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Zouvelou V, Tatouli I, Lymperopoulos L, Strataki E, Tzavella D, Vourlakou C, Zisis C, Kontogiannis S. Thymoma Associated Myasthenia Gravis Successfully Treated With Ravulizumab. Muscle Nerve 2024. [PMID: 39668649 DOI: 10.1002/mus.28320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 12/02/2024] [Accepted: 12/03/2024] [Indexed: 12/14/2024]
Affiliation(s)
- Vasiliki Zouvelou
- 1st Neurology Department, National and Kapodistrian University of Athens, Greece Eginitio Hospital, ERN EURO-MND, Athens, Greece
| | - Ioanna Tatouli
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Loukas Lymperopoulos
- 1st Neurology Department, National and Kapodistrian University of Athens, Greece Eginitio Hospital, ERN EURO-MND, Athens, Greece
| | - Eleni Strataki
- 1st Neurology Department, National and Kapodistrian University of Athens, Greece Eginitio Hospital, ERN EURO-MND, Athens, Greece
| | - Dimitra Tzavella
- 1st Neurology Department, National and Kapodistrian University of Athens, Greece Eginitio Hospital, ERN EURO-MND, Athens, Greece
| | | | - Charalampos Zisis
- Department of Thoracic Surgery, Chest Disease Hospital "Sotiria", Athens, Greece
| | - Sofoklis Kontogiannis
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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2
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Huang L, Li Z, Li F, Zhang H, Zhang W, Elsner A, Strauchmann J, Andreas MN, Dziodzio T, Lask A, Neudecker J, Ismail M, Xie D, Zhou H, Meisel A, Rueckert JC. Robotic-assisted extended thymectomy for large resectable thymoma: 21 years' experience. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00689-5. [PMID: 39159885 DOI: 10.1016/j.jtcvs.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/12/2024] [Accepted: 08/05/2024] [Indexed: 08/21/2024]
Abstract
OBJECTIVE This study aims to evaluate the perioperative and midterm oncological outcomes of robotic-assisted thoracic surgery extended thymectomy for patients with large resectable thymomas compared with small thymomas. METHODS This retrospective single-center study included 204 patients with thymomas who underwent robotic-assisted thoracic surgery extended thymectomy between January 2003 and February 2024. Patients were divided into 2 groups based on the thymoma size (5-cm threshold). RESULTS The study comprised 114 patients (55.9%) in the small thymoma group and 90 patients (44.1%) in the large thymoma group. No significant differences were found between the groups regarding gender, age, proportion of elderly patients, or pathologic high-risk classifications. Apart from a longer operative time (P = .009) in the large thymoma group, no differences were observed between the 2 groups regarding surgical parameters and postoperative outcomes. No deaths occurred within 30 days in either group. During a median follow-up of 61.0 months (95% CI, 48.96-73.04), 4 patients experienced recurrence (1.96%). No significant differences in the 5-year overall survival (P = .25) or recurrence-free survival (P = .43) were observed between groups. CONCLUSIONS Robotic-assisted thoracic surgery extended thymectomy is technically feasible, safe, and effective for treating large resectable thymomas. Moreover, midterm outcomes for patients with completely resected large thymomas were comparable to those with small thymomas during a median follow-up period of up to 5 years.
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Affiliation(s)
- Luyu Huang
- Department of Surgery, Competence Center of Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zhongmin Li
- Department of Surgery, Competence Center of Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Feng Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongbin Zhang
- Department of Surgery, Competence Center of Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wenqiang Zhang
- Department of Surgery, Competence Center of Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Thoracic Surgery, Klinikum Ernst von Bergmann Potsdam, Academic Hospital of the Charité-Universitätsmedizin Humboldt University Berlin, Potsdam, Germany
| | - Aron Elsner
- Department of Surgery, Competence Center of Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Strauchmann
- Department of Surgery, Competence Center of Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Nicolas Andreas
- Department of Surgery, Competence Center of Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tomasz Dziodzio
- Department of Surgery, Competence Center of Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Aina Lask
- Department of Surgery, Competence Center of Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Neudecker
- Department of Surgery, Competence Center of Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann Potsdam, Academic Hospital of the Charité-Universitätsmedizin Humboldt University Berlin, Potsdam, Germany
| | - Daipeng Xie
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Andreas Meisel
- Department of Neurology, Integrated Myasthenia Gravis Center, Charité University Medicine Berlin, Berlin, Germany
| | - Jens-C Rueckert
- Department of Surgery, Competence Center of Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.
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3
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Luo S, Jiang Q, Zeng W, Wang Q, Zou Z, Yu Y, Hong D, Zeng Q, Tan S, Zhang Z, Zhang Y, Guo X, Chen J, Zhao Z, Huang S, Shi J, Chen Y, Du L, Yan C, Xi J, Song J, Zhao C. Efgartigimod for generalized myasthenia gravis: A multicenter real-world cohort study in China. Ann Clin Transl Neurol 2024; 11:2212-2221. [PMID: 38973109 PMCID: PMC11330228 DOI: 10.1002/acn3.52142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/10/2024] [Accepted: 06/21/2024] [Indexed: 07/09/2024] Open
Abstract
OBJECTIVE Efgartigimod, a neonatal Fc receptor antagonist, facilitates antibody degradation including pathogenic IgGs. The ADAPT study demonstrated the tolerability and efficacy of efgartigimod in the treatment of generalized myasthenia gravis (gMG). However, very limited evidence is available for the Chinese population, and it remains inconclusive about which kind of patients are selected to preferentially receive efgartigimod in real-world settings. METHODS This multicenter cohort study included gMG patients treated at 14 neuromuscular reference centers in China. The Myasthenia Gravis Activities of Daily Living (MG-ADL) score, immunosuppressants, and the incidence of treatment-emergent adverse events (TEAEs) were prospectively collected. RESULTS Of the 1640 gMG admitted between September and December 2023, 61 (3.7%) received efgartigimod for at least one treatment cycle. Among them, 56 cases (92%) were anti-AChR antibody-positive, 4 were anti-MuSK antibody-positive, and 1 was seronegative. Thymoma-associated myasthenia gravis accounted for most cases (44%, 27 out of 61). The principal causes of efgartigimod initiation included MG acute exacerbation (MGAE) (48%, 29 out of 61) and myasthenic crisis (MC) (15%, 9 out of 61). Clinically meaningful improvement was rapidly achieved in 97% (58 out of 61) of patients at 1.3 ± 0.7 weeks. By week 12, the MG-ADL score reduced to 3.8 ± 4.1 (baseline:10.5 ± 5.2) for all participants, while it reduced to 4.0 ± 4.7 for MGAE and 3.8 ± 4.2 for MC, respectively. All but one TMG patient required no additional rescue therapies after efgartigimod initiation. 11.5% (7 out of 61) reported ≥1 TEAEs. INTERPRETATION This multicenter cohort study demonstrated the efficacy of efgartigimod in rapid control of gMG. Patients with MGAE or MC would benefit from efgartigimod treatment.
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Affiliation(s)
- Sushan Luo
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, Shanghai Medical College, National Center for Neurological DisordersFudan UniversityShanghai200040China
| | - Qilong Jiang
- Department of MyopathyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou510405China
| | - Wenshuang Zeng
- Department of NeurologyHongkong University Shenzhen HospitalShenzhen518053China
| | - Qinzhou Wang
- Department of NeurologyQilu Hospital of Shandong UniversityJinan250012China
| | - Zhangyu Zou
- Department of NeurologyFujian Medical University Union HospitalFuzhou350001China
| | - Yanyan Yu
- Department of NeurologyThe First Affiliated Hospital of Nanchang UniversityNanchang330006China
| | - Daojun Hong
- Department of NeurologyThe First Affiliated Hospital of Nanchang UniversityNanchang330006China
| | - Quantao Zeng
- Department of Neurology, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengdu610072China
| | - Song Tan
- Department of Neurology, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengdu610072China
| | - Zhouao Zhang
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityXuzhou221004China
| | - Yong Zhang
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityXuzhou221004China
| | - Xiuming Guo
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqing400016China
| | - Jing Chen
- Department of NeurologyThe Second Affiliated Hospital of Soochow UniversitySuzhou215004China
| | - Zhongyan Zhao
- Department of Neurology, Hainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikou570311China
| | - Shixiong Huang
- Department of Neurology, Hainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikou570311China
| | - Jianquan Shi
- Department of Neurology, Nanjing First HospitalNanjing Medical UniversityNanjing210006China
| | - Ying Chen
- Department of NeurologyThe First Affiliated Hospital of Wannan Medical CollegeWuhu241004China
| | - Lei Du
- Department of NeurologyThe First Affiliated Hospital of Xinjiang Medical UniversityUrumqi830054Xinjiang Uygur Autonomous RegionChina
| | - Chong Yan
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, Shanghai Medical College, National Center for Neurological DisordersFudan UniversityShanghai200040China
| | - Jianying Xi
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, Shanghai Medical College, National Center for Neurological DisordersFudan UniversityShanghai200040China
| | - Jie Song
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, Shanghai Medical College, National Center for Neurological DisordersFudan UniversityShanghai200040China
| | - Chongbo Zhao
- Huashan Rare Disease Center and Department of Neurology, Huashan Hospital, Shanghai Medical College, National Center for Neurological DisordersFudan UniversityShanghai200040China
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Dhandapani K, Gandhi J, Timaniya S, Joshi K, Gami A, Shah A, Trivedi P. Histomorphological Spectrum and Diagnostic Challenges in Thymic Epithelial Neoplasms with their Prognostic Significance: A Case Series of 33 Cases at a Regional Cancer Center in Western India. South Asian J Cancer 2024; 13:191-202. [PMID: 39410987 PMCID: PMC11473134 DOI: 10.1055/s-0042-1757556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Jahnavi Gandhi, DCPObjective Pathological diagnosis of thymic epithelial neoplasms is challenging due to multiple subtypes, tumor heterogeneity, and variations in inter-observer reproducibility. Very few studies are available on their spectrum in the Indian subcontinent. In this study, we aimed to explore the morphological spectrum and diagnostic difficulties in the classification and subtyping of thymic epithelial neoplasms along with their prognostic significance in the Indian population. Material and Methods Retrospectively, all surgically resected thymectomy specimens operated at our institute as well as outside review cases during the period were included. Histomorphology and immunohistochemistry (IHC) slides were reviewed and correlated with clinicopathological variables. Statistical Analysis Microsoft Excel 2019 and SPSS version 20 were used for data analysis. Results Among the 33 thymic epithelial neoplasms operated during the study period, the commonest subtype was thymoma B2 type followed by AB, B1, A, and B3 types. A single case each of micronodular thymoma, microscopic thymoma, and thymic carcinoma were identified. Six cases of thymomas with more than one pattern (other than 'A') were noted. The male:female ratio was 2:1. Stage I in Modified Masaoka staging and pT1a in TNM staging were most common. Seven cases had metastasis, four during initial presentation and three during subsequent follow-up. Discussion and Conclusion Thymic epithelial neoplasms show morphological overlapping of features. Thorough sampling, morphology, and IHC for exact subtyping of thymoma and diligent search and documenting of lymphovascular invasion (LVI) are vital as both are separate risk factors for metastasis/recurrence and help the clinician in a better follow-up of patients.
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Affiliation(s)
- Karthik Dhandapani
- Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Jahnavi Gandhi
- Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Sonali Timaniya
- Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Krutika Joshi
- Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Amisha Gami
- Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Ashini Shah
- Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Priti Trivedi
- Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Suzuki T, Hishida T, Suzuki S, Okubo Y, Masai K, Kaseda K, Asakura K, Emoto K, Asamura H. Clinicopathological predictors of postoperative long-term myasthenic status in resected thymoma with myasthenia gravis. Surg Today 2024; 54:787-794. [PMID: 38416144 DOI: 10.1007/s00595-024-02806-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/22/2023] [Indexed: 02/29/2024]
Abstract
PURPOSE Surgical patients with thymoma and myasthenia gravis (MG) must have their MG status and oncological outcomes critically monitored. We aimed to identify clinicopathological predictors of the postoperative MG status. METHODS We conducted a retrospective review of 40 consecutive surgical patients with MG-related thymomas between 2002 and 2020. The quantitative myasthenia gravis score (QMGS) and Myasthenia Gravis Foundation of America post-intervention status (MGFA-PIS) were used to evaluate postoperative MG status. RESULTS All patients underwent extended total thymectomy. The most common WHO type was type B2 (32%), while 65% of patients had type B1-B3 and 35% had type A-AB thymomas. Eleven patients (28%) achieved controlled MG status in MGFA-PIS 6 months after surgery. This controlled status was observed more frequently in type A-AB than in B1-B3 (57% vs. 12%, p = 0.007). In a multivariate analysis, WHO type (A-AB or B1-B3) was an independent predictor of worsening episodes of MG based on the QMGS (Type B1-B3, hazard ratio: 3.23, 95% confidence interval: 1.12-9.25). At the last follow-up, 23 patients (58%) achieved controlled MG status. The 5-year overall survival rate of all patients was 93.7%. CONCLUSION The WHO type of thymoma is an informative predictor of postoperative MG status in patients with MG-related thymoma.
