Both true thymic hyperplasia and lymphoid hyperplasia manifest as diffuse symmetric enlargement of the thymus, so that it is difficult to distinguish between the two types on the basis of imaging findings alone (,24). Several proposals to simplify the classification scheme according to similar prognostic appearance have been made to facilitate clinical-pathologic understanding of thymic epithelial tumors. A thymoma is a localized tumor which originates from the epithelial cells of the thymus, a lymphoid organ. Preoperative predictions based on WHO histologic subtypes of thymic epithelial tumors may help determine if tumors can be treated with surgical resection alone or if they require pre- or postoperative adjuvant treatment (,30). In questionable cases, correlation with morphologic findings obtained at CT or MR imaging is appropriate (,27). For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. Several classification schemes and staging systems for thymic epithelial tumors have been proposed. Cystic thymoma in a 48-year-old woman. Of note, T-cell antigen receptors of thymocytes interact with epithelial major histocompatibility complex antigens in the process of thymocyte maturation (,5). 91, No. Chest radiographic signs … Low-dose CT Chest (CPT® G0297) See CH-33: Lung Cancer Screening. Imaging tests show pictures of the inside of the body. (b) Photomicrograph (original magnification, ×40; H-E stain) shows a predominance of polygonal epithelial cells with nuclear atypia. Diffuse symmetric enlargement of the gland is the key morphologic feature of hyperplasia, whereas neoplasm tends to manifest as a focal mass, as in thymoma (,24). The WHO classification scheme correlates with invasiveness: Types A and AB are usually clinically benign and encapsulated (stage I), type B has a greater likelihood of invasiveness (especially type B3), and type C is almost always invasive. Figure 9b. Patterns of metastasis and recurrence in thymic epithelial tumours: longitudinal imaging review in correlation with histological subtypes, Rebound adenoid hyperplasia after chemotherapy in pediatric patients with head and neck lymphoma: MR imaging findings, Adult-Onset Hyperplasia of An Ectopic Cervical Thymus Associated with Uncontrolled Hyperthyroidism: A Case Report, Induction of epithelial to mesenchymal transition (EMT) and inhibition on adipogenesis: Two different sides of the same coin? 2, Seminars in Roentgenology, Vol. For example, imaging tests can show if the cancer has spread. 14, No. 10, Advances in Neuroimmune Biology, Vol. Often manifesting as a neck mass, these entities are sometimes examined with computed tomography (CT) or magnetic resonance (MR) imaging (,8,,9). 4, 2 April 2013 | Indian Journal of Surgical Oncology, Vol. The lesion is indistinguishable from a solid mass. 1, Journal of Pediatric Surgery, Vol. Possibly: CT scan without intravenous contrast is a reasonable study to evaluate for thymoma or lung cancer. Hodgkin disease accounts for the majority of thymic lymphomas, with nodular sclerosis being the most common histologic finding identified in the thymus (,18,,24). (b) Photomicrograph (original magnification, ×40; H-E stain) demonstrates mixed histologic features, with foci of medullary and spindle cells admixed with lymphocytes. 1, European Journal of Radiology Open, Vol. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. In general, it is difficult to distinguish lymphoma from other thymic masses, especially thymoma, on the basis of imaging findings alone. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. At imaging, a thymic carcinoid usually manifests as a large anterior mediastinal mass, often with invasion of adjacent structures and metastasis. Incidentally noted thymic carcinoma in a 79-year-old man who presented with bronchiectasis and cough. 5, 19 July 2016 | Japanese Journal of Radiology, Vol. The role of thymoma in the occurrence of pure red cell aplasia is not known at present. This disease entity is seen when a patient is recovering from some recent stress, such as chemotherapy for neoplasm, corticosteroid therapy, irradiation, or thermal burns (,5,,18,,24). 4, 25 March 2018 | Journal of Clinical Ultrasound, Vol. In addition to epithelial cells and lymphocytes, the thymus contains a variety of other types of cells, including macrophages and myoid cells. 37, No. (b) Photomicrograph (original magnification, ×40; H-E stain) shows tumor cells in a trabecular growth pattern with oncocytic cytoplasm and oval to irregular nuclear contours. True thymic hyperplasia is defined as enlargement of the thymus, which remains normally organized, beyond the upper limit of normal for a given patient age. (a) Contrast-enhanced CT scan shows an incidentally noted anterior mediastinal lesion (arrow) with well-circumscribed borders and soft-tissue attenuation. 