The area in our chest cavity located right behind the breastbone (sternum) and in front of the heart is called the “anterior mediastinum.” The most important organ in this region is the thymus gland. This gland, which plays a vital role in the development of the immune system during childhood, usually shrinks and turns into fatty tissue in adulthood.
However, sometimes the cells in this gland multiply uncontrollably, forming tumors we call “Thymoma.” Thymomas are generally slow-growing tumors; however, if neglected, they can spread to surrounding tissues (major vessels, pericardium). When completely removed by surgical methods (total resection), the recovery rate for patients is quite high.
The Relationship Between Thymoma and Myasthenia Gravis (Muscle Weakness Syndrome)
Timoma hastalarının yaklaşık %30-40’ında, aynı zamanda Myasthenia Gravis adı verilen bir kas hastalığı görülür. Göz kapağı düşüklüğü, çift görme veya genel kas yorgunluğu ile kendini belli eden bu hastalıkta, timus bezinin cerrahi olarak çıkarılması (Timektomi), hem tümörün tedavisi hem de kas güçsüzlüğünün iyileşmesi (veya ilaç dozunun azaltılması) için bilinen etkili yöntemlerden biridir. Bu ameliyatın kararı, hastanın nörolojik muayenesi ve takibini yapan nörolog tarafından verilir ve tarafımıza yönlendirilir.
Surgical Treatment: Open Surgery or VATS?
In the past, thymoma surgeries were performed with a large incision similar to “open heart surgery,” where the breastbone was completely cut (sternotomy). While this method is still valid today for very large tumors that have encased the vessels, we now prefer minimally invasive methods for standard thymoma surgeries.
At the Marmara University Faculty of Medicine Thoracic Surgery clinic, the advantages of the VATS (Video-Assisted Thoracoscopic) methods we apply are:
- Visual Dominance: It provides the surgeon with a magnified view in the anterior mediastinum, which is a narrow area. This allows the tumor to be precisely dissected without damaging nerves (especially the nerve going to the respiratory muscle).
- Less Pain and Incision: Since the breastbone is not cut (the chest is entered through only 2-3 small holes), there are no bone healing issues and the pain is much less.
- Cosmetic Result: In young patients, leaving small scars near the armpit area instead of a full-length surgical scar is a great psychological advantage.
Challenging and Recurrent Cases
Not every thymoma case is standard. Some tumors may be adherent to the pleura, lung tissue, or pericardium. Especially in recurrent thymoma cases, surgical experience is of critical importance. In our clinical practice, we aim to minimize the risk of recurrence by removing not only the tumor but also all potentially risky surrounding tissues (e.g., the entire thymus gland and surrounding fatty tissues). This is called “Total Thymectomy” and is the gold standard treatment. Even in cases where thymoma recurs, the most effective known treatment is surgery.
Frequently Asked Questions – FAQ
Question: Is thymoma cancer?
Answer: Thymomas fall into the category of “epithelial tumors.” Some types behave more benignly and are known to follow a slow course. However, this does not prevent them from affecting surrounding organs. Some (e.g., Thymic Carcinoma) can be more aggressive. In general, they are considered tumors with "malignant potential" and must be surgically removed.
Question: Will my Myasthenia Gravis symptoms disappear immediately after thymectomy surgery?
Answer: The effect may not be seen immediately. Improvement in muscle strength after thymectomy can take months, or sometimes even 1-2 years. During this process, your medication is managed together with your neurologist.
Question: Will my immune system weaken if my thymus gland is removed?
Answer: No, you do not need to worry. The thymus gland is a vital organ for the development of the immune system, especially in childhood. However, it completes its task after puberty and shrinks over time, turning into fatty tissue. Removing the thymus gland in an adult individual does not lead to a deficiency or disease in the immune system; your body continues to fight infections in the same way.
*This content was produced by Dr. Eyüp Halit Yardımcı for patient information purposes and does not serve academic objectives.