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Affiliation(s)
- Takahiro Suzuki
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Shigeaki Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Yu Okubo
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kyohei Masai
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kaoru Kaseda
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Keisuke Asakura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Katsura Emoto
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
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6
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Ferré EMN, Nichols-Vinueza DX, Rosen LB, Burbelo PD, Fennelly KP, Pechacek J, Goldstein DM, Agharahimi A, Saksena A, Kleiner DE, Demirdag YY, Rajan A, Schrump DS, Holland SM, Freeman AF, Lionakis MS. Lymphocyte-Directed Immunomodulation Remits Thymoma-Associated Autoimmune Pneumonitis. J Clin Immunol 2024; 44:156. [PMID: 38954150 PMCID: PMC11219442 DOI: 10.1007/s10875-024-01760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Thymoma presents with several autoimmune manifestations and is associated with secondary autoimmune regulator (AIRE) deficiency. Pneumonitis has recently been described as an autoimmune manifestation associated with thymoma presenting with similar clinical, radiographic, histological, and autoantibody features as seen in patients with inherited AIRE deficiency who suffer from Autoimmune PolyEndocrinopathy-Candidiasis-Ectodermal Dystrophy (APECED) syndrome. OBJECTIVES To treat two patients with biopsy-proven thymoma-associated pneumonitis with lymphocyte-directed immunomodulation. METHODS Two patients with thymoma were enrolled on IRB-approved protocols at the NIH Clinical Center. We performed history and physical examination; laboratory, radiographic, histologic and pulmonary function evaluations; and measurement of the lung-directed autoantibodies KCNRG and BPIFB1 prior to and at 1- and 6-months following initiation of lymphocyte-directed immunomodulation with azathioprine with or without rituximab. RESULTS Combination T- and B-lymphocyte-directed immunomodulation resulted in improvement of clinical, functional, and radiographic parameters at 6-month follow-up evaluations in both patients with sustained remission up to 12-36 months following treatment initiation. CONCLUSION Lymphocyte-directed immunomodulation remitted autoimmune pneumonitis in two patients with thymoma.
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Affiliation(s)
- Elise M N Ferré
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Diana X Nichols-Vinueza
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Lindsey B Rosen
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Peter D Burbelo
- National Institute of Dental and Craniofacial Research (NIDCR), NIH, Bethesda, MD, USA
| | - Kevin P Fennelly
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD, USA
| | - Joseph Pechacek
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | | | - Anahita Agharahimi
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Annapurna Saksena
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, MD, USA
| | - David E Kleiner
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, MD, USA
| | - Yesim Yilmaz Demirdag
- Department of Medicine, Division of Basic and Clinical Immunology, University of California of Irvine, Irvine, CA, USA
| | - Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, NCI, NIH, Bethesda, MD, USA
| | | | - Steven M Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Alexandra F Freeman
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Michail S Lionakis
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA.
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7
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Lucà S, Accardo M, Campione S, Franco R. Immunotherapy in thymic epithelial tumors: tissue predictive biomarkers for immune checkpoint inhibitors. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2024; 5:465-476. [PMID: 38966177 PMCID: PMC11220306 DOI: 10.37349/etat.2024.00229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/02/2024] [Indexed: 07/06/2024] Open
Abstract
Thymic epithelial tumors (TETs) are rare malignant neoplasms arising in the thymus gland. Nevertheless, TETs, including thymomas (TMs), thymic carcinomas (TCs), and thymic neuroendocrine neoplasms (TNENs), are the most common mediastinal malignancies overall. A multidisciplinary approach is required for the appropriate diagnostic and therapeutic management of TETs. To date, the main therapeutic strategies are largely depended on the stage of the tumor and they include surgery with or without neoadjuvant or adjuvant therapy, represented by platinum-based chemotherapy, radiotherapy or chemoradiotherapy. Immune checkpoint inhibitors (ICIs) are ongoing under evaluation in the advanced or metastatic diseases despite the challenges related to the very low tumor mutation burden (TMB) and the high incidence of immune-related adverse events in TETs. In this regard, predictive impact of tissue biomarkers expression such as programmed cell death ligand-1 (PD-L1), and other emerging biomarkers, as well as their optimal and shared interpretation are currently under evaluation in order to predict response rates to ICIs in TETs.
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Affiliation(s)
- Stefano Lucà
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Marina Accardo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Severo Campione
- Department of Advanced Diagnostic-Therapeutic Technologies and Health Services Section of Anatomic Pathology, A. Cardarelli Hospital, 80131 Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “L. Vanvitelli”, 80138 Naples, Italy
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8
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Wang T, Wang B, Fan X, Cai Y, Li L, Fu S. Type B thymomas in patients with myasthenia gravis display a distinctive pattern of αβ TCR and IL-7 receptor α expression on CD4 +CD8 + thymocytes. Autoimmunity 2024; 57:2347379. [PMID: 38723105 DOI: 10.1080/08916934.2024.2347379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/21/2024] [Indexed: 06/07/2024]
Abstract
Thymoma is closely associated with myasthenia gravis (MG). However, due to the heterogeneity of thymoma and the intricate pathogenesis of MG, it remains unclear why some patients with thymoma develop MG and others do not. In this study, we conducted a comparative phenotype analysis of thymocytes in type B thymomas in patients with MG (MG (+) thymomas) and without MG (MG (-) thymomas) via fluorescence-activated cell sorting (FACS). Our results show that the developmental stages defined by the expression of CD3, CD4, and CD8 were largely maintained in both MG (+) and MG (-) thymomas, with CD4+CD8+ cells constituting the majority of thymocytes in type B thymoma, and no significant difference between this cell population was observed in MG (+) and MG (-) thymomas.We discovered that CD4+CD8+ thymocytes in MG (+) thymomas expressed low levels of αβ TCR and high levels of IL-7 receptor α (IL-7Rα), whereas in MG (-) thymomas, CD4+CD8+ thymocytes exhibited the opposite pattern of αβ TCR and IL-7Rα expression. These results suggest that the positive and negative selection processes of CD4+CD8+ thymocytes might differ between MG (+) thymomas and MG (-) thymomas. The expression of the Helios transcription factor is induced during negative selection and marks a group of T cells that have undergone negative selection and are likely to be deleted due to strong TCR binding with self-peptides/MHC ligands. We observed that the percentage of Helios-positive CD4SP T cells was greater in MG (-) than in MG (+) thymomas. Thus, the differentially regulated selection process of CD4+CD8+ thymocytes, which involves TCR and IL-7/IL-7Rα signaling, is associated with the presence of MG in type B thymomas.
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Affiliation(s)
- Tianlai Wang
- Thoracic Surgery Laboratory, Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Boyu Wang
- Thoracic Surgery Laboratory, Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaowu Fan
- Thoracic Surgery Laboratory, Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yixin Cai
- Thoracic Surgery Laboratory, Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lequn Li
- Thoracic Surgery Laboratory, Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shengling Fu
- Thoracic Surgery Laboratory, Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Croitoru CG, Pavel-Tanasa M, Cuciureanu DI, Hodorog DN, Cianga P. Autoimmune and Non-Autoimmune Comorbidities in Myasthenic Patients of East-European Descent: A Case-Control Study. J Clin Med 2024; 13:2273. [PMID: 38673546 PMCID: PMC11051044 DOI: 10.3390/jcm13082273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Background: As the life expectancy of patients with myasthenia gravis (MG) is improving, so the number of comorbidities continues to rise, with a potentially significant impact on the overall morbidity and mortality. The main aim of the study was to assess comorbidities of MG in a group of patients of East-European descent. Methods: We retrospectively compared 185 adult myasthenic patients with 895 sex- and age-matched controls, admitted from January 2013 to December 2021. Results: Of these patients, 60% had late-onset MG (LOMG), with a clear predominance of women in both the LOMG and early-onset (EOMG) types; and 23.8% of the patients had a radiological description consistent with thymoma. All myasthenic patients had at least one comorbidity; 20 (10.8%) of the patients associated at least one autoimmune comorbidity. Obesity (p < 0.01), type 2 diabetes (p < 0.0001), cerebrovascular diseases (p < 0.0001), essential hypertension (p < 0.01), and cardiac arrythmias (p < 0.0001) were more frequent in patients than in the control group. The granulocyte-to-lymphocyte ratio was higher in the myasthenic patients compared to the controls (p < 0.01 for LOMG). Discussion: We, thus, suggest a common chronic low-grade inflammatory background as a possible connection between MG subtypes and some of these apparently unconnected comorbidities. Conclusions: The East-European origin of the patients offered a different social and cultural angle of a disease studied mainly on populations of West-European and Asian descent.
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Affiliation(s)
- Cristina Georgiana Croitoru
- I Neurology Clinic, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, 700309 Iași, Romania
- Department of Immunology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Mariana Pavel-Tanasa
- Department of Immunology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Dan Iulian Cuciureanu
- I Neurology Clinic, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, 700309 Iași, Romania
- Department Medical III, Discipline of Neurology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Diana Nicoleta Hodorog
- I Neurology Clinic, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, 700309 Iași, Romania
- Department Medical III, Discipline of Neurology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Petru Cianga
- Department of Immunology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
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10
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Perrino M, Voulaz E, Balin S, Cazzato G, Fontana E, Franzese S, Defendi M, De Vincenzo F, Cordua N, Tamma R, Borea F, Aliprandi M, Airoldi M, Cecchi LG, Fazio R, Alloisio M, Marulli G, Santoro A, Di Tommaso L, Ingravallo G, Russo L, Da Rin G, Villa A, Della Bella S, Zucali PA, Mavilio D. Autoimmunity in thymic epithelial tumors: a not yet clarified pathologic paradigm associated with several unmet clinical needs. Front Immunol 2024; 15:1288045. [PMID: 38629065 PMCID: PMC11018877 DOI: 10.3389/fimmu.2024.1288045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/29/2024] [Indexed: 04/19/2024] Open
Abstract
Thymic epithelial tumors (TETs) are rare mediastinal cancers originating from the thymus, classified in two main histotypes: thymoma and thymic carcinoma (TC). TETs affect a primary lymphoid organ playing a critical role in keeping T-cell homeostasis and ensuring an adequate immunological tolerance against "self". In particular, thymomas and not TC are frequently associated with autoimmune diseases (ADs), with Myasthenia Gravis being the most common AD present in 30% of patients with thymoma. This comorbidity, in addition to negatively affecting the quality and duration of patients' life, reduces the spectrum of the available therapeutic options. Indeed, the presence of autoimmunity represents an exclusion criteria for the administration of the newest immunotherapeutic treatments with checkpoint inhibitors. The pathophysiological correlation between TETs and autoimmunity remains a mystery. Several studies have demonstrated the presence of a residual and active thymopoiesis in adult patients affected by thymomas, especially in mixed and lymphocytic-rich thymomas, currently known as type AB and B thymomas. The aim of this review is to provide the state of art in regard to the histological features of the different TET histotype, to the role of the different immune cells infiltrating tumor microenvironments and their impact in the break of central immunologic thymic tolerance in thymomas. We discuss here both cellular and molecular immunologic mechanisms inducing the onset of autoimmunity in TETs, limiting the portfolio of therapeutic strategies against TETs and greatly impacting the prognosis of associated autoimmune diseases.
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Affiliation(s)
- Matteo Perrino
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Emanuele Voulaz
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Simone Balin
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Gerardo Cazzato
- Section of Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Elena Fontana
- Istituto di Ricerca Genetica e Biomedica (IRGB), National Research Council (CNR), Milan, Italy
- Human Genome and Biomedical Technologies Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Sara Franzese
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Martina Defendi
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Fabio De Vincenzo
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Nadia Cordua
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Roberto Tamma
- Section of Human Anatomy and Histology, Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari “Aldo Moro”, Bari, Italy
| | - Federica Borea
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marta Aliprandi
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marco Airoldi
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luigi Giovanni Cecchi
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Roberta Fazio
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Marulli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Armando Santoro
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luca Di Tommaso
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Pathology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giuseppe Ingravallo
- Section of Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Laura Russo
- Clinical Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giorgio Da Rin
- Clinical Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Anna Villa
- Istituto di Ricerca Genetica e Biomedica (IRGB), National Research Council (CNR), Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Della Bella
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Paolo Andrea Zucali
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Domenico Mavilio
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
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11
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Rajan A, Sivapiromrat AK, McAdams MJ. Immunotherapy for Thymomas and Thymic Carcinomas: Current Status and Future Directions. Cancers (Basel) 2024; 16:1369. [PMID: 38611047 PMCID: PMC11010813 DOI: 10.3390/cancers16071369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Thymic epithelial tumors are a histologically diverse group of cancers arising from the epithelial compartment of the thymus. These tumors are characterized by a low tumor mutation burden, a lack of actionable genomic changes, and, especially with thymomas, defects in immune tolerance. Surgery is the mainstay of the management of resectable disease, whereas advanced, unresectable tumors are treated with platinum-based chemotherapy. Disease recurrence can occur months to years after frontline treatment. Although several options are available for conventional treatment of recurrent thymic tumors, response rates are generally low, and treatment-related toxicity can affect quality of life. A subset of patients benefit from biologic therapies, but there remains an unmet need for the development of new treatments. Immune checkpoint inhibitors are safe, clinically active, and have contributed to an improvement in survival for patients with a wide variety of cancers. However, the application of these revolutionary treatments for thymic cancers is limited to their use for the management of recurrent thymic carcinoma because of the risk of immune toxicity. In this paper, we review the current uses of immunotherapy for the management of thymic epithelial tumors and highlight potential strategies to improve safety and broaden the application of these treatments for patients with thymic cancers.