6, No. 2, Current Opinion in Immunology, Vol. Sasaki et al (,32) reported that the standardized uptake value (SUV) for thymic carcinoma was significantly greater than that for invasive or noninvasive thymoma. (a) Photomicrograph (original magnification, ×10; hematoxylineosin [H-E] stain) of the thymus shows the cortex, mainly composed of lymphocytes (thymocytes), and the medulla, mainly composed of epithelial cells. 7, Seminars in Ultrasound, CT and MRI, Vol. (B) A 50-year-old woman mainly complains of general fatigue and subsequently was confirmed myasthenia gravis. I would … In this article, we discuss and illustrate t… 27, No. With the increased prevalence of advanced CT technology, detailed characterization of thymic epithelial tumors at CT has become possible; therefore, the correlation of radiologic findings with WHO classifications, clinical behaviors, and prognosis has also been investigated (,28–,30). CT Chest without contrast (CPT® 71250) can be used for the following: Patient has contraindication to contrast. WHO type AB thymoma in a 68-year-old woman. The WHO classification scheme is relatively new and is based on histologic features. (b) Photomicrograph (original magnification, ×40; H-E stain) of the medulla shows Hassall corpuscles (arrows) as round, keratinized formations with mature epithelial cells. Thymoma is the most common carcinoma of the anterior mediastinum. 5, No. One of the major functions of the thymus, the maturation of thymocytes, has been studied extensively with molecular and cellular biology. Myoid cells are of great interest because of their potential role in the pathogenesis of myasthenia gravis (discussed later) (,5). It is important that radiologists be able to distinguish thymic hyperplasia from neoplasm. Jeong et al (,30) simplified the WHO histologic classification scheme into three subgroups—low-risk thymomas (types A, AB, and B1), high-risk thymomas (types B2 and B3), and thymic carcinomas (type C)—and correlated CT findings in the three tumor subgroups with prognosis. (a) Contrast-enhanced CT scan demonstrates a lobulated, heterogeneously enhancing mass in the anterior mediastinum. 25, No. (a) Contrast-enhanced CT scan shows a lobulated anterior mediastinal mass. 21, No. These two types are associated with different groups of pathologic conditions (,Table 2) (,5,,24). Thymic hyperplasia in a 25-year-old woman with Graves disease. 49, No. Feasible roles and mechanisms of transforming growth factor β1 (TGF-β1) in age-related thymic involution, Diffusion-weighted magnetic resonance imaging of thymoma: ability of the Apparent Diffusion Coefficient in predicting the World Health Organization (WHO) classification and the Masaoka-Koga staging system and its prognostic significance on disease-free survival, Solid Tumors of the Mediastinum in Adults, Chemical shift and diffusion-weighted magnetic resonance imaging of the anterior mediastinum in oncology: Current clinical applications in qualitative and quantitative assessment, Normal thymus in adults: appearance on CT and associations with age, sex, BMI and smoking, Computed Tomography of the Pediatric Chest, Feeding Pregnant and Lactating Mice Rhodiola kirilowii Extracts helps to Preserve Thymus Function of their Adult Progeny, Pitfalls and mimics: The many facets of normal paediatric thymus, Intrathyroidal Ectopic Thymus in Children, Evaluation of thymic volume by postmortem computed tomography, Value of Computerized 3D Shape Analysis in Differentiating Encapsulated from Invasive Thymomas, Prevalence of Ectopic Intrathyroidal Thymus in Japan: The Fukushima Health Management Survey, Anterior mediastinal masses in the Framingham Heart Study: Prevalence and CT image characteristics, Diagnostic and functional imaging of thymic and mediastinal involvement in lymphoproliferative disorders, Chemical-shift MRI of rebound thymic hyperplasia with unusual appearance and intense 18F-FDG uptake in adulthood: report of two cases, Approaching the Patient with an Anterior Mediastinal Mass: A Guide for Radiologists, Intrathymic cyst: Clinical and radiological features in surgically resected cases, Thymic Measurements in Pathologically Proven Normal Thymus and Thymic Hyperplasia, The anticancer efficacy of pixantrone-loaded liposomes decorated with sialic acid–octadecylamine conjugate, Imaging of thymus in myasthenia gravis: From thymic