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Nishadham V, Bardhan M, Polavarapu K, Vengalil S, Nashi S, Menon D, Ganaraja VH, Preethish-Kumar V, Valasani RK, Huddar A, Unnikrishnan GK, Thomas A, Saravanan A, Kulanthaivelu K, Nalini A, Nandeesh BN. Thymic Lesions in Myasthenia Gravis: A Clinicopathological Study from India. J Neuromuscul Dis 2022; 9:411-422. [DOI: 10.3233/jnd-210785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Objectives: Thymic pathology is common in Myasthenia Gravis(MG) and plays a crucial role in its pathogenesis and clinical outcome. This study aims to discuss the clinicohistopathological spectrum of thymic lesions in MG. Methods: In this retrospective study, MG patients who underwent thymectomy from 2011 to 2020 were included. Clinical, radiological, serological, and histopathological details are described. Results: Of 83 patients(F = 45; M = 38), 7(8%) had ocular myasthenia, and the remaining 76(92%) had the generalized form. At onset, the median age was 36 years(M = 44; F = 31). AChR antibody was positive in 71/79 patients. RNST showed decrement response in 68/78 patients. The histopathological study demonstrated thymoma in 44(53%), thymic hyperplasias [32(38%)], involuted thymus [5(6%)], thymic cyst (1) and thymic lipoma (1). WHO grading of thymoma: B2- 48%, AB-18%, B-18%, B3-14%, A-2.3% . In these, capsular infiltration was noted in 11/44, 9 had focal and 2 had diffuse infiltration. Active germinal centers were present in 20/32 patients with thymic hyperplasia and 4/44 with thymoma. Thymomas were predominant in males and thymic hyperplasia in females. The age of onset and antibody positivity rate was higher in thymoma patients. Conclusion: In our cohort, there is a female preponderance. Thymoma was the commonest pathology followed by hyperplasia. We observed earlier onset of myasthenia in females. AChR antibody positivity rate was more frequent in thymomas. This study indicates that clinico-radiological evaluation adequately supported by serology and histopathology can effectively recognize the type of thymic pathology that can guide these patients’ treatment planning, management, prognosis and follow-up.
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Affiliation(s)
- Vikas Nishadham
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Deepak Menon
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | | | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Ravi Kiran Valasani
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Akshata Huddar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Gopi Krishnan Unnikrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Abel Thomas
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Akshaya Saravanan
- Neurointerventional and Imaging, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Karthik Kulanthaivelu
- Neurointerventional and Imaging, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
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Calabrese F, Fortarezza F, Pezzuto F, Lunardi F, Comacchio G, Sbaraglia M, Pasello G, Marulli G, Dei Tos AP, Rea F. The Rarest of Rare Thymic Lesions: A 10-Year Surgical Pathology Experience. Cancers (Basel) 2021; 13:4056. [PMID: 34439210 PMCID: PMC8392427 DOI: 10.3390/cancers13164056] [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: 07/21/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
The thymus is a specialized primary lymphoid organ located in the midline pre-vascular mediastinum. The organ is the site of various pathological processes, neoplastic and not, whose rarity has not allowed in-depth studies on clinical or histological features of rarest and unusual variants. Herein, we report a 10-year Padova experience in the surgical pathology of the thymus, focusing on the pathological description of nonneoplastic lesions and rare epithelial and mesenchymal tumors recorded in our database, which comprises over 600 thymectomies. The extrapolated rare cases have been categorized into four groups that included 15 cysts, 18 carcinomas, 5 neuroendocrine tumors, and 2 soft tissue tumors. The cases are described from a clinical and pathological point of view and discussed in dedicated sections with a review of the most important literature. In this case, review series, we aim to update the epidemiology of these rare entities, improve diagnostic awareness, and finally, promote a collaborative network between referral centers.
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Affiliation(s)
- Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Francesco Fortarezza
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Federica Pezzuto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Francesca Lunardi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Giovanni Comacchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Marta Sbaraglia
- Department of Medicine, University of Padova, 35121 Padova, Italy; (M.S.); (A.P.D.T.)
| | - Giulia Pasello
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, 35121 Padova, Italy;
| | - Giuseppe Marulli
- Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Angelo Paolo Dei Tos
- Department of Medicine, University of Padova, 35121 Padova, Italy; (M.S.); (A.P.D.T.)
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
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Damaskos C, Garmpis N, Garmpi A, Georgakopoulou VE, Tomos P. Multilocular Thymic Cyst in a Young, Otherwise Healthy Woman: A Case Report. Cureus 2020; 12:e11210. [PMID: 33269141 PMCID: PMC7704160 DOI: 10.7759/cureus.11210] [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] [Indexed: 11/15/2022] Open
Abstract
Thymic cysts are rare lesions, accounting approximately for 1% of all mediastinal masses. We report a case of a 36-year old woman who presented preoperatively with a calcified mass shadow found on a routine chest radiograph X-ray. After further investigation with chest computed tomography (CT), magnetic resonance imaging (MRI), and tests for Myasthenia gravis, a benign mediastinal cyst was diagnosed and the patient underwent median sternotomy and complete surgical excision of the lesion. The histological examination described a multilocular thymic cyst. Thymic cysts are usually associated with thymic epithelial tumors, such as thymomas, or multisystemic morbid conditions such as human immunodeficiency virus (HIV) infection, rheumatologic disease, and Myasthenia gravis. At all follow-up examinations to date, the patient remains healthy.
