Pseudo‐tumours of the thymus after correction of hypercortisolism in patients with ectopic ACTH syndrome: a report of five cases

Tabarin, A.; Catargi, Bogdan; Chanson, P; Hiéronimus, S.; Corcuff, Jean-Benoı̂t; Laurent, F.; Harter, M; Drouillard, J; Roger, Patrick

doi:10.1111/j.1365-2265.1995.tb01865.x

Cited by 25 publications

(20 citation statements)

References 17 publications

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“…This possibility is underscored by the observation that most infected individuals with a CD4 count in the range of 300-500 cells/l have a high thymic index (scores of 3-4). In the same manner that thymic rebound has been observed in adults after myeloablation (62)(63)(64)(65)(66)(67) and after correction of Cushing's disease (68,69), the peripheral T cell depletion induced by HIV-1 may drive renewed thymocyte maturation in an otherwise dormant thymic remnant. Thymic rebound may contribute to host compensation during the early phase of HIV-1 infection, characterized by maintenance of total T cell counts (70).…”

Section: Cd62lmentioning

confidence: 65%

High prevalence of thymic tissue in adults with human immunodeficiency virus-1 infection.

McCune¹,

Loftus²,

Schmidt³

et al. 1998

J. Clin. Invest.

244

149

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The thymus in adults infected with the HIV-1 is generally thought to be inactive, both because of age-related involution and viral destruction. We have revisited the question of thymic function in adults, using chest-computed tomography (CT) to measure thymic tissue in HIV-1-seropositive ( n ϭ 99) or HIV-1-seronegative ( n ϭ 32) subjects, and correlating these results with the level of circulating CD4 ϩ and CD8 ϩ T cells that are phenotypically described as naive thymic emigrants. Abundant thymic tissue was detectable in many (47/99) HIV-1-seropositive adults, aged 20-59. Independent of age, radiographic demonstration of thymic tissue was significantly associated with both a higher CD4 ϩ T cell count ( P ϭ 0.02) and a higher percentage and absolute number of circulating naive (CD45RA ϩ CD62L ϩ ) CD4 ϩ T cells ( P Ͻ 0.04). The prevalence of an abundant thymus was especially high in younger HIV-1-seropositive adults ( Յ 39 yr) with CD4 counts in the range 300-500 cells/ l and in older subjects ( Ͼ 40 yr) regardless of CD4 count ( P ϭ 0.03). These studies suggest that the thymus is functional in some but not all adults with HIV-1 disease. ( J. Clin. Invest. 1998.

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Section: Cd62lmentioning

confidence: 65%

High prevalence of thymic tissue in adults with human immunodeficiency virus-1 infection.

McCune¹,

Loftus²,

Schmidt³

et al. 1998

J. Clin. Invest.

244

149

View full text Add to dashboard Cite

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“…It may result from atrophy due to antiblastic chemotherapy (generally for lymphoma or germ-cell tumour) [13] or from hypercortisolism [14]; more frequently, however, there is no correlation with other conditions and the finding is incidental. There may be a history of stressful events, such as sepsis or massive burns.…”

Section: Iperplasia Timica Follicolare (O Linfoide)mentioning

confidence: 96%

“…La patogenesi dell'iperplasia è varia: talora si verifica secondariamente all'atrofia causata da un trattamento chemioterapico antiblastico (in genere per linfoma o tumore a cellule germinali) [13] o è causata da una condizione di ipercortisolismo [14]; più frequentemente, peraltro, non si ha alcuna correlazione con altre condizioni e la dimostrazione è casuale. È possibile il riscontro anamnestico di eventi causa di stress, quali la sepsi o le ustioni massive.…”

