication
Pericardial thymoma complications Complications
Complications such as pericardial effusion and pericardial tamponade may occur. Surgery mortality is relatively low, operative mortality is often associated with myasthenia gravis, superior vena cava syndrome is a sign of poor prognosis, metastasis, large tumor diameter (greater than 10cm), tracheal vascular compression, epithelial or mixed histopathological type , the tumor syndrome of the blood system. There are local invasion, dissemination, recurrence and distant metastasis, which make the thymoma show low or potential malignancy in biological behavior.
Symptom
Pericardial thymoma symptoms Common symptoms Heart rate increased, unable to discharge blood, reduce edema, heart sound, distant jugular vein anger
Because the occurrence of pericardial thymoma is extremely rare, there is a lack of relevant male-to-male incidence ratio, but from clinical observations, there are far more female patients than male patients, especially older women, whether primary or secondary pericardial thymus. Tumors, often malignant thymus tissue, acute onset, severe disease, rapid progression, malignant neonatal obstruction disrupts the balance between filtration and permeation of capillaries in the pericardium, causing excessive accumulation of pericardial fluid, so patients are mainly Symptoms of pericardial effusion and pericardial tamponade, manifested as: jugular vein engorgement, hepatic jugular vein regurgitation sign (+), heart sounds distant, heart boundary to both sides, liver enlargement, edema of both lower extremities, venous pressure rise, Patients with secondary pericardial thymoma may also show symptoms of severe muscle weakness, such as decreased arterial pressure, increased heart rate, and shock caused by decreased cardiac output.
Examine
Examination of pericardial thymoma
1. Blood test: ESR increases.
2. Urine, routine examination of feces is often normal.
3. Pericardial effusion examination: bloody, transparent, no sediment, biochemical examination showed exudate, specific gravity > 1.016, protein qualitative > 3mg / dl, cell count > 500.
4. Ultrasound examination: suggesting a large number of pericardial effusions, sometimes can be found in the pericardium multiple large, small and strong echo group.
5. X-ray chest X-ray: The heart shadow is enlarged, the normal contour of the heart disappears, and the heart beat is weakened in a flask-like or pear-shaped shape (Fig. 1C, D).
6. Electrocardiogram: ST segment elevation is often indicated, T wave is flat and inverted, and QRS complex exhibits low voltage.
Diagnosis
Diagnosis and diagnosis of pericardial thymoma
diagnosis
According to the clinical manifestations, comprehensive examination of the results of the auxiliary examination and pericardial puncture examination, the diagnosis can be confirmed. The tumor cells are not easily found in the pericardial effusion. The symptoms of the pericardial puncture are significantly reduced, but the recurrence of pericardial effusion is fast and requires repeated puncture.
Differential diagnosis
Mainly easy to be confused with some diseases that can lead to pericardial effusion, such as: acute suppurative pericarditis, tuberculous pericarditis and pericardial malignant tumors, acute suppurative pericarditis in addition to symptoms of pericardial effusion, but also high fever, Pain in the anterior region, early in the early stage of the disease, you can hear the symptoms of systemic poisoning such as pericardial friction, and the pericardial effusion is purulent discharge. The patient's anti-inflammatory treatment is obvious. Tuberculous pericarditis is low fever, night sweats, pericardium. The effusion can culture acid-fast bacilli, and the pericardial malignant tumor is not easy to distinguish from pericardial thymoma. If there is no obvious clinical manifestation of the primary lesion, it depends on postoperative pathological examination.