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Affiliation(s)
- Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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12
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Popovich SM, Vetter TR. Preoperative Management of the Adult Oncology Patient. Anesthesiol Clin 2024; 42:145-158. [PMID: 38278586 DOI: 10.1016/j.anclin.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Anesthesiologists are experiencing first-hand the aging population, given older patients more frequently presenting for surgery, often with geriatric syndromes influencing their anesthetic management. The overall incidence and health burden of cancer morbidity and mortality are also rapidly increasing worldwide. This growth in the cancer population, along with the associated risk factors and comorbidities often accompanying a cancer diagnosis, underscores the need for anesthesiologists to become well versed in the preoperative evaluation and management of the adult patient with cancer. This article will focus on the unique challenges and opportunities for the anesthesiologist caring for the adult oncology patient presenting for surgery.
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Affiliation(s)
- Shannon M Popovich
- Department of Anesthesiology and Perioperative Medicine, Division of Anesthesiology, Critical Care Medicine and Pain Medicine, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA.
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13
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Vega Prado I, Shymansky J, Apte A, Mortman K, Kaminski HJ, Barak S. A Rare Case of Metaplastic Thymoma Presenting With Myasthenia Gravis. Int J Surg Pathol 2024; 32:155-159. [PMID: 37093756 DOI: 10.1177/10668969231168344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Thymomas are tumors of the mediastinum often associated with autoimmune conditions, in particular myasthenia gravis. In contrast, among the fewer than 40 reports of metaplastic thymoma, myasthenia gravis is rarely found. We describe the fourth patient, and first man, with metaplastic thymoma and myasthenia gravis. A 34-year-old had acute onset of double vision with associated dysphagia and was found to have an elevation of serum acetylcholine receptor antibodies. He underwent a transsternal thymectomy. Tissue sections showed a biphasic proliferation of keratin-positive epithelial cells with a complement of spindle cells confirming the diagnosis of metaplastic thymoma. Terminal deoxynucleotidyl transferase (TDT)-positive T lymphocytes were rare and only found in the periphery of the tumor, consistent with thymic remnant. A YAP1::MAML2 gene fusion, with an in-frame fusion between genes YAP1 Exon5 (NM_001130145) and MAML2 Exon2 (NM_032427) was found, supporting further the diagnosis of metaplastic thymoma (Anchored multiplex RNA sequencing [Archer Dx, Boulder, CO] assay). The patient's gender and relatively young age, the presence of an autoimmune condition, and the lack of lymphocytic infiltrate all contribute unusual features to this case and suggest avenues for further exploration.
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Affiliation(s)
- Ilianne Vega Prado
- Department of Pathology, The George Washington University, Washington, DC, USA
| | - John Shymansky
- Department of Neurology & Rehabilitation Medicine, The George Washington University, Washington, DC, USA
| | - Anisha Apte
- Department of Surgery, The George Washington University, Washington, DC, USA
| | - Keith Mortman
- Department of Surgery, The George Washington University, Washington, DC, USA
| | - Henry J Kaminski
- Department of Neurology & Rehabilitation Medicine, The George Washington University, Washington, DC, USA
| | - Stephanie Barak
- Department of Pathology, The George Washington University, Washington, DC, USA
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14
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Perrino M, Cordua N, De Vincenzo F, Borea F, Aliprandi M, Cecchi LG, Fazio R, Airoldi M, Santoro A, Zucali PA. Thymic Epithelial Tumor and Immune System: The Role of Immunotherapy. Cancers (Basel) 2023; 15:5574. [PMID: 38067278 PMCID: PMC10705681 DOI: 10.3390/cancers15235574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 10/16/2024] Open
Abstract
Thymic epithelial tumors (TETs) comprise a rare group of thoracic cancers, classified as thymomas and thymic carcinomas (TC). To date, chemotherapy is still the standard treatment for advanced disease. Unfortunately, few therapeutic options are available for relapsed/refractory tumors. Unlike other solid cancers, the development of targeted biologic and/or immunologic therapies in TETs remains in its nascent stages. Moreover, since the thymus plays a key role in the development of immune tolerance, thymic tumors have a unique biology, which can confer susceptibility to autoimmune diseases and ultimately influence the risk-benefit balance of immunotherapy, especially for patients with thymoma. Indeed, early results from single-arm studies have shown interesting clinical activity, albeit at a cost of a higher incidence of immune-related side effects. The lack of knowledge of the immune mechanisms associated with TETs and the absence of biomarkers predictive of response or toxicity to immunotherapy risk limiting the evolution of immunotherapeutic strategies for managing these rare tumors. The aim of this review is to summarize the existing literature about the thymus's immune biology and its association with autoimmune paraneoplastic diseases, as well as the results of the available studies with immune checkpoint inhibitors and cancer vaccines.
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Affiliation(s)
- Matteo Perrino
- Department of Oncology, IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.P.); (N.C.); (F.D.V.); (A.S.)
| | - Nadia Cordua
- Department of Oncology, IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.P.); (N.C.); (F.D.V.); (A.S.)
| | - Fabio De Vincenzo
- Department of Oncology, IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.P.); (N.C.); (F.D.V.); (A.S.)
| | - Federica Borea
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (F.B.); (M.A.); (L.G.C.); (R.F.); (M.A.)
| | - Marta Aliprandi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (F.B.); (M.A.); (L.G.C.); (R.F.); (M.A.)
| | - Luigi Giovanni Cecchi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (F.B.); (M.A.); (L.G.C.); (R.F.); (M.A.)
| | - Roberta Fazio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (F.B.); (M.A.); (L.G.C.); (R.F.); (M.A.)
| | - Marco Airoldi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (F.B.); (M.A.); (L.G.C.); (R.F.); (M.A.)
| | - Armando Santoro
- Department of Oncology, IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.P.); (N.C.); (F.D.V.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (F.B.); (M.A.); (L.G.C.); (R.F.); (M.A.)
| | - Paolo Andrea Zucali
- Department of Oncology, IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.P.); (N.C.); (F.D.V.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (F.B.); (M.A.); (L.G.C.); (R.F.); (M.A.)
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15
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Herranz-Cabarcos A, Alcubierre R, Van der Veen RLP. Paraneoplastic orbital myositis as a first manifestation of renal cell carcinoma. Orbit 2023:1-5. [PMID: 37837294 DOI: 10.1080/01676830.2023.2264916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023]
Abstract
Paraneoplastic syndromes (PNSs) are remote effects of the primary tumor on tissues and organs, not related to direct invasion or metastasis. Ophthalmological involvement has been reported in 0.01-0.1% cases of PNSs. It may present as retinopathy, optic neuritis, myasthenia-like syndromes, or orbital myositis (OM), among others. An 89-year-old male with bilateral ocular pain and chemosis, was given an initial diagnosis of bilateral acute conjunctivitis. After 5 days, the patient presented worsening of the pain and bilateral complete ophthalmoplegia. Cranial CT scan showed diffuse bilateral thickening of the four rectus muscles. Inflammatory markers, thyroid hormones, and thyroid antibodies were normal. An abdominal ultrasound test was performed, observing a mass in the right kidney. After confirmation of the lesion with a CT scan, the radiological characteristics of the lesion were highly suggestive of renal cell carcinoma. Treatment with intravenous corticosteroids was ensued with complete resolution of all ophthalmological symptoms. Paraneoplastic orbital panmyositis was first described in 1994. Since then it has been reported scarcely, remaining an extremely rare entity. To our knowledge, this is the first report of its association with renal cell carcinoma. In the absence of inflammatory or dysthyroid blood markers, bilateral orbital panmyositis warrants further investigation for a possible underlying oncological pathology.
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Affiliation(s)
- A Herranz-Cabarcos
- Ophthalmology Department, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | | | - R L P Van der Veen
- Ophthalmology Department, Barraquer Ophthalmology Center, Barcelona, Spain
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16
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Ali SF, Nolan B, D'Agostino T, Clare K, Henson T, Rahman M, Rosenberg J, Li J, Al-Mufti F. Thymoma Associated With Autoimmune Encephalitis and Subsequent Myasthenia Gravis. J Clin Neuromuscul Dis 2023; 25:56-57. [PMID: 37611273 DOI: 10.1097/cnd.0000000000000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Syed F Ali
- Department of Neurology, Westchester Medical Center, Valhalla, NY
| | - Bridget Nolan
- School of Medicine, New York Medical College, Valhalla, NY
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY
| | | | - Kevin Clare
- School of Medicine, New York Medical College, Valhalla, NY
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY
| | - Theresa Henson
- Department of Pulmonary Critical Care, Westchester Medical Center, Valhalla, NY
| | - Mozibur Rahman
- Department of Pathology, Westchester Medical Center, Valhalla, NY
| | - Jon Rosenberg
- Department of Neurology, Westchester Medical Center, Valhalla, NY
- School of Medicine, New York Medical College, Valhalla, NY
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY
| | - Jin Li
- Department of Neurology, Westchester Medical Center, Valhalla, NY
- School of Medicine, New York Medical College, Valhalla, NY
| | - Fawaz Al-Mufti
- Department of Neurology, Westchester Medical Center, Valhalla, NY
- School of Medicine, New York Medical College, Valhalla, NY
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY
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17
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Oftedal BE, Assing K, Baris S, Safgren SL, Johansen IS, Jakobsen MA, Babovic-Vuksanovic D, Agre K, Klee EW, Majcic E, Ferré EM, Schmitt MM, DiMaggio T, Rosen LB, Rahman MO, Chrysis D, Giannakopoulos A, Garcia MT, González-Granado LI, Stanley K, Galant-Swafford J, Suwannarat P, Meyts I, Lionakis MS, Husebye ES. Dominant-negative heterozygous mutations in AIRE confer diverse autoimmune phenotypes. iScience 2023; 26:106818. [PMID: 37235056 PMCID: PMC10206195 DOI: 10.1016/j.isci.2023.106818] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/20/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
Autoimmune polyendocrine syndrome type 1 (APS-1) is an autosomal recessive disease characterized by severe and childhood onset organ-specific autoimmunity caused by mutations in the autoimmune regulator (AIRE) gene. More recently, dominant-negative mutations within the PHD1, PHD2, and SAND domains have been associated with an incompletely penetrant milder phenotype with later onset familial clustering, often masquerading as organ-specific autoimmunity. Patients with immunodeficiencies or autoimmunity where genetic analyses revealed heterozygous AIRE mutations were included in the study and the dominant-negative effects of the AIRE mutations were functionally assessed in vitro. We here report additional families with phenotypes ranging from immunodeficiency, enteropathy, and vitiligo to asymptomatic carrier status. APS-1-specific autoantibodies can hint to the presence of these pathogenic AIRE variants although their absence does not rule out their presence. Our findings suggest functional studies of heterozygous AIRE variants and close follow-up of identified individuals and their families.