hyperplasia to thymic tumor, Imaging Characteristics of Pathologically Proven Thymic Hyperplasia: Identifying Features That Can Differentiate True From Lymphoid Hyperplasia, Thymic Maturation and Programmed Cell Death, Thymoma and thymic carcinoma in the target therapies era, Sonographic Evaluation of Congenital and Acquired Thoracic Disorders in Pediatric Patients. In spite of the frequent association between thymoma and myasthenia gravis, the mechanism of the association is not fully understood. During involution, the epithelial component atrophies, resulting in scattered small lymphocytes in abundant adipose tissue (,5). A biopsy is not usually the first test done for a thymic tumor. However, because of the rarity of thymoma, there are few published series assessing this disease, many of which are single-institution studies spanning several decades, which may lead to potentially misleading conclusions related to diagnosis, staging, and treatment. Figure 1.Tumor size and pleural effusion are associated with patient's symptoms. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. 30, No. Technical parameters were set at 120 kVp, 180 mAs, pitch of 1, section thickness of 5 mm, contiguous section interval, and 512 × 512 matrix without contrast agent intravenous injection. 11, Radiologic Clinics of North America, Vol. Epithelial cells compose the framework of the thymus; they are functionally essential for the maturation of T lymphocytes and thus are called “nurse cells” (,5). Magnetic resonance imaging (MRI). High Resolution CT (HRCT). (a) Photomicrograph (original magnification, ×10; hematoxylineosin [H-E] stain) of the thymus shows the cortex, mainly composed of lymphocytes (thymocytes), and the medulla, mainly composed of epithelial cells. (a) Contrast-enhanced CT scan shows a lobulated anterior mediastinal mass. Thereafter, the thymus grows rapidly and attains its greatest weight in relation to body weight before birth (average, 15 g) (,5). Figure 5a. There are a variety of pathologic entities of the thymus. 4, 27 January 2017 | RadioGraphics, Vol. 2, Environmental Health Perspectives, Vol. The Masaoka clinical-pathologic staging system is based on surgical findings, including the presence of invasion or metastasis, and tumors are classified as follows: stage I, macroscopically encapsulated tumor with no microscopic evidence of capsular invasion; stage II, macroscopic invasion of the surrounding fatty tissue of the mediastinal pleura or microscopic evidence of capsular invasion; stage III, macroscopic invasion of a neighboring organ; stage IVa, pleural or pericardial dissemination; and stage IVb, lymphogenous or hematogenous metastasis (,48). A CT scan of the chest is the most common test used to look for and evaluate a thymic tumor. Axial short inversion time inversion-recovery MR image shows hyperintense cystic lesions in the mediastinum abutting the pericardium. 3, Ukraïnsʹkij žurnal medicini, bìologìï ta sportu, Vol. 2, General Thoracic and Cardiovascular Surgery, Vol. Further differentiation into cortex and medulla is completed by 14–16 weeks. Use of chemical shift MR imaging and FDG PET in this setting have been described previously; however, further study will be needed to determine their utility (,26,,27). I am now panicking that it wont be as effective. (b) On a sagittal reformatted image, the mass is closely attached to the pericardium with loss of the fat plane (arrow) between the two entities, findings that suggest pericardial involvement. A special dye called a contrast medium is given before the scan to create a clearer picture. 5, Anales de Pediatría (English Edition), Vol. Because the current WHO classification scheme correlates with the oncologic behavior of thymic epithelial tumors and affects treatment strategy, familiarity with the imaging features that suggest specific histologic subtypes is important for radiologists, allowing them to contribute to the clinical treatment of affected patients. Thymoma is a rare tumor that originates from thymic epithelial cells and is usually associated with myasthenia gravis. 9, 15 August 2016 | Iranian Journal of Radiology, Vol. 6, Progress in Histochemistry and Cytochemistry, Vol. No extracapsular invasion was noted. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. 34, No. Lymphoid hyperplasia of the thymus is observed in a number of immunologically mediated disorders, including SLE, rheumatoid arthritis, scleroderma, vasculitis, thyrotoxicosis, and Graves disease (,Fig 4). Thymic epithelial tumors most frequently manifest as soft-tissue masses in the anterior mediastinum, vary in size, and can have smooth and lobulated borders. Galen of Pergamum (130–200 ad), who first noted that the thymus was proportionally largest during infancy (,4), referred to the thymus as an “organ of mystery,” a moniker that remained fairly accurate for almost two millennia. 