Myasthenia gravis associated with invasive malignant thymoma: two case reports and a review of the literature

Journal of Medical Case Reports

Richard Alan Rison²  Nazely Ashikian³  Hui Gong¹  Said R Beydoun¹ 

[1] Department of Neurology, University of Southern California, Keck School of Medicine, Los Angeles County Medical Center, 1520 San Pablo Street, Los Angeles, CA 90033, USA;Department of Neurology, PIH Health Stroke Program, 12401 Washington Boulevard, Whittier, CA 90602, USA;Department of Neurology, Kaiser Permanente, 15788 Midwood Drive, Granada Hills, CA 91344, USA

关键词: Intravenous immunoglobulin;    Plasmapheresis;    Myasthenia gravis;    Thymoma;    Invasive malignant thymoma;    Thymomatous myasthenia gravis;   

Others  :  1181013
DOI  :  10.1186/1752-1947-8-340

 received in 2014-05-19, accepted in 2014-08-20,  发布年份 2014

【 摘 要 】

Introduction

Approximately ten to fifteen percent of patients with myasthenia gravis are found to have a thymoma, and twenty to twenty-five percent of patients with thymoma have myasthenia gravis. Thymomatous myasthenia gravis tends to have a difficult clinical course and poor prognosis.

Case presentation

We report two cases (one patient of Asian ethnicity and the other of Caucasian ethnicity) of atypical presentations of myasthenia gravis associated with invasive malignant thymoma. Both patients were diagnosed at a young age, in their 20s. They presented with a turbulent course of myasthenia gravis and recurrent thymoma, but obtained good outcome after aggressive treatment involving multiple different specialists.

Conclusions

Although thymomatous myasthenia gravis tends to have a difficult clinical course and poor prognosis, early and aggressive treatment along with multidisciplinary management may improve the outcome of these patients.

【 授权许可】

   
2014 Beydoun et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Tormoehlen LM, Pascuzzi RM: Thymoma, myasthenia gravis, and other paraneoplastic syndromes. Hematol Oncol Clin North Am 2008, 22:509-526.
• [2]Cheney RT: The biologic spectrum of thymic epithelial neoplasms: current status and future prospects. J Natl Compr Canc Netw 2010, 8:1322-1328.
• [3]Romi F: Thymoma in myasthenia gravis: from diagnosis to treatment. Autoimmune Dis 2011, 2011:474512.
• [4]Okumura M, Shiono H, Minami M, Inoue M, Utsumi T, Kadota Y, Sawa Y: Clinical and pathological aspects of thymic epithelial tumors. Gen Thorac Cardiovasc Surg 2008, 56:10-16.
• [5]Amdahl C, Alseth EH, Gilhus NE, Nakkestad HL, Skeie GO: Polygenic disease associations in thymomatous myasthenia gravis. Arch Neurol 2007, 64:1729-1733.
• [6]Mikhail M, Mekhail Y, Mekhail T: Thymic neoplasms: a clinical update. Curr Oncol Rep 2012, 14:350-358.
• [7]Rosai J, Sobin LH: Histological typing of tumors of the thymus. In World Health Organization International Histological Classification of Tumours. 2nd edition. New York: Springer; 1999:9-14.
• [8]Masaoka A, Monden Y, Nakahara K, Tanioka T: Follow-up study of thymomas with special reference to their clinical stages. Cancer 1981, 48:2485-2492.
• [9]Jaretzki A 3rd, Barohn RJ, Ernstoff RM, Kaminski HJ, Keesey JC, Penn AS, Sanders DB: Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology 2000, 55:16-23.
• [10]Maggi G, Casadio C, Cavallo A, Cianci R, Molinatti M, Ruffini E: Thymectomy in myasthenia gravis. Results of 662 cases operated upon in 15 years. Eur J Cardiothorac Surg 1989, 3:504-509. discussion 510-511
• [11]Maggi L, Andreetta F, Antozzi C, Baggi F, Bernasconi P, Cavalcante P, Cornelio F, Muscolino G, Novellino L, Mantegazza R: Thymoma-associated myasthenia gravis: outcome, clinical and pathological correlations in 197 patients on a 20-year experience. J Neuroimmunol 2008, 201–202:237-244.
• [12]Ruffini E, Filosso PL, Mossetti C, Bruna MC, Novero D, Lista P, Casadio C, Oliaro A: Thymoma: inter-relationships among World Health Organization histology, Masaoka staging and myasthenia gravis and their independent prognostic significance: a single-centre experience. Eur J Cardiothorac Surg 2011, 40:146-153.
• [13]Thomas CR, Wright CD, Loehrer PJ: Thymoma: state of the art. J Clin Oncol 1999, 17:2280-2289.
• [14]Margaritora S, Cesario A, Cusumano G, Meacci E, D'Angelillo R, Bonassi S, Carnassale G, Porziella V, Tessitore A, Vita ML, Lauriola L, Evoli A, Granone P: Thirty-five-year follow-up analysis of clinical and pathologic outcomes of thymoma surgery. Ann Thorac Surg 2010, 89:245-252. discussion 252
• [15]Matsushima S, Yamamoto H, Egami K, Suzuki S, Tanaka S: Evaluation of the prognostic factors after thymoma resection. Int Surg 2001, 86:103-106.
• [16]Lucchi M, Ricciardi R, Melfi F, Duranti L, Basolo F, Palmiero G, Murri L, Mussi A: Association of thymoma and myasthenia gravis: oncological and neurological results of the surgical treatment. Eur J Cardiothorac Surg 2009, 35:812-816. discussion 816
• [17]Lococo F, Cesario A, Margaritora S, Granone P: Twenty-one-year survival in an invasive thymoma successfully treated with seven-fold iterative surgery. Interact Cardiovasc Thorac Surg 2010, 11:322-324.