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Affiliation(s)
- Bergithe E. Oftedal
- Department of Clinical Science, University of Bergen and Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kristian Assing
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Safa Baris
- Marmara University, Faculty of Medicine, Pediatric Allergy and Immunology, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
| | - Stephanie L. Safgren
- Center for Individualized Medicine, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Isik S. Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | | | | | | | - Eric W. Klee
- Mayo Clinic, Department of Quantitative Health Sciences, Rochester, MN, USA
| | - Emina Majcic
- Department of Clinical Science, University of Bergen and Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Elise M.N. Ferré
- Laboratory of Clinical Immunology & Microbiology, National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Monica M. Schmitt
- Laboratory of Clinical Immunology & Microbiology, National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Tom DiMaggio
- Laboratory of Clinical Immunology & Microbiology, National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Lindsey B. Rosen
- Laboratory of Clinical Immunology & Microbiology, National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Muhammad Obaidur Rahman
- Department of Clinical Science, University of Bergen and Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Dionisios Chrysis
- Department of Pediatrics, Division of Pediatric Endocrinology, Medical School, University of Patras, Rion, Greece
| | - Aristeidis Giannakopoulos
- Department of Pediatrics, Division of Pediatric Endocrinology, Medical School, University of Patras, Rion, Greece
| | - Maria Tallon Garcia
- Pediatric Hematology and Oncology Department, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Luis Ignacio González-Granado
- Unidad de Inmunodeficiencias, Pediatría, Instituto de Investigación Hospital 12 de Octubre, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Katherine Stanley
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente MidAtlantic, Rockville, MD, USA
| | | | - Pim Suwannarat
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente MidAtlantic, Rockville, MD, USA
| | - Isabelle Meyts
- Department of Pediatrics, University Hospital Leuven, Laboratory for Inborn Errors of Immunity, Department of Microbiology Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Michail S. Lionakis
- Laboratory of Clinical Immunology & Microbiology, National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Eystein S. Husebye
- Department of Clinical Science, University of Bergen and Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Mignan T, White R, Stee K, Bonanno G, Targett M, Lowrie M. Case report: Immune remission from generalized myasthenia gravis in a dog with a thymoma and cholangiocellular carcinoma. Front Vet Sci 2023; 10:1124702. [PMID: 37008354 PMCID: PMC10063851 DOI: 10.3389/fvets.2023.1124702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/24/2023] [Indexed: 03/19/2023] Open
Abstract
A 9-year-old male neutered Cockapoo was presented with an acute and progressive history of exercise induced weakness involving all limbs, and bilateral decreased ability to blink. Investigations revealed generalized myasthenia gravis alongside the presence of a thymoma and a cholangiocellular carcinoma. Symptomatic treatment through pyridostigmine bromide was used to control clinical signs, and complete surgical removal of the thymoma and cholangiocellular carcinoma was performed. Serum acetylcholine receptor antibody concentration was measured serially. Clinical remission defined as resolution of clinical signs alongside discontinuation of treatment was achieved by day 251 (8.2 months). Immune remission defined as normalization of serum acetylcholine receptor antibody concentration alongside resolution of clinical signs and discontinuation of treatment was achieved by day 566 (18.5 months). Neurological examination was normal, and the owners did not report any clinical deterioration during the final follow-up appointment on day 752 (24 months), hence outcome was considered excellent. This is the first report describing the temporal evolution of serum acetylcholine receptor antibody concentration in a dog with thymoma-associated myasthenia gravis which achieved immune remission following thymectomy. Treatment was successfully discontinued without any evidence of clinical deterioration thereafter despite serum acetylcholine receptor antibody concentration not normalizing for another 315 days (10 months).
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Affiliation(s)
- Thomas Mignan
- Dovecote Veterinary Hospital, CVS Group PLC, Castle Donington, United Kingdom
- School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington, United Kingdom
- *Correspondence: Thomas Mignan
| | - Robert White
- School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington, United Kingdom
| | - Kimberley Stee
- Dovecote Veterinary Hospital, CVS Group PLC, Castle Donington, United Kingdom
| | - Giuseppe Bonanno
- Dovecote Veterinary Hospital, CVS Group PLC, Castle Donington, United Kingdom
| | - Mike Targett
- School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington, United Kingdom
| | - Mark Lowrie
- Dovecote Veterinary Hospital, CVS Group PLC, Castle Donington, United Kingdom
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Randhawa JS, Kim LS, Aguilar C, Phan AT, Abou-El-Hassan H, Sovory LH. Atypical Seropositive Striated Muscle Antibody Myasthenia Gravis Presentation With Metastatic B1 Thymoma: A Rare Case. Cureus 2023; 15:e35221. [PMID: 36968847 PMCID: PMC10032554 DOI: 10.7759/cureus.35221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
The association between myasthenia gravis (MG) and thymomas is well-documented. Thymomas are rare epithelial cell tumors that arise from the thymus gland and occur in the mediastinum. Myasthenia gravis is a neuromuscular disorder that causes skeletal muscle weakness due to the presence of anti-acetylcholinesterase antibodies. Roughly 60% of thymomas are associated with MG, while only 10% of MG patients have thymomas. We present an atypical presentation of myasthenia gravis with an associated unusual metastatic thymoma. This case is of a young, previously healthy 26-year-old male with no previous medical history who presented with non-specific symptoms of fatigue, diarrhea, abdominal pain, back pain, blurry vision, and unintended weight loss. He underwent treatment with intravenous immunoglobulins (IVIG), had two surgical resections of the thymoma, and ultimately received radiotherapy. Based on our experience with this case, diagnosing myasthenia gravis by testing for specific muscle antibodies for patients with ptosis in the setting of non-specific complaints, including fatigue, vomiting, diarrhea, and abdominal or back pain, should be considered. Routine imaging should follow with a chest computed tomography to screen for thymomas if the specific anti-titin and anti-ryanodine receptor (anti-RyR) muscle antibodies are positive and myasthenia gravis is suspected. If a thymoma is confirmed, it is best to confirm; and mass characterizes with chest magnetic resonance imaging. A treatment approach of IVIG followed by surgical resection and possible debulking if the lesion is deemed metastatic could also be considered thereafter, especially in young patients with few comorbidities. Treatment with Pyridostigmine 30 mg twice daily for 25 days post-surgically and radiation for treatment of any remaining unresectable tumor should also be considered.
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Song Y, Xing C, Lu T, Liu C, Wang W, Wang S, Feng X, Bi J, Wang Q, Lai C. Aberrant Dendritic Cell Subsets in Patients with Myasthenia Gravis and Related Clinical Features. Neuroimmunomodulation 2023; 30:69-80. [PMID: 36780882 DOI: 10.1159/000529626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/13/2022] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION Dendritic cells (DCs) play critical roles in the pathogenesis of myasthenia gravis (MG), and a series of DC-based experimental strategies for MG have recently been developed. However, the definite roles of different DC subsets in the mechanism of MG have scarcely been covered by previous studies. The present study aimed to investigate the levels of three main DC subsets, plasmacytoid DCs (pDCs) (CD303 positive) and two distinct subsets of conventional DCs (cDCs), namely CD1c+ cDCs and CD141+ cDCs, in MG patients and analyze related clinical features. METHODS From January 2016 to December 2020, 160 newly diagnosed MG patients and matched healthy controls (n = 160) were included in the study, and their clinical data were collected. The blood samples from MG patients before treatment and controls were collected for flow cytometry analysis. A total of 14 MG thymoma, 24 control thymoma, and 3 thymic cysts were used to immunostain the DC subsets. RESULTS The flow cytometry analysis showed a significantly higher frequency of circulating pDCs, CD1c+ cDCs, and CD141+ cDCs in MG patients than in healthy controls (p < 0.001 for all). Patients with early-onset MG (<50 years old) had a lower frequency of circulating pDCs but a higher frequency of circulating CD1c+ cDCs than those with late-onset MG (≥50 years old) (p = 0.014 and p = 0.025, respectively). The frequency of circulating pDCs was positively associated with the clinical severity of late-onset MG patients (r = 0.613, p < 0.001). 64.3% (9/14) of MG thymoma is of type B2 under the World Health Organization classification, which is higher than that in control thymoma (33.3%, 8/24) (p = 0.019). For type B2 thymoma, there were significantly more pDCs but fewer CD1c+ cDCs in MG thymoma than in the controls. CONCLUSION The distribution of aberrant pDCs, CD1c+ cDCs, and CD141+ cDCs in MG patients displayed age- and thymoma-related differences, which may contribute to the impaired immune tolerance and lead to the onset of MG.
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Affiliation(s)
- Yan Song
- Department of Neurology, The Second Hospital of Shandong University, Jinan, China
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Chunye Xing
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Tianyang Lu
- Department of Public Health, Monash University, Melbourne, Victoria, Australia
| | - Chen Liu
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Wei Wang
- Department of Pathology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Shaoqiang Wang
- Department of Thoracic Surgery, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China
| | - Xungang Feng
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Jianzhong Bi
- Department of Neurology, The Second Hospital of Shandong University, Jinan, China
| | - Qian Wang
- Department of Neurology, The First Hospital of Tsinghua University, Beijing, China
| | - Chao Lai
- Department of Neurology, The Second Hospital of Shandong University, Jinan, China
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Kuhn E, Pescia C, Mendogni P, Nosotti M, Ferrero S. Thymic Epithelial Tumors: An Evolving Field. Life (Basel) 2023; 13:314. [PMID: 36836670 PMCID: PMC9964105 DOI: 10.3390/life13020314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Despite their rarity, thymic epithelial tumors (TETs) have attracted much interest over the years, leading to an impressive number of histological and staging classifications. At present, TETs are divided by the WHO classification into four main subtypes: type A, type AB, and type B thymomas (subdivided into B1, B2, and B3), and thymic carcinomas, going from the more indolent to the most aggressive ones. Among many debated staging proposals, the TNM and the Masaoka-Koga staging systems have been widely accepted and used in routine practice. The four-tiered histological classification is symmetrically mirrored by the molecular subgrouping of TETs, which identifies an A-like and an AB-like cluster, with frequent GTF2I and HRAS mutations; an intermediate B-like cluster, with a T-cell signaling profile; and a carcinoma-like cluster comprising thymic carcinomas with frequent CDKN2A and TP53 alterations and a high tumor molecular burden. Molecular investigations have opened the way to tailored therapies, such as tyrosine kinase inhibitors targeting KIT, mTOR, and VEGFR, and immune-checkpoints that have been adopted as second-line systemic treatments. In this review, we discuss the crucial events that led to the current understanding of TETs, while disclosing the next steps in this intriguing field.
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Affiliation(s)
- Elisabetta Kuhn
- S.C. Anatomia Patologica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, 20122 Milano, Italy
| | - Carlo Pescia
- S.C. Anatomia Patologica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, 20122 Milano, Italy
| | - Paolo Mendogni
- S.C. Chirurgia Toracica e Trapianti di Polmone, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Mario Nosotti
- S.C. Chirurgia Toracica e Trapianti di Polmone, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Dipartimento di Patofisiologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, 20122 Milano, Italy
| | - Stefano Ferrero
- S.C. Anatomia Patologica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, 20122 Milano, Italy
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Matsumoto M, Yoshida H, Tsuneyama K, Oya T, Matsumoto M. Revisiting Aire and tissue-restricted antigens at single-cell resolution. Front Immunol 2023; 14:1176450. [PMID: 37207224 PMCID: PMC10191227 DOI: 10.3389/fimmu.2023.1176450] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/20/2023] [Indexed: 05/21/2023] Open
Abstract
The thymus is a highly specialized organ that plays an indispensable role in the establishment of self-tolerance, a process characterized by the "education" of developing T-cells. To provide competent T-cells tolerant to self-antigens, medullary thymic epithelial cells (mTECs) orchestrate negative selection by ectopically expressing a wide range of genes, including various tissue-restricted antigens (TRAs). Notably, recent advancements in the high-throughput single-cell analysis have revealed remarkable heterogeneity in mTECs, giving us important clues for dissecting the mechanisms underlying TRA expression. We overview how recent single-cell studies have furthered our understanding of mTECs, with a focus on the role of Aire in inducing mTEC heterogeneity to encompass TRAs.
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Affiliation(s)
- Minoru Matsumoto
- Department of Molecular Pathology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
- Division of Molecular Immunology, Institute for Enzyme Research, Tokushima University, Tokushima, Japan
- *Correspondence: Minoru Matsumoto,
| | - Hideyuki Yoshida
- YCI Laboratory for Immunological Transcriptomics, RIKEN Center for Integrative Medical Science, Yokohama, Japan
| | - Koichi Tsuneyama
- Department of Pathology and Laboratory Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takeshi Oya
- Department of Molecular Pathology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Mitsuru Matsumoto
- Division of Molecular Immunology, Institute for Enzyme Research, Tokushima University, Tokushima, Japan
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Svahn J, Coudert L, Streichenberger N, Kraut A, Gravier-Dumonceau-Mazelier A, Rotard L, Calemard-Michel L, Menassa R, Errazuriz-Cerda E, Chalabreysse L, Osseni A, Vial C, Jomir L, Tronc F, Le Duy D, Bernard E, Gache V, Couté Y, Jacquemond V, Schaeffer L, Leblanc P. Immune-Mediated Rippling Muscle Disease Associated With Thymoma and Anti-MURC/Cavin-4 Autoantibodies. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 10:10/1/e200068. [PMID: 36522170 PMCID: PMC9756388 DOI: 10.1212/nxi.0000000000200068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/10/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Rippling muscle disease (RMD) is characterized by muscle stiffness, muscle hypertrophy, and rippling muscle induced by stretching or percussion. Hereditary RMD is due to sequence variants in the CAV3 and PTRF/CAVIN1 genes encoding Caveolin-3 or Cavin-1, respectively; a few series of patients with acquired autoimmune forms of RMD (iRMD) associated with AChR antibody-positive myasthenia gravis and/or thymoma have also been described. Recently, MURC/caveolae-associated protein 4 (Cavin-4) autoantibody was identified in 8 of 10 patients without thymoma, highlighting its potential both as a biomarker and as a triggering agent of this pathology. Here, we report the case of a patient with iRMD-AchR antibody negative associated with thymoma. METHODS We suspected a paraneoplastic origin and investigated the presence of specific autoantibodies targeting muscle antigens through a combination of Western blotting and affinity purification coupled with mass spectrometry-based proteomic approaches. RESULTS We identified circulating MURC/Cavin-4 autoantibodies and found strong similarities between histologic features of the patient's muscle and those commonly reported in caveolinopathies. Strikingly, MURC/Cavin-4 autoantibody titer strongly decreased after tumor resection and immunotherapy correlating with complete disappearance of the rippling phenotype and full patient remission. DISCUSSION MURC/Cavin-4 autoantibodies may play a pathogenic role in paraneoplastic iRMD associated with thymoma.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pascal Leblanc
- From the Electroneuromyography and Neuromuscular Department (J.S., A.G.-D.-M., C.V., L.J., E.B.), Pierre Wertheimer Hospital, Hospices Civils de Lyon; Institut NeuroMyoGène Physiopathologie et Génétique du neurone et du muscle (INMG-PGNM) (J.S., Laurent Coudert, N.S., L.R., L.C.-M., R.M., A.O., E.B., V.G., V.J., L.S., P.L.), CNRS UMR5261, INSERM U1315, Faculté de Médecine Rockefeller, Université Claude Bernard Lyon, Cedex; Department of Neuropathology (N.S., Lara Chalabreysse), Hospices Civils de Lyon; Univ. Grenoble Alpes (A.K., Y.C.), INSERM, CEA, UMR BioSanté U1292, CNRS, CEA; Department of Molecular Endocrinology and Rare Diseases (L.C.-M., R.M.), Hospices Civils de Lyon; Centre d'imagerie quantitative Lyon Est (CIQLE) (E.E.-C.), Department of Thoracic Surgery (F.T.), Hospices Civils de Lyon; Institut NeuroMyoGène INMG-MeLiS (D.L.D.), CNRS UMR5284, INSERM U1314, SynatAc Team, Faculté de Médecine Rockefeller, Universités de Lyon, Université Claude Bernard Lyon 1; and French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (D.L.D.), Hospices Civils de Lyon, France.
