Ask an Oncology Doctor a Question Regarding Thymoma and Thymic Carcinoma

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Ask an Oncology Doctor a Question Regarding Thymoma and Thymic Carcinoma


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[momto5]

I am a 33 year old female. I'll explain my story first. I have been having recurring chest pain over the past few years and have been to the doctor a few times. They have done heart work-ups (mostly echos) a few times. This past June the chest pain had been becoming more frequent and stronger at times. It got to the point where I was having (and still do) a constant "pressure" uncomfortability in my chest, just left of the sternum and will get intermittent sharp pains throughout the day. I also have been having shortness of breath occasionally - where I feel like I need to concentrate on taking some deep breaths. I will also get sharp pains when I take a really deep breath. One night when it was pretty bad I went to the ER. Again they did a heart work up and all seemed fine. They did a CT scan (looking for PE) and found small thyroid nodules and a soft-bodied mass in anterior mediastinum resembling residual thymus. I was sent to ENT and cardiology for follow-ups.

ENT told me I needed to go to Cardiothoracic so I got a refferal. It took me 1 1/2 months to get in (Military). I met with Dr. in cardiothoracic almost two weeks ago now and he showed me my scan and showed me the mass that he said was a little bigger than a golf ball where my thymus would be. He asked me lots of questions and explained a lot of things - he was very thorough. He sent me to neurology to be tested for autoimmune particularly MG and to have a CT/PET scan. This past week I met with Neuro. He does not think i have MG but took a lot of blood and is setting me up with a muscle test to rule out completely. I also had the CT/PET scan.

This is where it gets interesting. My doc called on Thurs and said he is confused. The CT portion of the PET scan did not show any mass????? however the whole anterior mediastinum had a SUV uptake of 2.4. He talked things through with Radiology and they have decided I should now have an MRI - which I need to wait till next week to schedule.

What is your impression of these results? Is the uptake of 2.4 indicative of cancer? Is it possible for the mass not to show up but still be there?

Thanks for your opinion!!! I'm just trying to understand it all. I am a mother to 5 children so don't want to miss anything and end up having cancer that gets worse.

[oncology.dr]

Thanks for your excellent question.

So the first thing you need to know is that there is a difference between a diagnostic CT scan and a CT that is used in combination with PET. A diagnostic CT will give a better resolution of structures because its purpose is indeed to identify abnormal structures. Now, the "CT" in PET/CT is used as an adjunct to the PET scan (which is the primary imaging modality in this case). It varies from one institution to the next, but we actually use a low quality CT with the PET scans at our institution and the picture quality is often subpar (but the main purpose of the PET/CT is not to define the anatomy - rather it serves to identify 'active' tissues). All that to say that it may be possible to miss a small mass in the anterior mediastinum on the CT images of the PET/CT because it may not have adequate anatomical resolution. This is why they recommend an MRI in order to better characterize this potential mass that they are searching for.

To answer your second question, no one can conclusively say that the SUV of 2.4 on your scan is definitely cancer. Perhaps if you had told me that the SUV was 15, then it would undoubtedly raise my suspicion. You should know that an elevated uptake reflects increased cellular activity, and that means that cells are eating up sugar more than the nearby cells. This occurs in infection, inflammation, tissue healing, and yes, cancer. You need the MRI to have a better look at what this potential mass looks like. Sometimes, radiologists can give a fairly accurate assessment based on what they see. Then your doctor puts together all the info and discusses with you the next step.

I hope this helps.

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