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Affiliation(s)
- Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, Athens, GRC.,Medicine, N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, GRC
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Athens, GRC.,Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Athens, GRC.,Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Vasiliki E Georgakopoulou
- Pulmonology Department, Laiko General Hospital, Athens, GRC.,First Pulmonology Department, Sismanogleio Hospital, Athens, GRC
| | - Periklis Tomos
- Department of Thoracic Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
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Abstract
The thymus is a dynamic organ that undergoes changes throughout life and can demonstrate a myriad of pathologic alterations. A number of benign entities of the thymus prove to be diagnostic dilemmas owing to their resemblance and association with true thymic tumors. These are usually discovered incidentally on routine imaging and most patients are either asymptomatic or present with signs and symptoms of compression of adjacent organs. The radiologic appearance of these lesions varies from simple cysts to complex masses that are suspicious for malignancy. The diagnosis is usually made purely on morphologic grounds, however, immunohistochemical stains can help rule out possible differential diagnoses. Surgical removal is usually curative in these lesions and recurrences are rare. The prognosis is excellent, however, some of these lesions may be associated with myasthenia gravis and/or thymomas. In this review, we describe non-neoplastic lesions and benign tumoral lesions of the thymus, with emphasis on the clinical, radiologic, and pathologic features. The differential diagnosis of each entity is also discussed.
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Matsumoto H, Ohtomo G, Akahori T, Hashida H. Lambert-Eaton myasthenic syndrome with anti-acetylcholine receptor antibody and anterior mediastinal tumor. J Gen Fam Med 2017; 18:282-284. [PMID: 29264043 PMCID: PMC5689432 DOI: 10.1002/jgf2.66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 10/18/2016] [Indexed: 11/09/2022] Open
Abstract
This report describes the case of a 65-year-old male who complained of muscular weakness of the legs with easy fatigability. Blood and imaging examinations showed positive anti-acetylcholine receptor antibody and an anterior mediastinal tumor (probably a thymic cyst), suggesting the diagnosis of myasthenia gravis (MG). However, neurological and electrophysiological examinations suggested the diagnosis of Lambert-Eaton myasthenic syndrome (LEMS). We searched repeatedly for malignant tumors. Small cell lung cancer (SCLC) was found. Chemotherapy reduced the SCLC and improved the patient's clinical symptoms. On the basis of an accurate diagnosis of LEMS, we were able to detect SCLC and administer chemotherapy at an early stage. Anti-P/Q-type voltage-gated calcium channel antibody was negative. In our case, MG and LEMS overlap syndrome in addition to MG should be differentiated. For the differentiation, the strict electrophysiological criteria of LEMS were useful.
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Affiliation(s)
- Hideyuki Matsumoto
- Department of Neurology Japanese Red Cross Medical Center Shibuya-ku TokyoJapan
| | - Gaku Ohtomo
- Department of Neurology Japanese Red Cross Medical Center Shibuya-ku TokyoJapan
| | - Tsugumi Akahori
- Department of Neurology Japanese Red Cross Medical Center Shibuya-ku TokyoJapan
| | - Hideji Hashida
- Department of Neurology Japanese Red Cross Medical Center Shibuya-ku TokyoJapan
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Morollón N, Guerrero P, Duarte J. Thymic cyst associated with myasthenia gravis. Neurologia 2016; 33:S0213-4853(16)30045-7. [PMID: 27293024 DOI: 10.1016/j.nrl.2016.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 04/02/2016] [Accepted: 04/04/2016] [Indexed: 11/27/2022] Open
Affiliation(s)
- N Morollón
- Sección Neurología, Complejo Asistencial de Segovia, Segovia, España.
| | - P Guerrero
- Sección Neurología, Complejo Asistencial de Segovia, Segovia, España
| | - J Duarte
- Sección Neurología, Complejo Asistencial de Segovia, Segovia, España
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Araki T, Sholl LM, Gerbaudo VH, Hatabu H, Nishino M. Intrathymic cyst: clinical and radiological features in surgically resected cases. Clin Radiol 2014; 69:732-8. [PMID: 24824976 DOI: 10.1016/j.crad.2014.03.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/27/2014] [Accepted: 03/03/2014] [Indexed: 02/01/2023]
Abstract
AIM To investigate radiological and clinical characteristics of pathologically proven cases of intrathymic cysts. MATERIALS AND METHODS The study population consisted of 18 patients (five males, 13 females; median age 56 years) with pathologically confirmed intrathymic cysts who underwent thymectomy and had preoperative chest computed tomography (CT) available for review. The patient demographics, clinical presentation, and preoperative radiological diagnoses were reviewed. CT images were evaluated for shape, contour, location of the cysts and the presence of adjacent thymic tissue, mass effect, calcifications, and septa. The size and CT attenuations of the cysts were measured. RESULTS The most common CT features of intrathymic cysts included oval shape (9/18; 50%), smooth contour (12/18; 67%), midline location (11/18; 61%), the absence of visible adjacent thymic tissue (12/18; 67%), and the absence of calcification (16/18; 89%). The mean longest diameter and the longest perpendicular diameter were 25 mm (range 17-49 mm) and 19 mm (range 10-44 mm), respectively. The mean CT attenuation was 38 HU (range 6-62 HU) on contrast-enhanced CT, and was 45 HU (range 26-64 HU) on unenhanced CT (p = 0.41). The CT attenuation was >20 HU in 15 of 18 patients (83%). Preoperative radiological diagnosis included thymoma in 11 patients. CONCLUSION In surgically removed, pathologically proven cases of intrathymic cyst, the CT attenuation was >20 HU in most cases, leading to the preoperative diagnosis of thymoma. Awareness of the spectrum of imaging findings of the entity is essential to improve the diagnostic accuracy and patient management.
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Affiliation(s)
- T Araki
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - L M Sholl
- Department of Pathology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, USA
| | - V H Gerbaudo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - H Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - M Nishino
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, USA; Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
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