The effect of thymectomy on myasthenia gravis, thrombocytopenia, and granulocytopenia associated with thymoma: Report of a case

Abstract

We report the case of a 47-year-old woman with thymoma who developed myasthenia gravis, thrombocytopenia, and granulocytopenia, simultaneously, the concurrent association of these four disorders being extremely rare. Thymectomy was performed, and, during the post-thymectomy course, there were surprising findings concerning the recovery of not only the myasthenia gravis but also of the hematologic disorders. Immediately after thymectomy, the myasthenic symptoms completely disappeared, and the granulocyte and platelet counts recovered to within the normal range within a few days. The laboratory data revealed no difference between pre- and post-thymectomy in the release of cytokines (tumor necrosis factor; TNF, interleukin; IL-2, and IL-6), anti-acetylcholine receptor antibody, or platelet-associated IgG. On the other hand, the serum level of anti-neutrophil cytoplasmic antibody (p-ANCA), against the myeloperoxidase of the granulocytes was dramatically decreased, after thymectomy, showing a significant correlation with the granulocyte count. According to our survey of the literature, this is the first report to show that the removal of a thymoma led to the dramatic resolution not only of myasthenia gravis but also of other associated diseases. It is possible that p-ANCA may be regulated by thymoma, thus causing severe granulocytopenia.

Pure white cell aplasia an exceptional condition in the immunological conundrum of thymomas: Responses to immunosuppression and literature review

“…It has been reported the case of a patient with thymoma and granulocytopenia in whom a decrease in anti-pANCA antibody titer and elevation of granulocytes in peripheral blood was observed after thymectomy. 9 However, in other cases neutropenia has not resolved after thymectomy and a second line of treatment is necessary. 10,11 The medical treatment of these patients is not established currently due to low incidence of cases.…”

Paraneoplastic immune-mediated neutropenia in a dog following thymoma excision with later development of metastatic thymic carcinoma treated with toceranib phosphate

“…Response to immunosuppressive therapy is often used to confirm the diagnosis in dogs, while documentation of antineutrophil antibodies is preferred to confirm the diagnosis in human medicine. Antineutrophil antibodies were documented in human patients with thymoma and granulocytopenia,20 21 although this is an inconsistent finding,11 possibly due to specific toxicity to the myelomonocytic precursor cells in the bone marrow. Antineutrophil antibodies have been documented in dogs with immune‐mediated neutropenia,22 23 and they could not be used to distinguish primary from secondary disease.…”

Myasthenia Gravis Associated with Thymoma and Aplastic Anemia: Case Report

“…PRCA is also known as a concomitant disorder with MG. Th ey concluded that thymoma, bulbar involvement and high level of AChR antibodies were signifi cantly higher in patients with PRCA. Kobayashi et al report a case of a patient with MG, thymoma, thrombocytopenia and granulocytopenia 6 . After thymectomy, not only the symptoms of MG but also hematologic fi ndings improved.…”