Doctors Lounge - Hematology Answers
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Forum Name: Hematology Topics
|pam2wise - Wed Jul 21, 2010 5:56 pm||
History. Summary: Had Benign Thymolipoma Thymus Tumor 2005. Persistent Luekocytosis. Kidney Stones, Asthma, possible COPD, High Triglycerides, depression, anxiety, progressive degenerative disc disease, Dense Bones, Factor V Leiden, High Factor VIII Assay, Reactive Protein C, obese and Diabetic, on Insulin. I have had DVT's and PE's. On coumadin. Super Ventricular Tachycardia. Pseudocholinestrase Deficiency. Thoracic Outlet Symdrom, Have HBP, Microcytosis RBC's. Had Ketos in my urine when checked a week ago. The reason behind the thymolipoma has been undetermined. Included the ABNORMAL results here from latest labs. I am wondering if they point to Leukemia or Heart Disease or anything else. I have seen my WBC in the 50,000 range yet, no reason was ever found. I have not had a normal WBC in years. Results: WBC - 12.4, RBC 5.16, MCH 26.9, RDW 15.3, NEUTROPHILS (ABSOLUTE) 8.0, GLUCOSE, SERUM 121, TRIGLYCERIDES 329, VLDL CHOLESTROL CAL 66, T. CHOL/HDL RATIO 4.8, TSH 4.560, INR 3.8, PTT 37.1, HEMOGLOBIN A1C 6.2 Other tests pending. Could there be a genetic link (one thing that is causing all of this?)
|Dr.M.Aroon kamath - Mon Aug 02, 2010 10:38 am||
Thank you for this very interesting and thought-provoking post.
The fact that you had a thymolipoma in the past, and that you are concerned that all your symptoms and signs may be due to one single diagnosis, prompts one to consider a possible “syndromic” diagnosis which of course, features thymolipoma.
Thymolipomas are rare, benign tumors of the anterior mediastinum accounting for up to 9% of all thymic tumors. They are rarer than the non-thymic lipomas of the mediastinum In the majority of cases, the tumors are incidental discoveries on routine chest X-rays.
Approximately 10% of them are associated with paraneoplastic syndromes..
Thymolipomas are associated with autoimmune diseases in up to 50% of the patients, which include,
- myasthenia gravis,
- aplastic anemia,
- hodgkin lymphoma,
- lichen planus,
- Graves’ disease, and
- chromic lymphocytic leukaemia.
Thymolipomas show an excellent outcome following surgical excision. Patients with symptoms of underlying autoimmune disease occasionally show an improvement of the symptoms after a resection of the tumors.
As you have not provided the laboratory reference ranges, it is not possible to interpret them meaningfully.
One of the paraneoplastic syndromes reported wit thymolipomas and thymomas is
Hypogammaglobulinemia. Ig deficiency with thymoma (Good syndrome) affects adults aged 40-70 years
I will discuss it briefly the entity of hypogammaglobulinemia.
Hypogammaglobulinemia comprises of a set of disorders showing deficiencies of humoral immunity. ‘IgA deficiency’ is the most common antibody deficiency syndrome, followed by the ‘Common variable immunodeficiency’ (CVID). All types are characterized by recurrent infections.
The incidence of autoimmune and collagen vascular diseases is increased, especially in IgA deficiency. IgA deficiency may remain asymptomatic in childhood, and manifest usually during early adulthood.
Systemic lupus erythematosus without renal disease, neutropenia, rheumatoid arthritis, autoimmune hepatitis, hemolytic anemia, and endocrinopathies have been described, especially in CVID. Neutopenia is frequently seen. Many of the CVID has a variable age of onset, usually occurring around the third decade of life. However, many of the other types of hypogammaglobulinemias (including the hereditary ones) present at birth, infancy or early childhood.
In your case, I am not certain if all your symptoms, past history and laboratory results can be packaged into one single “syndromic” diagnosis, but it may be worth excluding hypogammaglobulinemia (especially considering your persistently high total white cell counts indicating some underlying infection or recurrent infections).
- either a paraneoplastic syndrome (akin to the Good syndrome),
perhaps persisting after thymectomy, or
- a completely unrelated isolated hypogammaglobulinemia.
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