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Yoshikawa H, Adachi Y, Nakamura Y, Kuriyama N, Murai H, Nomura Y, Sakai Y, Iwasa K, Furukawa Y, Kuwabara S, Matsui M. Two-step nationwide epidemiological survey of myasthenia gravis in Japan 2018. PLoS One 2022; 17:e0274161. [PMID: 36129914 PMCID: PMC9491589 DOI: 10.1371/journal.pone.0274161] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To study the updated prevalence and clinical features of myasthenia gravis (MG) in Japan during 2017. Methods We sent survey sheets to the randomly selected medical departments (number = 7,545). First, we asked the number of MG patients who visited medical departments from January 1, 2017, to December 31, 2017. Then, we sent the second survey sheet to the medical departments that answered the first survey to obtain the clinical information of patients who received MG diagnosis between January 1, 2015, and December 31, 2017. Results The received answer to the first survey were 2,708 (recovery rate: 35.9%). After all, the prevalence of the 100,000 population was estimated as 23.1 (95%CI: 20.5–25.6). As a result of the second survey, we obtained 1,464 case records. After checking the duplications and lacking data, we utilized 1,195 data for further analysis. The median [interquartile range (IQR)] from the onset age of total patients was 59 (43–70) years old. The male-female ratio was 1: 1.15. The onset age [median (IQR)] for female patients was 58 (40–72) years old, and that for male patients was 60 (49–69) years old (Wilcoxon-Mann-Whitney test, p = 0.0299). We divided patients into four categories: 1) anti-acetylcholine receptor antibody (AChRAb) (+) thymoma (Tm) (-), 2) AChRAb(+)Tm(+), 3) anti-muscle-specific kinase antibody (MuSKAb) (+), and AChRAb(-)MuSKAb(-) (double negative; DN). The onset age [median (IQR)] of AChRAb(+)Tm(-) was 64 (48–73) years old, and AChRb(+)Tm(+) was 55 (45–66), MuSKAb(+) was 49 (36–64), DN was 47 (35–60) year old. The multivariate logistic regression analysis using sex, initial symptoms, repetitive nerve stimulation test (RNST), and edrophonium test revealed that sex, ocular symptoms, bulbar symptoms, and RNST were factors to distinguish each category. The myasthenia gravis activities of daily living profile at the severest state were significantly higher in MuSKAb(+). MuSKAb(+) frequently received prednisolone, tacrolimus plasmapheresis, and intravenous immunoglobulin; however, they received less acetylcholine esterase inhibitor. 99.2% of AChRAb(+)Tm(+) and 15.4% of AChRAb(+)Tm(-) received thymectomy. MuSKAb(+) did not receive thymectomy, and only 5.7% of DN received thymectomy. The prognosis was favorable in all categories. Conclusion Our result revealed that the prevalence of Japanese MG doubled from the previous study using the same survey method in 2006. We also found that the onset age shifted to the elderly, and the male-female ratio reached almost even. Classification in four categories; AChRAb(+)Tm(-), AChRAb(+)Tm(+), MuSKAb(+), and DN, well describe the specific clinical features of each category and differences in therapeutic approaches.
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Affiliation(s)
- Hiroaki Yoshikawa
- Health Service Center, Kanazawa University, Kanazawa, Ishikawa, Japan
- * E-mail:
| | - Yumi Adachi
- Health Service Center, Kanazawa University, Kanazawa, Ishikawa, Japan
| | | | - Nagato Kuriyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kamigyo-Ku, Kyoto, Japan
| | - Hiroyuki Murai
- Department of Neurology, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan
| | - Yoshiko Nomura
- Yoshiko Nomura Neurological Clinic for Children, Bunkyo-Ku, Tokyo, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Kazuo Iwasa
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yutaka Furukawa
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Makoto Matsui
- Department of Neurology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
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Zouvelou V, Michail M, Belimezi M, Haroniti A, Zisimopoulou P. Characterization of the nicotinic acetylcholine receptor antibodies after an unexpected increase of antibody titer in thymoma associated myasthenia gravis patients. Neuromuscul Disord 2022; 32:847-850. [PMID: 36028368 DOI: 10.1016/j.nmd.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022]
Abstract
Two thymoma-associated myasthenia gravis patients with chronic well-controlled disease but an unexpected increase in anti-nAChR autoantibodies titer are reported. The specificity of anti-nAChR autoantibodies directed against extracellular parts of the receptor was studied in order to investigate the discrepancy between clinical and immunological status. Analysis of the anti-nAChR autoantibodies recognizing the extracellular parts of the nAChR revealed that when the concentration of anti-nAChR autoantibodies titer increased both patients had non-anti-α1 autoantibodies. Since the clinical profile of both patients remained unchanged, the increase of non-anti-α1 autoantibodies did not affect the 2 patients' disease progression. Thus, immunotherapy modification due to an increase of anti-nAChR autoantibodies titer could be erroneous and potentially harmful.
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Affiliation(s)
- Vasiliki Zouvelou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Michail
- Laboratory of Molecular Neurobiology and Immunology, Hellenic Pasteur Institute, Athens, Greece; Department of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Belimezi
- Diagnostic Department, Hellenic Pasteur Institute, Athens, Greece
| | - Anna Haroniti
- Laboratory of Molecular Neurobiology and Immunology, Hellenic Pasteur Institute, Athens, Greece
| | - Paraskevi Zisimopoulou
- Laboratory of Molecular Neurobiology and Immunology, Hellenic Pasteur Institute, Athens, Greece.
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Parrado-Carrillo A, Alcubierre R, Camós-Carreras A, Sanchez-Dalmau BF. Paraneoplastic syndromes in ophthalmology. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:350-357. [PMID: 35292226 DOI: 10.1016/j.oftale.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/03/2021] [Indexed: 06/14/2023]
Abstract
Paraneoplastic syndromes consist on systemic manifestations associated with certain cancers which are not a direct consequence of tumor invasion or its metastases. It is known that autoimmunity and autoantibody synthesis play an important role in its pathophysiology due to a process of molecular mimicry. Paraneoplastic syndromes in ophthalmology are rare, but it is important to recognize them clinically because in some cases symptoms preceded the diagnosis of an underlying neoplasia. Most frequently involved cancer is small cell lung carcinoma, but there is also a relationship with other tumor etiologies such as thymoma, gynecological tumors or neuroblastoma in children. Paraneoplastic syndromes with ocular involvement can be divided into those that affect the afferent visual pathway, such as cancer-associated retinopathy, melanoma-associated retinopathy, or paraneoplastic optic neuropathy; and the ones that affect the efferent visual pathway, such as bilateral tonic pupils, Myasthenia Gravis, Lambert-Eaton syndrome or paraneoplastic cerebellar degeneration. The presence of autoantibodies is helpful in clinical practice but negativity does not exclude this diagnosis. Although evolution and prognosis is linked to primary disease, in some cases specific treatment, usually immunosuppressive therapy, can help improving patients quality of life.
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Affiliation(s)
- A Parrado-Carrillo
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - R Alcubierre
- Complex Hospitalari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - A Camós-Carreras
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
| | - B F Sanchez-Dalmau
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Structural and Functional Thymic Biomarkers Are Involved in the Pathogenesis of Thymic Epithelial Tumors: An Overview. IMMUNO 2022. [DOI: 10.3390/immuno2020025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The normal human thymus originates from the third branchial cleft as two paired anlages that descend into the thorax and fuse on the midline of the anterior–superior mediastinum. Alongside the epithelial and lymphoid components, different types of lymphoid accessory cells, stromal mesenchymal and endothelial cells migrate to, or develop in, the thymus. After reaching maximum development during early postnatal life, the human thymus decreases in size and lymphocyte output drops with age. However, thymic immunological functions persist, although they deteriorate progressively. Several major techniques were fundamental to increasing the knowledge of thymic development and function during embryogenesis, postnatal and adult life; these include immunohistochemistry, immunofluorescence, flow cytometry, in vitro colony assays, transplantation in mice models, fetal organ cultures (FTOC), re-aggregated thymic organ cultures (RTOC), and whole-organ thymic scaffolds. The thymic morphological and functional characterization, first performed in the mouse, was then extended to humans. The purpose of this overview is to provide a report on selected structural and functional biomarkers of thymic epithelial cells (TEC) involved in thymus development and lymphoid cell maturation, and on the historical aspects of their characterization, with particular attention being paid to biomarkers also involved in Thymic Epithelial Tumor (TET) pathogenesis. Moreover, a short overview of targeted therapies in TET, based on currently available experimental and clinical data and on potential future advances will be proposed.
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28
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Estephan EDP, Baima JPS, Zambon AA. Myasthenia gravis in clinical practice. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:257-265. [PMID: 35976295 PMCID: PMC9491427 DOI: 10.1590/0004-282x-anp-2022-s105] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/29/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND Myasthenia gravis is largely a treatable disease, but it can result in significant morbidity and even mortality, which can usually be avoided, or at least mitigated, with timely diagnosis and appropriate treatment of the disease. Objective: this review aims to summarize the main practical aspects of the diagnostic approach, treatment and care of myasthenic patients. METHODS The authors performed a non-systematic critical review summarizing the main practical aspects of myasthenia gravis. RESULTS Most patients with myasthenia have autoantibodies targeted at acetylcholine receptors or, less commonly, muscle-specific kinase - MuSK. Electrophysiology plays an important role in the diagnosis of neuromuscular junction dysfunction. The central clinical manifestation of myasthenia gravis is fatigable muscle weakness, which can affect eye, bulbar, respiratory, and limb muscles. With rare exceptions, patients have a good response to symptomatic treatment, but corticosteroids and/or immunosuppressants are usually also necessary to obtain good control of the manifestations of the disease. CONCLUSION Knowledge of the peculiar aspects of their clinical and electrophysiological presentations is important for the diagnosis. Likewise, specific treatment and response time to each drug are crucial for proper care.
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Affiliation(s)
- Eduardo de Paula Estephan
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
- Fundação Faculdade Regional de Medicina de São José do Rio Preto, Hospital de Base, Departamento de Neurologia, São José do Rio Preto SP, Brazil
- Faculdade de Medicina Santa Marcelina, São Paulo SP, Brazil
| | - José Pedro Soares Baima
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Antonio Alberto Zambon
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
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Willner J, Zhou F, Moreira AL. Diagnostic Challenges in the Cytology of Thymic Epithelial Neoplasms. Cancers (Basel) 2022; 14:cancers14082013. [PMID: 35454918 PMCID: PMC9024685 DOI: 10.3390/cancers14082013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Thymic epithelial neoplasms, including thymoma, thymic carcinoma, and thymic neuroendocrine neoplasms, constitute the majority of anterior mediastinal masses. Fine needle aspirations (FNA) of mediastinal masses are infrequently encountered and are highly challenging to interpret. Thymic neoplasms display a significant degree of histologic diversity and have overlapping morphologic features with tumors from other sites. However, when properly interpreted alongside ancillary studies and radiologic findings, FNAs can yield clinically actionable results. This review aims to illustrate the usefulness and diagnostic pitfalls of thymic FNAs to assist pathologists in analyzing these specimens. Abstract Thymic epithelial neoplasms are rare tumors that constitute the majority of anterior mediastinal masses. They are classified as thymomas, thymic carcinomas, and thymic neuroendocrine neoplasms. Biopsy diagnosis is not common, and most tumors are surgically resected. Biopsy, including cytology, is indicated when a non-surgical entity is suspected or in cases of locally advanced disease. Smears of thymomas consist of round or spindle epithelial cells admixed with varying amounts of lymphocytes depending on the type of thymoma. Smears of thymic carcinoma and thymic neuroendocrine neoplasms are often indistinguishable from corresponding tumor types from other organs. Accurate cytological diagnosis can be difficult due to the histological diversity of thymomas, as well as the morphological features that certain thymic tumors share with similar tumors from other organs. However, fine needle aspiration (FNA) of anterior mediastinal masses can provide clinically actionable information and can be used to determine whether lesions require surgical, systemic, or local noninvasive treatments. Ancillary studies, namely, immunocytochemical stains, flow cytometry, and radiology, are important tools in the evaluation of thymic aspirates. This review discusses the utility and limitations of thymic FNAs and illustrates the diagnostic features and pitfalls of these specimens.