20, No. WHO type B1 thymoma (lymphocyte rich, predominantly cortical) in a 57-year-old woman. 2, Acta Otorrinolaringologica (English Edition), Vol. Use the menu to choose a different section to read in this guide. This section describes options for diagnosing thymoma and thymic carcinoma. A CT scan is a low-risk procedure. 27, No. 107, European Journal of Radiology Open, Vol. Tomiyama et al (,28) assessed the CT features of various subtypes of thymic epithelial tumors in 53 patients and reported that smooth contours and a round shape are most suggestive of type A tumors, irregular contours are most suggestive of type C tumors, and calcification is suggestive of type B tumors. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. 1, Korean Journal of Radiology, Vol. Thymoma in a 40-year-old woman with myasthenia gravis. Comment différentier une simple hyperplasie thymique d’une tumeur médiastinale antérieure ? 7, No. This dye can be injected into a person’s vein. The nodule demonstrated enhancement after contrast material administration. However, experience and previous publications have shown that it is difficul… A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. 1, 19 December 2018 | Radiology, Vol. Helical CT was performed from the lung apices to the middle portion of both kidneys with 5-mm collimation and a pitch of 3. Familiarity with the current WHO classification scheme, which is based on histologic features, is also essential (,5). With an SUV cutoff point of 5.0, thymic carcinoma can be differentiated from thymoma with reasonably high sensitivity (84.6%), specificity (92.3%), and accuracy (88.5%). Although rare, thymomas are the most frequently occurring tumors of the anterior mediastinum. At surgery, pericardial invasion was noted, and pathologic analysis showed squamous cell thymic carcinoma. 12, 1 January 2009 | Journal of Ultrasound in Medicine, Vol. 19, No. Tumors can appear cystic and hemorrhagic. (a) Axial half-Fourier acquisition single-shot turbo spin-echo MR image shows an anterior mediastinal mass that is slightly hyperintense relative to skeletal muscle. (b) Photomicrograph (original magnification, ×40; H-E stain) shows tumor cells in a trabecular growth pattern with oncocytic cytoplasm and oval to irregular nuclear contours. Pleural seeding from a WHO type B2 (cortical) thymoma in a 40-year-old woman who presented with myasthenia gravis. Thymolipoma is a rare, benign, slow-growing tumor that accounts for 2%–9% of all thymic neoplasms. What is the patient’s clinical stage? 12, No. 6, No. These entities are round, keratinized formations with mature epithelial cells and undergo marked cystic change into multilocular thymic cysts (,5). 2, Korean Journal of Radiology, Vol. 1, Journal of Thoracic Imaging, Vol. A physical exam provides information about possible signs of thymic cancer and other health problems. 9, American Journal of Roentgenology, Vol. Thymic carcinoid has a poor prognosis due to a high prevalence of recurrence and metastasis. What constitutes a normal thymus is another important issue. Because the thymus demonstrates unique changes over time, differentiation of a normal thymus from a thymic disorder can sometimes be problematic for radiologists. Journal of Clinical Neuroscience, Vol. 1, World Journal of Clinical Pediatrics, Vol. Surgery was performed, and pathologic analysis helped confirm a cystic type AB thymoma. Chemical shift imaging was recently used in an attempt to distinguish normal thymus from thymic hyperplasia, with the latter demonstrating homogeneously decreased signal intensity on opposed-phase images. This sugar substance is taken up by cells that use the most energy. Myasthenia gravis (MG) is an autoimmune disease that often is associated with thymic abnormalities. Figure 10a. 5, Asia-Pacific Journal of Clinical Oncology, Vol. 6, 15 March 2018 | Muscle & Nerve, Vol. 302, No. The maximum thickness was 1.8 cm in patients under age 20 years and 1.3 cm in patients over age 20 years. There are two main types of thymus gland cancer: Thymoma – this cancer is more common and is usually diagnosed in people aged between 40 and 60.Some thymomas grow very slowly and may not have spread outside the thymus when they are diagnosed. CT scan image of a well-circumscribed, anterior mediastinal thyoma. Thymic carcinoid in a 74-year-old man. †Less common than myasthenia gravis, but with a well-known association with thymoma. