Ronda's Mediastinal Mass

Hello All,

I’m writing this post in response to questions many of you will have regarding Ronda’s recently diagnosed chest mass – or more correctly: mediastinal mass.

Ronda’s most recent life chapter, since returning from Scotland in June, includes a persistent hideous cough, asthma, and shortness of breath. By her assessment, it was likely bad hay fever-induced asthma that required several trips to her ENT doc attempting to find the right combination of steroids, inhalers, irrigations, antibiotics, injections, etc. Her symptoms waxed and waned for a few weeks, but never totally disappeared. During her last appointment, I was convinced she needed a chest scan; the ENT agreed, and after finding the lost request for the scan, Logan Regional Hospital (LRH) finally scanned the poor woman’s chest – looking for any airway obstruction that could account for her symptoms. Due to some other foot-dragging that occurred by the ENT and/or the radiology department at LRH, we learned +/- 3 weeks after the scan that Ronda had a 12cm x 8cm x 6cm (4.8” x 3.2” x 2.4”) mass sitting right underneath her sternum nestled atop the great vessels of the heart, along with a small pericardial effusion (fluid collection.) The official diagnosis described this mass to be consistent with a Thymoma – typically a non-malignant mass of the thymus gland and part of the lymphatic system that makes T-cells. Normally we don’t need a thymus gland after puberty (and BTW, it has nothing to do with puberty.)

It's amazing after the CT report came to all of our attentions, how fast (today) we were able to get Ronda in to see a cardiothoracic surgeon, Dr. David R. Goff, at McKay Dee Hospital in Ogden. Dr. Goff had access to Ronda’s, CT scan, and spoke to us clearly and at length about this tumor.

Today was the first day Ronda and I had seen the tumor on the scan (I will use the terms mass and tumor interchangeably) and by my MD/urologist's eyes it is impressive and it’s an alien and

shouldn’t be there. Dr. Goff said he was uncertain exactly what cell-type the mass was, but benign thymoma is at the top of the list, followed by malignant germ cell tumor, and finally lymphoma. Ruling out a germ cell tumor requires a blood draw which was done today. And if this happens to be a germ cell tumor, they are usually sensitive to both low-dose chemo and radiation therapy and usually require no surgery. Absent germ cell tumor, Ronda will be scheduled for a thoracotomy (same incision for an open-heart case) to remove the mass completely. Although thymoma is generally benign, there are a lot of important vessels and nerves in the neighborhood particularly nerves to the diaphragm and larynx, so a meticulous dissection, to say the least. Dr. Goff was careful and spoke at length regarding the risks.

We also asked about the possibility of inheritance of thymoma, and after describing the case of her father’s mediastinal mass in 2004. Note: there was no autopsy or biopsy of his mass. Dr. Goff said he would do some additional investigation on the subject but was unaware of any

inheritability.

We left the hospital after 3:00 PM moderately stunned and hungry. We stopped at a Wendy’s in Far West, UT. I thought about a chocolate Frosty but demurred. We then proceeded on Highway 89 to the fruit stands in Willard and Perry, UT, and purchased, a box of peaches. The Spirit also whispered we should procure and share a fresh peach milkshake at Pettingill’s Fruit Stand in Willard: infinitely better than Frosty. Besides, we needed that tender mercy.

Finally, had it not been for the persistent cough, shortness of breath, and other symptoms

described above, the presence of the mass would very likely have remained unknown for how long? Ronda has no additional symptoms and is not incapacitated in any way. She walks daily, bakes fresh bread never, goes out to lunch with her cronies, interacts with the children and grandchildren, and puts up with me in the normal fashion. I will try and update this document as new data arrives.