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Vanoli F, Mantegazza R. Antibody Therapies in Autoimmune Neuromuscular Junction Disorders: Approach to Myasthenic Crisis and Chronic Management. Neurotherapeutics 2022; 19:897-910. [PMID: 35165857 PMCID: PMC9294078 DOI: 10.1007/s13311-022-01181-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 02/06/2023] Open
Abstract
Myasthenia gravis (MG) is a neurological autoimmune disorder characterized by muscle weakness and fatigue. It is a B cell-mediated disease caused by pathogenic antibodies directed against various components of the neuromuscular junction (NMJ). Despite the wide range of adverse effects, current treatment is still based on non-specific immunosuppression, particularly on long-term steroid usage. The increasing knowledge regarding the pathogenic mechanisms of MG has however allowed to create more target-specific therapies. A very attractive therapeutic approach is currently offered by monoclonal antibodies (mAbs), given their ability to specifically and effectively target different immunopathological pathways, such as the complement cascade, B cell-related cluster of differentiation (CD) proteins, and the human neonatal Fc receptor (FcRn). Up to now, eculizumab, a C5-directed mAb, has been approved for the treatment of generalized MG (gMG) and efgartigimod, a FcRn inhibitor, has just been approved by the U.S. Food and Drug Administration for the treatment of anti-acetylcholine receptor (AChR) antibody positive gMG. Other mAbs are currently under investigation with encouraging preliminary results, further enriching the new range of therapeutic possibilities for MG. This review article provides an overview of the present status of mAb-based therapies for MG, which offer an exciting promise for better outcomes by setting the basis of a precision medicine approach.
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Affiliation(s)
- Fiammetta Vanoli
- Neuroimmunology and Neuromuscular Disease Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Renato Mantegazza
- Neuroimmunology and Neuromuscular Disease Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
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Ao YQ, Jiang JH, Gao J, Wang HK, Ding JY. Recent thymic emigrants as the bridge between thymoma and autoimmune diseases. Biochim Biophys Acta Rev Cancer 2022; 1877:188730. [DOI: 10.1016/j.bbcan.2022.188730] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/27/2022]
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Wang F, Zhang H, Qiu G, Li Z, Wang Y. The LINC00452/miR-204/CHST4 Axis Regulating Thymic Tregs Might Be Involved in the Progression of Thymoma-Associated Myasthenia Gravis. Front Neurol 2022; 13:828970. [PMID: 35432149 PMCID: PMC9005856 DOI: 10.3389/fneur.2022.828970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Myasthenia gravis (MG) is an autoimmune disease that mainly affects neuromuscular junctions and is usually associated with immune disorders in the thymoma. The competitive endogenous RNA (ceRNA) hypothesis has been demonstrated to be an intrinsic mechanism regulating the development of several autoimmune diseases; however, the mechanism where the ceRNA network regulates immune cells in patients with thymoma-associated MG (TAMG) has rarely been explored. Methods RNA-seq data and clinical information of 124 patients with thymoma were obtained from The Cancer Genome Atlas (TCGA) database. The patients were divided into two groups according to whether they were diagnosed with MG. We applied the propensity score matching method to reduce the incidence of baseline confounders. We then constructed a ceRNA network with differentially expressed RNAs between the groups based on four public databases. The expression of genes of interest was validated by qPCR. Moreover, we predicted the immune cells that infiltrated the thymoma and then analyzed the association between immune cells and RNA in the ceRNA network. To further determine the function of the mRNAs associated with immune cells in patients with TAMG, we performed gene set enrichment analysis in thymoma patients with MG. Results After matching, 94 patients were included in the following analysis. A total of 847 mRNAs, 409 lncRNAs, and 45 miRNAs were differentially expressed between the groups. The ceRNA network, including 18 lncRNAs, four miRNAs, and 13 mRNAs, was then constructed. We then confirmed that CHST4 and LINC00452, miR-204-3p and miR-204-5p were differentially expressed between patients with TAMG and thymoma patients without MG (NMG) by qPCR. Moreover, we found that the percentage of predicted regulatory T (Treg) cells was significantly decreased in patients with TAMG. Further analysis indicated that the LINC00452/miR-204/CHST4 axis might regulate thymic regulatory T cells (Tregs) in the progression of MG. Conclusions In this research, we constructed a ceRNA network involved in the progression of TAMG, discovered that thymic Tregs were significantly decreased in patients with TAMG, and assumed that the LINC00452/miR-204/CHST4 axis may regulate thymic Tregs in the development of TAMG. These findings may deepen our understanding of the roles of the ceRNA network in regulating TAMG and highlight the function of CHST4 in recruiting peripheral T cells in the progression of TAMG.
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Affiliation(s)
- Fuqiang Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Hanlu Zhang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guanghao Qiu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhiyang Li
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yun Wang
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Cho YR, Kim JH, Kim KH. Surgical Removal of a Thymoma without Myasthenia Gravis Can Have a Therapeutic Effect on Concurrent Alopecia Areata: A Case Report. Ann Dermatol 2022; 34:287-290. [PMID: 35948331 PMCID: PMC9365659 DOI: 10.5021/ad.20.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
Alopecia areata is a chronic organ-specific autoimmune disease and it could be associated with other autoimmune diseases. We, herein, report a case of alopecia areata in a patient with a thymoma without myasthenia gravis. Multiple hairless patches rapidly developed 6 weeks before the first visit on the patient who had been newly diagnosed with thymoma 2 weeks before the hairless patches occurred, and thymectomy was done 2 weeks before visiting dermatologic department. She had no symptoms associated with myasthenia gravis, and there were no abnormal findings on neurologic exams and acetylcholine receptor autoantibody was not detected in serum. Scalp biopsy showed numerous lymphocytic inflammations around hair follicles and in immunohistochemical staining, the aggregation of CD4+ and CD8+ T cells was observed around hair follicles and FoxP3+ T lymphocytes were rarely observed around hair follicles. The patient refused any treatment and her hairless patches were completely recovered 3 months after thymectomy, without being recurred 3 years after thymectomy. On the basis of both clinical manifestations and histologic findings, we concluded that alopecia areata in the patient had developed in association with thymoma and was recovered rapidly after thymectomy.
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Affiliation(s)
- Yu-Ri Cho
- Department of Dermatology, College of Medicine, Dong-A University, Busan, Korea
| | - Jung-Hwan Kim
- Department of Dermatology, College of Medicine, Dong-A University, Busan, Korea
| | - Ki-Ho Kim
- Department of Dermatology, College of Medicine, Dong-A University, Busan, Korea
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Bortone F, Scandiffio L, Cavalcante P, Mantegazza R, Bernasconi P. Epstein-Barr Virus in Myasthenia Gravis: Key Contributing Factor Linking Innate Immunity with B-Cell-Mediated Autoimmunity. Infect Dis (Lond) 2021. [DOI: 10.5772/intechopen.93777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Epstein-Barr virus (EBV), a common human herpes virus latently infecting most of the world’s population with periodic reactivations, is the main environmental factor suspected to trigger and/or sustain autoimmunity by its ability to disrupt B-cell tolerance checkpoints. Myasthenia gravis (MG) is a prototypic autoimmune disorder, mostly caused by autoantibodies to acetylcholine receptor (AChR) of the neuromuscular junction, which cause muscle weakness and fatigability. Most patients display hyperplastic thymus, characterized by ectopic germinal center formation, chronic inflammation, exacerbated Toll-like receptor activation, and abnormal B-cell activation. After an overview on MG clinical features and intra-thymic pathogenesis, in the present chapter, we describe our main findings on EBV presence in MG thymuses, including hyperplastic and thymoma thymuses, in relationship with innate immunity activation and data from other autoimmune conditions. Our overall data strongly indicate a critical contribution of EBV to innate immune dysregulation and sustained B-cell-mediated autoimmune response in the pathological thymus of MG patients.
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Salame H, Mckey R, Ballout M, Saad W. The First Reported Case of Neurotrophic Tyrosine Receptor Kinase Fusion-Positive Thymoma Treated Successfully With Entrectinib. Cureus 2021; 13:e20588. [PMID: 35103164 PMCID: PMC8777170 DOI: 10.7759/cureus.20588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/05/2022] Open
Abstract
We present the first reported case of stage 4 thymoma with pleural metastases that was found to be driven by the neurotrophic tyrosine receptor kinase (NTRK)-fusion gene. The patient was started on chemotherapy but it was discontinued due to intolerable side effects. Alternative options in such patients with rare diseases are limited; in fact, many concerns exist regarding the safety and efficacy of newly approved agents for the treatment of advanced thymomas, such as pembrolizumab and sunitinib. Due to NTRK-fusion gene positivity, entrectinib, a novel NTRK-fusion inhibitor, was then initiated. This drug has shown an objective response of 57% in treating NTRK fusion-positive solid tumors of 19 different histological subtypes, predominantly sarcomas, non-small cell lung cancer (NSCLC), and mammary analogue secretory carcinoma of the salivary gland. However, it has never been assessed in the treatment of thymomas. After 10 months of follow-up, the patient showed a significant response with mild adverse events, which was managed by temporary discontinuation of the drug. This case highlights the crucial role of whole-genome sequencing and tissue-agnostic antineoplastics in the future of cancer treatment.
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Affiliation(s)
- Hassan Salame
- Internal Medicine, Lebanese University Faculty of Medicine, Beirut, LBN
| | - Remy Mckey
- Internal Medicine, Lebanese University Faculty of Medicine, Beirut, LBN
| | - Mohamad Ballout
- Cardiology, Hospital Center Agglomeration De Nevers, Nevers, FRA
| | - Wajih Saad
- Oncology, Al Zahraa Hospital University Medical Center, Beirut, LBN
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Ke J, Du X, Cui J, Yu L, Li H. LncRNA and mRNA expression associated with myasthenia gravis in patients with thymoma. Thorac Cancer 2021; 13:15-23. [PMID: 34773374 PMCID: PMC8720629 DOI: 10.1111/1759-7714.14201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Pathological alterations of the thymus are observed in the majority of patients with myasthenia gravis (MG). To explore the potential mechanisms of these alterations, we performed a transcriptome analysis and measured co‐expression of aberrant long non‐coding RNAs (lncRNAs) and messenger RNAs (mRNAs). Methods RNA was extracted from eight patients with thymoma, five of whom had MG. Transcriptome profiles were acquired through mRNA and lncRNA microarray analysis. Quantitative reverse transcription polymerase chain reaction was used to verify the results of the microarray analysis. LncRNAs co‐expressed with mRNA were analyzed with Pearson's coefficient. Next, cis‐regulated and trans‐regulated target genes were predicted. The functions of aberrant lncRNAs were explored on the basis of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of target mRNAs. Results The comparative microarray analysis identified 4360 lncRNAs and 2545 mRNAs with significant differential expression. The most significant GO enrichment terms were phosphoric ester hydrolase activity, phosphatase activity, and hydrolase activity, which were assigned as molecular functions. Regulation of endosome size was the most significant GO enrichment term assigned as a biological process, and Golgi apparatus was the most significant GO enrichment term assigned as cellular component. The reliability prediction terms of KEGG included calcium signaling pathway, glycosphingolipid biosynthesis, and caffeine metabolism. Conclusion MG‐positive thymoma is associated with overactive biological processes and molecular functions, especially dephosphorylation and hydrolysis, which may affect thymocyte survival during selection in the thymus.
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Affiliation(s)
- Ji Ke
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xin Du
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jian Cui
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lei Yu
- Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Thymoma-associated autoimmune enteropathy with colonic stricture: a diagnostic and histological challenge. Clin J Gastroenterol 2021; 15:112-116. [PMID: 34676508 DOI: 10.1007/s12328-021-01531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
Thymoma-associated autoimmune enteropathy is a rare paraneoplastic syndrome that is characterized by severe chronic diarrhea, malabsorption, and specific histological findings. Because of its rarity, it is difficult to diagnose. We describe an adult patient with protracted diarrhea and weight loss that developed recurrent sepsis and progressive colonic stenosis due to thymoma-associated autoimmune enteropathy. Ultimately, the diagnosis thymoma-associated autoimmune enteropathy was established by characteristic intestinal histology, anti-enterocytes antibodies, and thorax imaging. Radical thymectomy was performed without improvement. Therapy with azathioprine and infliximab induced clinical remission with complete recovery of the colonic stenosis.
