thymus tissue

I need some help understanding what to do next.  In 7/07 I had a ct scan and it stated that I had prominent thymus tissue new from all prior studies.  At first my doctor wanted to do a biopsy then he changed his mind and ordered a pet san.  The thymus tissue measured 3.1 cm.  What is protocol for taking care of this thymus tissue?  What is staging and how is that done?  My doctor is handling this very conservatively, should I get a second opinion?  It also seems not alot of doctor have an expertize in this matter, how would I go about findind another opinion?  I have been followed for carciniod syndrome can the thymus become enlarged due to that condition? It is so hard to figure out what to do next.

[Fernando Roque, MD]

Hi.  If that thymus tissue is persistently enlarged or is progressively enlarging on consecutive CT scans, I think that a biopsy is in order.  We cannot even discuss "staging" or "treatment protocols" if we don't have a tissue diagnosis, which can only be arrived at by doing the biopsy.  Any medical or surgical oncologist should have sufficient expertise in handling tumors originating from the thymus and could be consulted for a second opinion.  Your best bet would be to go to a dedicated cancer center near your place.  Carcinoid tumors can occur in the mediastinum (the area in the chest where the thymus is also located) and could appear as a mediastinal mass.  Again, biopsy of the mass needs to be done to confirm the diagnosis of a carcinoid tumor, so this probably should be your next step.