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. This process starts at puberty, when the thymus is at its maximum absolute weight. Lymphoma may involve the thymus as part of disseminated disease or sometimes as an isolated site. In a series of 29 patients, Choyke et al (,25) demonstrated that rebound hyperplasia, defined as a greater than 50% increase in thymic volume over baseline, was noted in 25% of patients several months (range, 3–8 months; mean, 4.2 months) after cessation of chemotherapy. Galen of Pergamum (130–200 ad), who first noted that the thymus was proportionally largest during infancy (,4), referred to the thymus as an “organ of mystery,” a moniker that remained fairly accurate for almost two millennia. MR imaging may also be useful in differentiating between thymoma and thymic cysts that demonstrate increased CT attenuation due to hemorrhage or high mucinous content (,Fig 10,). 1, 20 April 2011 | Journal of Magnetic Resonance Imaging, Vol. 34, No. Later, the thymus was thought to be a protective thoracic cushion (,10) or the regulator of fetal and neonatal pulmonary function (,1,,11). 1, 4 October 2017 | Evolution, Medicine, and Public Health, Vol. Lung cancer-Noninvasive staging Chest CT with or without contrast if renal failure or PET/CT Screening for pulmonary metastases CT chest with or without for initial evaluation or surveillance. At CT, the thymus appears as a bilobed triangular structure located in the anterior mediastinum, most commonly anterior to the proximal ascending aorta, the pulmonary outflow tract, and the distal superior vena cava before it enters the right atrium (,Fig 2) (,14). 80, No. 2, American Journal of Physiology-Cell Physiology, Vol. An MRI and PET may provide more information but are not always needed (see below). Thymomas are malignant tumors that arise in the thymus gland, typically in the anterior mediastinum. The mass is outlined and the volume estimated using 3D reconstruction. You will also be asked about your general health. *Most common, with the most well established association with thymoma. (b) Contrast-enhanced CT scan obtained at the level of the upper abdomen shows an enhancing pleura-based nodule (arrow), a finding that represents pleural seeding. 6, No. Figure 7a. 4, No. 5, Topics in Magnetic Resonance Imaging, Vol. 3, Environmental Health Perspectives (Chinese), Vol. However, the thickness is greater at MR imaging (15–20 mm between ages 20 and 70 years), which may be due to better detection of (a) thymic tissue partially replaced by fat and (b) the margins of the thymus with this modality (,17). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. The other diseases, including pure red cell aplasia, hypogammaglobulinemia, SLE, rheumatoid arthritis, and nonthymic cancers, occur less frequently than myasthenia gravis but are relatively well recognized associated conditions (,5,,18). It is essential to differentiate thymic … (b) Photomicrograph (original magnification, ×40; H-E stain) shows a predominance of polygonal epithelial cells with nuclear atypia. There is no evidence of metastatic disease or lymphadenopathy. Figure 12b. Thymic epithelial tumors, which include thymoma and thymic carcinoma, arise from thymic epithelium and demonstrate various histologic features and biologic behaviors (,29). Knowledge of the embryologic, histologic, and normal morphologic features of the thymus is essential for comprehensive understanding of the normal thymus and thymic diseases. Pure red cell aplasia occurs in only 5% of thymoma patients, whereas thymomas are found in 50% of patients with pure red cell aplasia (,22). 8, 1 October 2015 | European Radiology, Vol. Several new imaging approaches have been attempted, including chemical shift MR imaging and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) (,26,,27). Chest CT demonstrate a small soft tissue mass at the anterior mediastinum, pathologically proven thymoma. This observation was verified in 1777 by William Hewson, who studied the evolution of thymic size during fetal and infant life (,1,,11). Cancer.Net GuideThymoma and Thymic Carcinoma. could a ct scan without contrast (allergy) be effective detecting lthymoma or small cell lung cancer or could mri no contrast be as good as ct. Dr. Mazen Ghani answered 24 years experience Radiology Possibly: CT scan without intravenous contrast is a reasonable study to … 58, No. It is usually detected incidentally at routine chest radiography and may occasionally mimic cardiac