Section: Thymusunclassified

The anterior mediastinum: diseases

Priola

Cardinale

et al. 2006

Radiol med

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Mediastinal tumours are frequently asymptomatic and first noted on routine chest radiograph. In most cases, evaluation should proceed to spiral computed tomography (sCT) of the chest with iodinated contrast material. The specific location and appearance of tumours on sCT is instrumental in planning further diagnostic and treatment strategies. Primary tumours in the anterior mediastinum account for half of all mediastinal masses. They comprise various benign and malignant neoplasms, but a wide variety of nonneoplastic lesions (developmental, inflammatory) can present as a localised mass in this compartment. The most common primary anterior mediastinal tumours are thymoma, teratoma and lymphoma; all other lesions are rare. Nonneoplastic conditions include thymic cysts, lymphangioma and intrathoracic goitre. Understanding the pathology, clinical presentation, imaging and diagnosis of the major tumour types is instrumental in the safe and efficient work-up of a mediastinal mass. Patients with primary mediastinal masses and cysts will usually undergo surgical resection; radiological and clinical features should prompt limited biopsy specimens followed by oncologic consultation, and chemotherapy or radiotherapy when appropriate. The objective of this review was to examine the role of diagnostic imaging in the management of masses of the anterior mediastinum.

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“…The natural history of thymic hyperplasia has not yet been defined, and may occur 3-4 weeks or several months after hypercortisolism resolution. Its average duration is variable, generally presenting spontaneous resolution and benign course (6,7). It is possible that the stroma and epithelial tissues present a variable resistance to glucocorticoids, superior to the lymphoid component (5).…”

Section: Discussionmentioning

confidence: 99%

“…In a large series (nZ530) of ectopic tumors, thymic etiologies (carcinoid tumors, malignant thymoma and thymus hyperplasia) accounted for 11.2% of the cases (4). Thymic hyperplasia has been described after the resolution of hypercortisolism in Cushing's syndrome, more commonly after adrenalectomy, but also after the resection of bronchial carcinoid tumors and corticotropic adenomas and following mitotane, ketoconazole and RU-486 use (5)(6)(7). The appearance of a thymic mass in a bilaterally adrenalectomized patient with ACTH-dependent Cushing's syndrome can create a dilemma regarding the differential diagnosis between thymic hyperplasia and ectopic tumor, especially in cases where the source of ACTH production remains occult.…”

Section: Introductionmentioning

confidence: 99%

Thymus hyperplasia after resolution of hypercortisolism in ACTH-dependent Cushing’s syndrome: the importance of thymic vein catheterization

Neto

Machado²,

Mesquita³

et al. 2006

eur j endocrinol

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Thymic hyperplasia has been described after the resolution of hypercortisolism from several etiologies, causing great diagnostic dilemmas. We describe a case where the catheterization of the thymic vein was essential for the differential diagnosis of a thymic enlargement in an adrenalectomized patient with ACTH-dependent Cushing's syndrome. The patient was a 48-year-old female with clinical and laboratorial data suggesting Cushing's disease. She underwent a transsphenoidal surgery with no tumor visualization and no remission of the syndrome. Histopathological studies disclosed a normal pituitary. She underwent a bilateral adrenalectomy and 8 months later a chest CT showed an increase of left thymic lobe, which was previously non-existent. After a negative 111 In-pentetreotide scintigraphy, the patient underwent simultaneous and bilateral catheterism of the petrosus sinuses and catheterization of the thymic and inominate veins and no ACTH gradient was shown among the sites of collection. She did not undergo thoracotomy and a follow-up was established. During the evolution, there was a spontaneous regression of the thymic lesion 38 months after the diagnosis. The ACTH gradient during the catheterization of thymic vein was essential for the differential diagnosis of the thymic enlargement tumor after hypercortisolism resolution in ACTH-dependent Cushing's syndrome, especially in this case, where the ACTH source was occult, thus avoiding an invasive surgical procedure for a benign entity with spontaneous resolution.European Journal of Endocrinology 154 807-811

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Pseudo‐tumours of the thymus after correction of hypercortisolism in patients with ectopic ACTH syndrome: a report of five cases

Cited by 25 publications

References 17 publications

High prevalence of thymic tissue in adults with human immunodeficiency virus-1 infection.

High prevalence of thymic tissue in adults with human immunodeficiency virus-1 infection.

The anterior mediastinum: diseases

Thymus hyperplasia after resolution of hypercortisolism in ACTH-dependent Cushing’s syndrome: the importance of thymic vein catheterization

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