These include: full blood count, protein electrophoresis, antibodies to the acetylcholine receptor (indicative of myasthenia), electrolytes, liver enzymes and renal function. Staging
The Masaoka Staging System is used widely and is based on the anatomic extent of disease at the time of surgery:
I:   Completely encapsulated
IIA: Microscopic invasion through the capsule into surrounding fatty tissue
IIB: Macroscopic invasion into capsule
III: Macroscopic invasion into adjacent organs
IVA: Pleural or pericardial implants
IVB: Lymphogenous or hematogenous metastasis to distant (extrathoracic) sites

Treatment
Surgery is the mainstay of treatment for thymoma. If the tumor is apparently invasive and large, preoperative (neoadjuvant) chemotherapy and/or radiotherapy may be used to decrease the size and improve resectability, before surgery is attempted. When the tumor is an early stage (Masaoka I through IIB), no further therapy is necessary. Removal of the thymus in adults does not appear to induce immune deficiency. In children, however, postoperative immunity may be abnormal and vaccinations for several infectious agents are recommended. Invasive thymomas may require additional treatment with radiotherapy and chemotherapy (cyclophosphamide, doxorubicin and cisplatin).. Recurrences of thymoma are described in 10-30% of cases up to 10 years after surgical resection, and in the majority of cases also pleural recurrences can be removed. Recently, surgical removal of pleural recurrences can be followed by hyperthermic intrathoracic perfusion chemotherapy or intrathoracic hyperthermic perfused chemotherapy (ITH). Prognosis
Prognosis is much worse for stage III or IV thymomas as compared with stage I and II tumors. Invasive thymomas uncommonly can also metastasize, generally to pleura, bones, liver or brain in approximately 7% of cases.
Most commonly acute cerebellar ataxia affects children between age 2 and 7 years. See also
Gluten ataxia

References


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