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Ballman M, Swift S, Mullenix C, Mallory Y, Zhao C, Szabo E, Shelat M, Sansone S, Steinberg SM, McAdams MJ, Rajan A. Tolerability of Coronavirus Disease 2019 Vaccines, BNT162b2 and mRNA-1273, in Patients With Thymic Epithelial Tumors. JTO Clin Res Rep 2021; 2:100229. [PMID: 34514444 PMCID: PMC8423742 DOI: 10.1016/j.jtocrr.2021.100229] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Defects in immunologic self-tolerance result in an increased risk for development of paraneoplastic autoimmune diseases (ADs) and immune-mediated toxicity in response to immune stimulation in individuals with thymic epithelial tumors (TETs). We conducted a survey to evaluate the tolerability of coronavirus disease 2019 (COVID-19) mRNA vaccines in patients with TETs, including individuals with preexisting AD. METHODS After reviewing published data on adverse events associated with the BNT162b2 (Pfizer, Inc., and BioNTech) and mRNA-1273 (ModernaTX, Inc.) mRNA vaccines, we designed and administered a questionnaire to participants at the following three time points: after each dose of vaccination and 1 month after the final dose. Questions related to AD and use of immunosuppressive drugs were included. Descriptive statistics were used to analyze data, and results were compared with previously described results related to the BNT162b2 and mRNA-1273 vaccines. RESULTS From February 26 to June 1, 2021, we administered the survey to 54 participants (median age = 58 y, thymoma = 33, preexisting AD = 19). Common adverse events included injection site pain, fatigue, and headaches. There were no vaccination-related hospitalizations or deaths. Autoimmune flares occurred in three patients (16%) after the first dose and three patients (17%) after the second dose. Most AD flares were mild and self-limited. One patient (2%) was diagnosed with having a new AD after vaccination. CONCLUSIONS Tolerability of COVID-19 mRNA vaccines in patients with TETs is comparable to the general population. Most patients with preexisting AD did not experience disease flares, and the development of new AD was rare. Patients with TETs should be encouraged to get vaccinated against COVID-19 owing to the documented benefits of vaccination and manageable risk profile.
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Affiliation(s)
- Madison Ballman
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Shannon Swift
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Cristina Mullenix
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Yvonne Mallory
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Chen Zhao
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Eva Szabo
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
- Lung and Upper Aerodigestive Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Meenakshi Shelat
- Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Susan Sansone
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Seth M. Steinberg
- Biostatistics and Data Management Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Meredith J. McAdams
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Raja SM, Guptill JT, McConnell A, Al-Khalidi HR, Hartwig MG, Klapper JA. Perioperative Outcomes of Thymectomy in Myasthenia Gravis: A Thoracic Surgery Database Analysis. Ann Thorac Surg 2021; 113:904-910. [PMID: 34339670 DOI: 10.1016/j.athoracsur.2021.06.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/22/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is clinical equipoise regarding the perioperative and long-term outcomes of autoimmune myasthenia gravis (MG) patients undergoing open vs minimally invasive thymectomy, particularly for non-thymomatous MG. This analysis utilizes multicenter, real-world clinical evidence to assess perioperative complications of open and minimally invasive thymectomy techniques in MG patients. METHODS Thymectomy cases 2009-2019 in MG patients were identified in the Society of Thoracic Surgeons General Thoracic Surgery Database. Thymectomies were grouped by surgical technique: transthoracic (TT), transcervical (TC), video-assisted thoracoscopic surgery (VATS), or Robotic VATS (RVATS). Multivariable logistic regression models assessed the association between surgical technique and perioperative complications. RESULTS Analysis of non-thymomatous cases (n=1,725) revealed VATS (OR 0.44, CI 0.23-0.83), RVATS (0.73, 0.48-1.26) and TC (0.19, 0.06-0.62) had lower odds of perioperative complications than TT thymectomies. VATS (2.29, 0.63-8.30) and RVATS (4.08, 1.21-3.78) thymectomies had higher odds of perioperative complications than TC. Analysis of thymomatous cases (n=311) found no significant difference in the odds of perioperative complications in TT vs minimally invasive (VATS/RVATS) procedures. The proportion of RVATS procedures increased from 6.43% to 44.27% while TT (56.43% to 34.35%) and TC (19.29% to 6.87%) thymectomies decreased. CONCLUSIONS Minimally invasive and TC thymectomies have fewer perioperative complications than TT when performed for non-thymomatous MG. Minimally invasive procedures are increasingly performed for both non-thymomatous and thymomatous disease. There is a nationwide shift towards minimally invasive procedures, even for thymoma resections. Long-term neurological outcome data are needed to determine whether a reduced perioperative risk for minimally invasive thymectomies translates to improved MG outcomes.
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Affiliation(s)
- Shruti M Raja
- Department of Neurology, Division of Neuromuscular Medicine, Duke University Medical Center.
| | - Jeffrey T Guptill
- Department of Neurology, Division of Neuromuscular Medicine, Duke University Medical Center
| | - Alec McConnell
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine
| | - Hussein R Al-Khalidi
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine
| | - Matthew G Hartwig
- Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center
| | - Jacob A Klapper
- Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center
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Guasp M, Landa J, Martinez-Hernandez E, Sabater L, Iizuka T, Simabukuro M, Nakamura M, Kinoshita M, Kurihara M, Kaida K, Bruna J, Kapetanovic S, Sánchez P, Ruiz-García R, Naranjo L, Planagumà J, Muñoz-Lopetegi A, Bataller L, Saiz A, Dalmau J, Graus F. Thymoma and Autoimmune Encephalitis: Clinical Manifestations and Antibodies. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/5/e1053. [PMID: 34301822 PMCID: PMC8312280 DOI: 10.1212/nxi.0000000000001053] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report the clinical, neuroimaging, and antibody associations in patients with autoimmune encephalitis (AE) and thymoma. METHODS A retrospective cohort study of 43 patients was conducted. Antibody determination and immunoprecipitation to characterize novel antigens were performed using reported techniques. RESULTS Patients' median age was 52 years (range: 23-88 years). Forty (93%) had neuronal surface antibodies: gamma-aminobutyric acid receptor A (GABAAR) (15), amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) (13), contactin-associated protein-like 2 (CASPR2) (4), leucine-rich, glioma inactivated 1 (LGI1) (3), glycine receptor (GlyR) (3), and unknown antigens (2). Concurrent antibodies against intracellular antigens occurred in 13 (30%; 9 anti-collapsin response mediator protein 5 [CRMP5]) and were more frequent in anti-AMPAR encephalitis (54% vs 20%; p = 0.037). The most common clinical presentation was encephalitis with multiple T2/fluid-attenuated inversion recovery hyperintense lesions in 23 (53%) patients (15 GABAAR, 5 AMPAR, and 1 unknown neuropil antibody), followed by encephalitis with peripheral nerve hyperexcitability in 7 (16%; 4 CASPR2, 2 LGI1, and 1 unknown antibody), limbic encephalitis in 6 (14%; 4 AMPAR, 1 LGI1, and 1 antibody negative), progressive encephalomyelitis with rigidity and myoclonus in 4 (9%; 3 GlyR and 1 AMPAR antibodies), and encephalitis with normal MRI in 3 (7%; AMPAR antibodies). Anti-GABAAR encephalitis was more prevalent in Japanese patients compared with Caucasians and other ethnicities (61% vs 16%; p = 0.003). In anti-AMPAR encephalitis, 3/4 patients with poor and 0/6 with good outcome had concurrent CRMP5 antibodies (p = 0.033). Immunoprecipitation studies identified metabotropic glutamate receptor 3 antibodies that were additionally found in 5 patients (3 with and 2 without encephalitis). CONCLUSIONS AE in patients with thymoma include several clinical-radiologic syndromes that vary according to the associated antibodies. Anti-GABAAR encephalitis was the most frequent AE and occurred more frequently in Japanese patients.
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Affiliation(s)
- Mar Guasp
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Jon Landa
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Eugenia Martinez-Hernandez
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Lidia Sabater
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Takahiro Iizuka
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Mateus Simabukuro
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Masataka Nakamura
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Makoto Kinoshita
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Masanori Kurihara
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Kenichi Kaida
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Jordi Bruna
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Solange Kapetanovic
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Pedro Sánchez
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Raquel Ruiz-García
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Laura Naranjo
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Jesús Planagumà
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Amaia Muñoz-Lopetegi
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Luis Bataller
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Albert Saiz
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Josep Dalmau
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Francesc Graus
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.G., J.L., E.M.-H., L.S., J.P., A.M.-L., A.S., J.D., F.G.), Hospital Clínic, Universitat de Barcelona; Neurology Department (M.G., E.M.-H., A.M.-L., A.S., J.D.), Institute of Neuroscience, Hospital Clínic, Barcelona; Centro de Investigación Biomédica en Red (M.G., E.M.-H., L.S., J.D.), Enfermedades Raras (CIBERER), Spain; Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan; Neurology Division (M.S.), University of São Paulo, School of Medicine, Brazil; Department of Neurology (M.N.), Kansai Medical University, Hirakata; Department of Neurology (M. Kinoshita), Osaka University Graduate School of Medicine; Department of Neurology (M. Kurihara), Graduate School of Medicine, University of Tokyo; Department of Neurology (K.K.), Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Neuro-Oncology Unit (J.B.), Hospital Universitari de Bellvitge-ICO L'Hospitalet, Spain; Department of Neurology (S.K.), Hospital de Basurto, Bilbao; Hospital Universitario de La Princesa (P.S.), Instituto de Investigación Sanitaria La Princesa, Madrid; Immunology Department (R.R.-G., L.N.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Neurology Department (L.B.), Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institute for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain.
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Giant cell myositis associated with concurrent myasthenia gravis: a case-based review of the literature. Clin Rheumatol 2021; 40:3841-3851. [PMID: 33629204 PMCID: PMC7904393 DOI: 10.1007/s10067-021-05619-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/10/2021] [Accepted: 01/27/2021] [Indexed: 11/09/2022]
Abstract
The term “giant cell myositis” has been used to refer to muscle diseases characterized histologically by multinucleated giant cells. Myasthenia gravis is an autoimmune neuromuscular junction disorder. The rare concurrence of giant cell myositis with myasthenia gravis has been reported; however, the clinical and histological features have varied widely. Here, we present such a case and a review of the literature. An 82-year-old woman admitted for subacute, progressive, proximal muscle weakness developed acute-onset dysphagia, dysphonia, and respiratory distress 5 days after admission. Laboratory findings were positive for acetylcholine receptor binding antibodies and striational muscle antibodies against titin. Muscle biopsy demonstrated widespread muscle fiber necrosis with multinucleated giant cells, consistent with giant cell myositis. She died despite treatment with pulse methylprednisolone and plasma exchange. A literature review of the PubMed and Scopus databases from 1944 to 2020 identified 15 additional cases of these co-existing diagnoses. We found that giant cell myositis with myasthenia gravis primarily affects female patients, is typically diagnosed in the 6–7th decades, and is characterized by the presence of thymoma. Muscle histology predominantly shows giant cell infiltrate without granulomas. The onset of myasthenia gravis symptoms may precede, follow, or coincide with symptoms of myositis. Treatment with thymectomy, anticholinesterase inhibitors, or immunosuppressive therapy may lead to favorable clinical outcomes.
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Bautista JL, Cramer NT, Miller CN, Chavez J, Berrios DI, Byrnes LE, Germino J, Ntranos V, Sneddon JB, Burt TD, Gardner JM, Ye CJ, Anderson MS, Parent AV. Single-cell transcriptional profiling of human thymic stroma uncovers novel cellular heterogeneity in the thymic medulla. Nat Commun 2021; 12:1096. [PMID: 33597545 PMCID: PMC7889611 DOI: 10.1038/s41467-021-21346-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/22/2021] [Indexed: 01/02/2023] Open
Abstract
The thymus' key function in the immune system is to provide the necessary environment for the development of diverse and self-tolerant T lymphocytes. While recent evidence suggests that the thymic stroma is comprised of more functionally distinct subpopulations than previously appreciated, the extent of this cellular heterogeneity in the human thymus is not well understood. Here we use single-cell RNA sequencing to comprehensively profile the human thymic stroma across multiple stages of life. Mesenchyme, pericytes and endothelial cells are identified as potential key regulators of thymic epithelial cell differentiation and thymocyte migration. In-depth analyses of epithelial cells reveal the presence of ionocytes as a medullary population, while the expression of tissue-specific antigens is mapped to different subsets of epithelial cells. This work thus provides important insight on how the diversity of thymic cells is established, and how this heterogeneity contributes to the induction of immune tolerance in humans.