enlargement or an elevated hemidiaphragm (,55). The median CT value of thymic cyst was reported to be 24.8 HU with range of −19.9–58.2 HU in a recent 6-year consecutive thymectomy cohort , and Araki et al. Because of their embryologic background and anatomic location, they can occur adjacent to the junction of the great vessels and the pericardium; less commonly, in the cardiophrenic angles or adjacent cardiac borders; and, rarely, in the neck or other mediastinal compartments (,5,,18). This dye can be injected into a person’s vein. If you have signs or symptoms that suggest you might have a thymus tumor, your doctor will want to take a complete medical history to check for symptoms. (a) Contrast-enhanced CT scan demonstrates a lobulated, heterogeneously enhancing mass in the anterior mediastinum. This scheme has been shown to reflect the clinical features of thymic epithelial tumors and to correlate with prognosis (,52). (a) Contrast-enhanced CT scan shows an incidentally noted anterior mediastinal lesion (arrow) with well-circumscribed borders and soft-tissue attenuation. 33, No. (a) Axial half-Fourier acquisition single-shot turbo spin-echo MR image shows an anterior mediastinal mass that is slightly hyperintense relative to skeletal muscle. 3, Critical Reviews in Oncology/Hematology, Vol. In the diagnosis of thymic tumors, radiologists should look carefully at the CT findings, which may serve as predictors of tumor invasiveness and of postoperative recurrence or metastasis. 128, No. 202, No. 4, World Journal of Radiology, Vol. Follow-up of pulmonary nodule(s). Pericardial effusion is also noted. Figure 3. The thymus subsequently undergoes a process called involution, which is defined as a decrease in the size and weight of the gland with advancing age. Development begins in the 6th gestational week. 72, No. A variety of diseases are seen in association with thymoma (,Table 1) (,5,,18,,19). 58, No. Thymoma is the most common primary tumor of anterior mediastinum and accounts for 20% of all mediastinal tumors. 1, Polish Journal of Veterinary Sciences, Vol. Jeong et al (,30) reviewed the CT findings in 91 patients who had undergone resection of thymic epithelial tumors and correlated these findings with their simplified classification scheme and with prognosis. At MR imaging, thymoma has a signal intensity similar to that of muscle or normal thymic tissue on T1-weighted images and appears heterogeneous on T2-weighted images (,Fig 9,) (,18,,29,,31). 1, 12 August 2015 | Journal of Ultrasound in Medicine, Vol. Biopsy and Chamberlain procedure. 59, No. 2, No. 66, No. Although unenhanced and contrast-enhanced CT of the thymus can solve this problem and answer the question most of the time, because an increase of 10 HU or more could be interpreted as enhancement, an undesirable doubling or tripling of the radiation dose would be required, and the patient would often have to be recalled for this additional imaging. I had this scan yesterday but due to collapsed, damaged veins they were unable to inject the dye and then decided to do the scan without. Figure 5b. (b) Three dimensional (3D) reconstruction of the thymoma prior to chemotherapy. 2, European Journal of Radiology Open, Vol. Pathologic analysis showed a predominance of lymphoid cells (type B2 tumor). Viewer, Case 261: Thymoma Embedded in Thymus with Pleural Implant in Myasthenia Gravis Lambert-Eaton Overlap Syndrome, Prevalence and sonographic features of ectopic thyroidal thymus in children: A retrospective analysis, Thymus imaging in myasthenia gravis: The relevance in clinical practice, Radiological features and metastatic patterns of thymic neuroendocrine tumours, Intrathyroidal thymic tissue in children: Avoiding unnecessary surgery, Anatomical variations of the thymus in relation to the left brachiocephalic vein, findings of necropsia, Pleural thymoma: Radiological and histological findings, Nonsuppressing normal thymus on chemical-shift MR imaging and anterior mediastinal lymphoma: differentiation with diffusion-weighted MR imaging by using the apparent diffusion coefficient, Doubling time of thymic epithelial tumours on CT: correlation with histological subtype, The Role of Brain –Pineal –Thymus System in the Determination of Lifespan: The Autoimmune Aging Theory, ITMIG Classification of Mediastinal Compartments and Multidisciplinary Approach to Mediastinal Masses, Current Updates on Pediatric Pulmonary Infections, Radiologic Features of Mediastinal Lesions, Imaging of the pediatric thymus: Clinicoradiologic approach.
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