Myasthenia gravis with thymic epithelial tumour: a retrospective analysis of a Japanese database

Nakajima, Jun; Okumura, Meinoshin; Yano, Motoki; Date, Hiroshi; Onuki, Takuya; Haniuda, Masayuki; Sano, Yoshifumi

doi:10.1093/ejcts/ezv380

Cited by 44 publications

(58 citation statements)

References 24 publications

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“…In other reports, the median maximal diameter of usual thymomas was 57-68 mm, and our case series was 50 mm, which was smaller than usual thymomas. 10,12,13) However, these cases were greater than or equal to 40 mm. Pathologically, only one case had type AB, and the other eight had type B (Type B1:B2:B3 = 4:3:1 cases).…”

Section: Commentmentioning

confidence: 82%

“…Pathologically, only one case had type AB, and the other eight had type B (Type B1:B2:B3 = 4:3:1 cases). All thymomas with ring calcification had pathologically 10,12) In this literature, 80% had thymomas equal to or more advanced than stage II, which meant that they were frequently invasive thymomas. Calcifications were pathologically found in more than half of the thymomas of type B2 and B3, and found more frequently in invasive thymomas than in noninvasive thymomas.…”

Section: Commentmentioning

confidence: 99%

“…Our all three cases were accompanied with MG, meanwhile remaining six of seven reported cases were not accompanied with MG. Their complication rate of MG with thymoma was between 20% and 40%, and the rate of MG with type B thymoma was 35%-49%. [10][11][12][13] Although the complication rate with MG could not simply compare due to the small number of cases, it was approximated rate. In other reports, the median maximal diameter of usual thymomas was 57-68 mm, and our case series was 50 mm, which was smaller than usual thymomas.…”

Section: Commentmentioning

confidence: 99%

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Clinicopathological Features of Thymoma with Ring Calcification: Case Reports

Nakada

Akiba

Yabe

et al. 2017

ATCS

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Section: Commentmentioning

confidence: 82%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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Clinicopathological Features of Thymoma with Ring Calcification: Case Reports

Nakada

Akiba

Yabe

et al. 2017

ATCS

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“…A recent analysis of the retrospective Japanese database of TETs that included 598 TETs in patients with myasthenia gravis did not reveal any difference in 5-and 10-year overall or recurrence-free survival. 19 A recent multicenter study from Italy including 375 patients with thymoma showed a slight protective effect of the presence of myasthenia gravis on overall survival, although that was not confirmed in multivariate analysis. 20 These findings suggest that today the outcome of patients with thymoma and myasthenia gravis is at least as good as the outcome of patients with thymoma without myasthenia gravis.…”

Section: Evolution Of the Histomorphologic Classification Of Thymic Ementioning

confidence: 94%

Evolution of Classification of Thymic Epithelial Tumors in the Era of Dr Thomas V. Colby

Roden¹

2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Numerous histomorphologic and staging classifications of thymic epithelial tumors (TETs) have been proposed during the last century, suggesting that the classification of these tumors is challenging and controversial. Difficulties of classifying TETs include various combinations of epithelial cells and lymphocytes and the paucity of these tumors. The prognostic significance, specifically of the histomorphologic classifications, has been debated. Early classifications were also challenged by the uncertainty of the neoplastic component(s) of the tumor.Objective.-To discuss the evolution of the histomorphologic classification and the staging system of TET. Controversies and problems of some classifications and their importance for therapeutic management and prognosis will be reviewed. Classifications that incorporated new concepts and approaches at the time or outcome studies will be highlighted. Current classifications will be discussed and the staging system that was recently proposed for the upcoming eighth American Joint Committee on Cancer staging will be described.Data Sources.-Search of literature database (PubMed) and current (2015) World Health Organization classification.Conclusions.-Histomorphologic and staging classifications of TET have evolved during the last century and especially during the era of Thomas V. Colby, MD. Evidence supports that the staging system has prognostic implications independent of and superior to the histomorphologic classification. Histomorphology appears to be important for biologic features of TET.

