Cytologic atypia is a hallmark of malignant thymomas. Extension beyond the tumor capsule may occur in benign thymomas. They may be associated with pure red cell aplasia and hypogammaglobulinemia. Distant metastases occur rather than local invasion. Treatment of invasive thymoma has been predominantly radical thymectomy. .
Thoracotomy is indicated in cases of gross mediastinal pleural invasion or fibrous adhesion.
Radiation therapy may be the primary treatment modality in cases of pleural dissemination. Octreotide has been used along with prednisone and resulted in anecdotal success in the treatment of thymomas. There is avid uptake by normal thymic tissue. Positivity may have prognostic significance in that treatment with octreotide may be efficacious. Treated thymomas tend to have higher uptake of radiotracer than untreated tumors.