Thymus Gland Pathology. Clinical, Diagnostic, and Therapeutic Features

About this book

The thymus has been a mysterious gland for centuries. The awareness of its role has been progressing, in particular during the second half of the twentieth century.

The thymic pathology is related to several complex congenital, non-oncological, and oncological diseases. Many of these illnesses require a multidisciplinary approach thus involving several specialists: the surgeon, the neurologist, the anesthetist, and the pathologist. For example, myasthenia gravis—the most challenging disease deriving from a thymic trouble—requires an accurate and multimodal treatment. The oncologic pathology of the thymus is likewise complex, and involves also the oncologist and the radiotherapist. In cases of congenital thymic diseases, a transplantation of the thymus can be taken into consideration.

This volume is an update on the pathology of this gland and includes 24 chapters written by international and well-known experts. The whole thymic pathology is described and new concepts about the nosological classification and the thymic neoplasm staging system are reported. Some chapters are focused on the radiologic, mini-invasive, and surgical diagnosis, and other chapters deal with surgical and non-surgical treatments. Special chapters are devoted to myasthenia gravis and thymus transplantation.

The book will appeal to all the specialists involved in the treatment of thymic pathology, but can also be of interest to practitioners, and undergraduate and graduate students.

Written for:

• Surgeons, neurologists, immunologists, general practitioners, pathologists, anaesthesiologists

Keywords:

• Multidisciplinar approach
• Thymus gland
• myasthenia gravis
• thymectomy
• thymus transplantation

Table of contents

The thymus : a mysterious gland with a complex history.- Embriology and anatomy of the thymus gland.- Physiology and immunology of the thymus gland.- Congenital pathology.- Flogistic and hypertrophic pathology.- Benign and malign tumors.- Clinical features of thymus pathology.- Thymus and myasthenia gravis: Physiopathological and clinical aspects.- Radiologic diagnosis : X-ray, CT scan and NMR.- PET features.- Minimally invasive and surgical diagnosis.- Surgical anatomy of the thymus gland.- Anesthesiologic problems.- Conventional techniques: Cervicotomy. Median sternotomy. Transthoracic approach.- "Open" videoassisted techniques: Cervicotomic approach. Subxiphoid approach with bilateral thoracoscopy. Cervicotomic and subxyphoid approach with bilateral thoracoscopy.- Totally endoscopic techniques: Right sided. Left sided. Bilateral approach with anterior chest wall lifting.- Robotic techniques.- Complex surgical interventions in superior cava vein syndrome.- Surgery of the thymus gland : re-interventions.- Chemotherapy in thymic neoplasms.- Radiotherapy in thymic neoplasms.- Complementary treatments in thymic neoplasms: Steroids. Octreotide.- Thymus-related myasthenia gravis multimodal treatment and follow up. Thymus transplantation.