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Affiliation(s)
- Jhoanne L Bautista
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Nathan T Cramer
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Corey N Miller
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jessica Chavez
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - David I Berrios
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lauren E Byrnes
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Joe Germino
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Bakar Institute for Computational Health Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Vasilis Ntranos
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Bakar Institute for Computational Health Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Julie B Sneddon
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, USA
- Department of Anatomy, University of California, San Francisco, San Francisco, CA, USA
- Department of Cell and Tissue Biology, School of Dentistry, University of California, San Francisco, San Francisco, CA, USA
| | - Trevor D Burt
- Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, USA
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
- Division of Neonatology and the Children's Health & Discovery Initiative, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - James M Gardner
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Chun J Ye
- Bakar Institute for Computational Health Sciences, University of California, San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Mark S Anderson
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Audrey V Parent
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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43
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Marx A, Yamada Y, Simon-Keller K, Schalke B, Willcox N, Ströbel P, Weis CA. Thymus and autoimmunity. Semin Immunopathol 2021; 43:45-64. [PMID: 33537838 PMCID: PMC7925479 DOI: 10.1007/s00281-021-00842-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/12/2021] [Indexed: 12/19/2022]
Abstract
The thymus prevents autoimmune diseases through mechanisms that operate in the cortex and medulla, comprising positive and negative selection and the generation of regulatory T-cells (Tregs). Egress from the thymus through the perivascular space (PVS) to the blood is another possible checkpoint, as shown by some autoimmune/immunodeficiency syndromes. In polygenic autoimmune diseases, subtle thymic dysfunctions may compound genetic, hormonal and environmental cues. Here, we cover (a) tolerance-inducing cell types, whether thymic epithelial or tuft cells, or dendritic, B- or thymic myoid cells; (b) tolerance-inducing mechanisms and their failure in relation to thymic anatomic compartments, and with special emphasis on human monogenic and polygenic autoimmune diseases and the related thymic pathologies, if known; (c) polymorphisms and mutations of tolerance-related genes with an impact on positive selection (e.g. the gene encoding the thymoproteasome-specific subunit, PSMB11), promiscuous gene expression (e.g. AIRE, PRKDC, FEZF2, CHD4), Treg development (e.g. SATB1, FOXP3), T-cell migration (e.g. TAGAP) and egress from the thymus (e.g. MTS1, CORO1A); (d) myasthenia gravis as the prototypic outcome of an inflamed or disordered neoplastic ‘sick thymus’.
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Affiliation(s)
- Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Yosuke Yamada
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, 606-8507, Japan
| | - Katja Simon-Keller
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Berthold Schalke
- Department of Neurology, Bezirkskrankenhaus, University of Regensburg, 93042, Regensburg, Germany
| | - Nick Willcox
- Neurosciences Group, Nuffield Department of Clinical Neurology, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, University of Göttigen, 37075, Göttingen, Germany
| | - Cleo-Aron Weis
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Cantini L, Pecci F, Merloni F, Lanese A, Lenci E, Paoloni F, Aerts JG, Berardi R. Old but gold: the role of drug combinations in improving response to immune check-point inhibitors in thoracic malignancies beyond NSCLC. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2021; 2:1-25. [PMID: 36046087 PMCID: PMC9400728 DOI: 10.37349/etat.2021.00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/08/2020] [Indexed: 12/02/2022] Open
Abstract
The introduction of immune checkpoint inhibitors (ICIs) in non-oncogene addicted non-small cell lung cancer (NSCLC) has revolutionized the treatment scenario and led to a meaningful improvement in patient prognosis. Disappointingly, the success of ICI therapy in NSCLC has not been fully replicated in other thoracic malignancies as small cell lung cancer (SCLC), malignant pleural mesothelioma (MPM), and thymic epithelial tumors (TETs), due to the peculiar biological features of these disease and to the difficulties in the conduction of well-designed, biomarker-driven clinical trials. Therefore, combination strategies of ICIs plus conventional therapies (either chemotherapy, alternative ICIs or targeted agents) have been implemented. Although first approvals of ICI therapy have been recently granted in SCLC and MPM (in combination with chemotherapy and different ICIs), results remain somewhat modest and limited to a small proportion of patients. This work reviews the trial results of ICI therapy in mesothelioma, SCLC, and TETs and discusses the potential of combining ICIs with old drugs.
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Affiliation(s)
- Luca Cantini
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
| | - Federica Pecci
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
| | - Filippo Merloni
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
| | - Andrea Lanese
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
| | - Edoardo Lenci
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
| | - Francesco Paoloni
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
| | - Joachim G.J.V. Aerts
- Department of Pulmonary Medicine, Erasmus MC, 3015 CE Rotterdam, The Netherlands 3Erasmus MC Cancer Institute, Erasmus MC, 3015 CE Rotterdam, The Netherlands
| | - Rossana Berardi
- Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy
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Thymic Hyperplasia with Lymphoepithelial Sialadenitis (LESA)-Like Features: Strong Association with Lymphomas and Non-Myasthenic Autoimmune Diseases. Cancers (Basel) 2021; 13:cancers13020315. [PMID: 33467055 PMCID: PMC7830871 DOI: 10.3390/cancers13020315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/15/2022] Open
Abstract
Thymic hyperplasia (TH) with lymphoepithelial sialadenitis (LESA)-like features (LESA-like TH) has been described as a tumor-like, benign proliferation of thymic epithelial cells and lymphoid follicles. We aimed to determine the frequency of lymphoma and autoimmunity in LESA-like TH and performed retrospective analysis of cases with LESA-like TH and/or thymic MALT-lymphoma. Among 36 patients (21 males) with LESA-like TH (age 52 years, 32-80; lesion diameter 7.0 cm, 1-14.5; median, range), five (14%) showed associated lymphomas, including four (11%) thymic MALT lymphomas and one (3%) diffuse large B-cell lymphoma. One additional case showed a clonal B-cell-receptor rearrangement without evidence of lymphoma. Twelve (33%) patients (7 women) suffered from partially overlapping autoimmune diseases: systemic lupus erythematosus (n = 4, 11%), rheumatoid arthritis (n = 3, 8%), myasthenia gravis (n = 2, 6%), asthma (n = 2, 6%), scleroderma, Sjögren syndrome, pure red cell aplasia, Grave's disease and anti-IgLON5 syndrome (each n = 1, 3%). Among 11 primary thymic MALT lymphomas, remnants of LESA-like TH were found in two cases (18%). In summary, LESA-like TH shows a striking association with autoimmunity and predisposes to lymphomas. Thus, a hematologic and rheumatologic workup should become standard in patients diagnosed with LESA-like TH. Radiologists and clinicians should be aware of LESA-like TH as a differential diagnosis for mediastinal mass lesions in patients with autoimmune diseases.
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Thymic Epithelial Neoplasms: Radiologic-Pathologic Correlation. Radiol Clin North Am 2021; 59:169-182. [PMID: 33551079 DOI: 10.1016/j.rcl.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Thymic epithelial neoplasms, as classified by the World Health Organization, include thymoma, thymic carcinoma, and thymic carcinoid. They are a rare group of tumors and are often diagnosed incidentally in the work-up of parathymic syndrome, such as myasthenia gravis, or when mass effect or local invasion causes other symptoms. In each of these scenarios, understanding the radiologic-pathologic relationship of these tumors allows clinical imagers to contribute meaningfully to management decisions and overall patient care. Integrating important imaging features, such as local invasion, and pathologic features, such as necrosis and immunohistochemistry, ensures a meaningful contribution by clinical imagers to the care team.
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Kousik V, Milap M, Bollam R, Prasad RK, Krishna G. Squamous Cell Carcinoma of Thymus Presenting as Constrictive Pericarditis Diagnosed With 18F-FDG PET/CT. Clin Nucl Med 2021; 46:e13-e15. [PMID: 32701799 DOI: 10.1097/rlu.0000000000003193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Constrictive pericarditis refers to focal or global thickening of pericardium causing impedance to diastolic filling and increased systemic venous pressure. We discuss a case of thymic carcinoma presenting as constrictive pericarditis. A 70-year-old man experiencing shortness of breath underwent Doppler echocardiography for further evaluation. Echocardiography was suggestive of thickened nodular pericardium with minimal pericardial effusion, and Doppler features were suggestive of constrictive pericarditis. F-FDG PET/CT done to exclude malignancy reveals locally advanced thymic carcinoma spreading along the pericardial sheath with metabolically active rib metastases.
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Affiliation(s)
| | | | | | | | - Gopi Krishna
- Pulmonary Medicine, Yashoda Super Speciality Hospital, Secunderabad, India
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Blum TG, Misch D, Kollmeier J, Thiel S, Bauer TT. Autoimmune disorders and paraneoplastic syndromes in thymoma. J Thorac Dis 2020; 12:7571-7590. [PMID: 33447448 PMCID: PMC7797875 DOI: 10.21037/jtd-2019-thym-10] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Thymomas are counted among the rare tumour entities which are associated with autoimmune disorders (AIDs) and paraneoplastic syndromes (PNS) far more often than other malignancies. Through its complex immunological function in the context of the selection and maturation of T cells, the thymus is at the same time highly susceptible to disruptive factors caused by the development and growth of thymic tumours. These T cells, which are thought to develop to competent immune cells in the thymus, can instead adopt autoreactive behaviour due to the uncontrolled interplay of thymomas and become the trigger for AID or PNS affecting numerous organs and tissues within the human body. While myasthenia gravis is the most prevalent PNS in thymoma, numerous others have been described, be they related to neurological, cardiovascular, gastrointestinal, haematological, dermatological, endocrine or systemic disorders. This review article sheds light on the pathophysiology, epidemiology, specific clinical features and therapeutic options of the various forms as well as courses and outcomes of AID/PNS in association with thymomas. Whenever suitable and backed by the limited available evidence, the perspectives from both the thymoma and the affected organ/tissue will be highlighted. Specific issues addressed are the prognostic significance of thymectomy on myasthenia gravis and other thymoma-associated AID/PND and further the impact and safety of immunotherapies on AID and PND relating to thymomas.
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Affiliation(s)
- Torsten Gerriet Blum
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Daniel Misch
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Jens Kollmeier
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Sebastian Thiel
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Torsten T Bauer
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
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Jakopovic M, Bitar L, Seiwerth F, Marusic A, Krpina K, Samarzija M. Immunotherapy for thymoma. J Thorac Dis 2020; 12:7635-7641. [PMID: 33447455 PMCID: PMC7797835 DOI: 10.21037/jtd-2019-thym-12] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022]
Abstract
Thymic epithelial tumors (TETs) are rare thymic neoplasms. There are approximately 1.5 cases per million TETs per year. They are the most common anterior mediastinal tumors in adults. Due to limited activity of available treatment options novel strategies and treatment options are needed and treatment with immune checkpoint inhibitors is an attractive option. Thymic epithelial tumors have one of the lowest tumor mutational burden among all cancer in adults, but high expression of PD-L1 on tumor cells and abundant CD8+ lymphocytes provide a strong rational for implementing immune checkpoint inhibitors (ICIs) which target PD-1/PD-L1 pathway in the treatment of TETs. Few small early stage clinical trials were published so far evaluating efficacy of pembrolizumab and avelumab in thymoma and thymic carcinoma patients. Al trials showed reasonable response rates and progression-free survival. Higher PD-L1 expression was predictor of response in all trials. However, increased incidence of immune-related adverse events was seen in TET patients treated with immune checkpoint inhibitors compared to patients with other cancers. At the moment, ICIs are not standard of care for patients with TET and larger trials are needed to establish the right role of ICIs regarding efficacy and safety of these agents.
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Affiliation(s)
- Marko Jakopovic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Lela Bitar
- Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Fran Seiwerth
- Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ante Marusic
- Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Kristina Krpina
- Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Miroslav Samarzija
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
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Lopes DTP, Gomes SMP, Siqueira SAC, Frassetto FP, Sampaio PHMA, Moreno CAM, Rocha MSG, Estephan EP. Myasthenia Gravis Related to Thymic Carcinoma: A Case Study. Thorac Cardiovasc Surg Rep 2020; 9:e33-e36. [PMID: 32963930 PMCID: PMC7500976 DOI: 10.1055/s-0040-1714075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/06/2020] [Indexed: 10/26/2022] Open
Abstract
Myasthenia gravis and thymoma are often presented in association with ∼10% of myasthenic cases having concomitant thymoma. Thymic carcinoma is one of the rarest/aggressive human epithelial tumors and has no correlation with myasthenia gravis hitherto. Here is provided a clinical case and review of literature on a very rare association of thymic carcinoma (with no sign of thymoma) and myasthenia gravis (antiacetylcholine receptor antibody positive). Two years after thymectomy, clinical evolution was satisfactory. This clinical case elicits hypothesis that thymic carcinoma may be related with myasthenia gravis, what may have good prognostic from oncologic and neurologic perspectives.
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Affiliation(s)
| | | | | | | | | | - Cristiane Araujo Martins Moreno
- Neurology Departament, Hospital Santa Marcelina, Sao Paulo, São Paulo, Brazil.,Neurology Departament, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
| | - Maria Sheila Guimarães Rocha
- Neurology Departament, Hospital Santa Marcelina, Sao Paulo, São Paulo, Brazil.,Neurology Departament, Faculdade Santa Marcelina Curso de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Eduardo Paula Estephan
- Neurology Departament, Hospital Santa Marcelina, Sao Paulo, São Paulo, Brazil.,Neurology Departament, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, São Paulo, Brazil
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