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“…Up to 25% of thymoma patients will have clinically overt MG and an additional 25% of clinically asymptomatic thymoma patients will have circulating anti-acetylcholinesterase receptor (anti-Ach-R) autoantibodies. Conversely, in 5-15% of the patients with MG, preoperative work up eventually demonstrates an unsuspected thymoma (18,19).Thymectomy in MG patients may lead to long-term complete long-term remission (35-40% of patients), or to clinical improvement, i.e., discontinuation of steroids, less need for resorting to immunosuppressive therapy, lower incidence of myasthenic crisis or symptom improvement in another 30-45% (12,19). Complete removal of the thymus gland and anterior mediastinal fat from neck to diaphragm and phrenic-to-phrenic nerve (so called maximal thymectomy) is required, as microscopic islets of functional thymic tissue can be found throughout the anterior mediastinal fat in over 20% of the patients.…”

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confidence: 99%

VATS thymectomy for early stage thymoma and myasthenia gravis: combined right-sided uniportal and left-sided three-portal approach

et al. 2017

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The traditional approach to thymectomy requires median sternotomy based on the assumption that it is the best means to achieve adequate resection margins, complete removal of the thymus and clearance of the anterior mediastinal fat. However, in recent years, VATS thymectomy has been gaining acceptance as a means to achieve adequate oncologic results and symptomatic improvement of myasthenic symptoms with less impact on the patient. We have adopted a flexible approach based on the location of the tumor and on whether the patient has myasthenia gravis (MG) or not when planning minimally invasive VATS thymectomy. A preferential approach from the left side is chosen for clinical stage I-II thymomas located on the left side or on the midline in patients without MG, and a bilateral approach (uniportal VATS on the right side and three-portal VATS on the left side) for MG patients with or without thymoma in order to achieve complete clearance of the anterior mediastinal fat on both sides. Such techniques are herewith clearly illustrated in hope that surgeons wishing to endeavor in such an effort will be facilitated. patients, and on the hypothetical risk that a second primary thymoma may develop in the residual thymus gland (4,7). However, an increasing number of reports over the recent years have shown that thymectomy can be accomplished safely and effectively by VATS both for early-stage thymoma and for MG (8)(9)(10)(11)(12)(13)(14).A recently published propensity-matched study on patients undergoing either trans-sternal or minimally invasive thymectomy for stage I-II thymoma showed overall postoperative complications rates to be lower with VATS thymectomy, and suggested that in fact, the majority of complications in the open group were due the complications of median sternotomy (15).There are no randomized trials that compare minimally invasive and open thymectomy, but VATS thymectomy was compared to the traditional open approach in two recent large meta-analyses (16,17). Both such studies showed significantly reduced postoperative blood loss and blood products requirements, reduced postoperative pain scores, reduced overall complications rates and reduced postoperative hospital stay with VATS thymectomy compared with open thymectomy. Operating-room time was not significantly different between the two techniques.Most importantly, the probability of achieving microscopically complete resection (i.e., tumor free margins at pathologic examination) and loco-regional recurrence rates were similar with either approach.Over 50% of thymoma patients may suffer from a variety of autoimmune diseases, the most common of which are MG, erythroid aplasia and hypogammaglobinemia. Up to 25% of thymoma patients will have clinically overt MG and an additional 25% of clinically asymptomatic thymoma patients will have circulating anti-acetylcholinesterase receptor (anti-Ach-R) autoantibodies. Conversely, in 5-15% of the patients with MG, preoperative work up eventually demonstrates an unsuspected thymoma (18,19).Thymectomy in M...

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Myasthenia gravis with thymic epithelial tumour: a retrospective analysis of a Japanese database

Cited by 44 publications

References 24 publications

Clinicopathological Features of Thymoma with Ring Calcification: Case Reports

Clinicopathological Features of Thymoma with Ring Calcification: Case Reports

Evolution of Classification of Thymic Epithelial Tumors in the Era of Dr Thomas V. Colby

VATS thymectomy for early stage thymoma and myasthenia gravis: combined right-sided uniportal and left-sided three-portal approach

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