Thymomas in Patients with Myasthenia Gravis

Slater, Gary; Papatestas, Angelos E.; Genkins, Gabriel; Kornfeld, Peter; Horowitz, Steven H.; Bender, Adam N.

doi:10.1097/00000658-197808000-00008

Cited by 50 publications

(18 citation statements)

References 9 publications

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“…In the current series a significant prevalence of BT over MT was found, which agrees with other authors 5,[20][21][22] , although some 13,15 have reported a high incidence of MT.…”

Section: Discussionsupporting

confidence: 93%

“…Most of the authors 2,4,5,7,15,34 agree that TMG prognosis is poorer than that for non thymomatous MG. However, early surgery with total excision of tumor and current MG management protocols have partially changed such prognosis, permitting SI and even CR of MG, especially in younger patients submitted to early surgery, as this series has proven.…”

Section: Discussionmentioning

confidence: 99%

“…However, its indication in presence of thymoma is consensual 2,6,[11][12][13][14] . In an effort to lessen risks of local infiltration and to maintain CR of MG, complete excision of the tumor, of the thymic tissue and of other non vital adjacent structures is recommended in invasive thymoma, but such objectives are not always met 6,13,[15][16][17] .…”

Section: Discussionmentioning

confidence: 99%

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Myasthenia gravis and thymoma: evaluation of 41 patients

Assis

Zambon²,

Souza³

et al. 1999

Arq. Neuro-Psiquiatr.

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-We evaluated the epidemiological, clinical, laboratory and therapeutical aspects of 41 patients with thymomatous myasthenia gravis. Thirty five patients (85.36%) were submitted to thymectomy. Follow-up ranged from two to 18 years. Diagnosis of thymoma was based upon clinical investigations and CT scan of the anterior mediastinum and in 11 patients supported by immunological tests of anti-striated muscle antibodies with a positive result in more than 80% of cases. Histopathologic examination of all thymomectomized patients confirmed the diagnosis of thymoma. There was a significant predominance of benign over malignant thymoma. Occurred higher prevalence of male patients and of patients over 40 years of age. The therapeutical strategy to control myasthenic clinical findings was the same as that for non-thymomatous myasthenia gravis. The corticosteroids associated to cytotoxic drugs were less often used. Radiotherapy of the anterior mediastinum was more often used in patients having invasive tumors submitted to surgery or not. With regard to survival and control of myasthenia gravis, especially in younger patients and in those submitted to early surgery, results of treatment were surprisingly favorable.KEY WORDS: myasthenia gravis, thymoma, thymectomy.Miastenia grave e timoma: avaliação de 41 pacientes RESUMO -Avaliamos 41 pacientes com miastenia grave timomatosa sob os aspectos epidemiológico, clínico e terapêutico. Trinta e cinco pacientes (85,36%) foram timectomizados. O seguimento clínico variou de dois meses até 18 anos. O diagnóstico do timoma foi fundamentado no estudo de imagem do mediastino (tomografia axial computadorizada) e, em 11 pacientes, complementado com a determinação sérica de anticorpos para músculo estriado com resultado positivo em mais de 80% dos casos e confirmado pelo exame anátomo-patológico do timo realizado em todos os pacientes operados. Ocorreu predomínio significante de timomas benignos sobre timomas malignos, forma clínica generalizada severa, frequente envolvimento do sexo masculino e, em pacientes com mais de 40 anos de idade. A estratégia terapêutica para o controle dos sintomas miastênicos foi a mesma que para os pacientes não timomatosos. O emprego de imunossupressão medicamentosa esteróide associada a drogas citotóxicas foi menos frequente. A radioterapia foi usada com mais frequência nos pacientes portadores de tumores invasivos operados ou não. PALAVRAS-CHAVE: miastenia grave, timoma, timectomia.Acquired myasthenia gravis (MG) is an immunological disease with antibody activity against the acetylcholine nicotine receptor (antiAChR) of the neuromuscular junction, with fluctuant weakness of the skeletal muscle which improves with the administration of cholinergic drugs (CD). These antibodies are produced by B lymphocytes activated by helper T lymphocytes antigen-specific (CD4) 1,2 in the thymus and peripheral blood of patients with MG 3,4 .

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“…In the current series a significant prevalence of BT over MT was found, which agrees with other authors 5,[20][21][22] , although some 13,15 have reported a high incidence of MT.…”

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Myasthenia gravis and thymoma: evaluation of 41 patients

Assis

Zambon²,

Souza³

et al. 1999

Arq. Neuro-Psiquiatr.

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“…However, the presently preferred treatment for invasive thymoma, namely nontotal excision, is still less than satisfactory. There arc many reports on invasive thy momas in the field of surgery [1][2][3][4][5] whereas we have seen only a few reports on the same topic in the field of neurol ogy [6,7],…”

Section: Introductionmentioning

confidence: 94%

Myasthenia Gravis and Invasive Thymoma

Wakata

Fujioka²,

Nishina³

et al. 1993

Eur Neurol

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Over the last 20 years, 15 patients with myasthenia gravis and invasive thymoma have been treated in our department. Eight of these patients underwent either nontotal excision or were not operated on due to massive invasion, while 7 underwent total excision. These 15 cases represent 6.2% of the 242 myasthenic patients treated during this period. Six of the 8 nontotal excision cases died, and 2 of the 7 total excision cases succumbed. The prognosis of total excision cases was better than that of nontotal excision cases. The overall 5-year survival rate was 73%, and the 10-year survival rate 20%. Total excision of the thymoma, if possible, and high doses of corticosteroids and combination chemotherapy for the remaining tumor seem to be the treatments of choice.

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“…Os resultados favoráveis de timectomia sobre a evolução da MG, obtidos nas décadas de 1940 e 1950 e o encontro de alterações no timo de pacientes operados, estabeleceram a relação entre o timo e a MG. Setenta por cento dos miastênicos apresentam alterações histológicas do timo, sendo a hyperplasia a mais comum 41214 enquanto timomas ocorrem entre 10 a 20% dos casos 6,14,15,23 . A ocorrência de MG após timectomia por timoma 14 indica, porém, que o processo imunológico pode ser desencadeado em outros órgãos do sistema linfóide.…”

Section: Comentáriosunclassified

Miastenia gravis: resultados de timectomia em 52 pacientes

Oliveira

Campos

Cardoso

1995

Arq. Neuro-Psiquiatr.

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PALAVRAS-CHAVE : miastenia gravis, timectomia Myasthenia gravis: results of thymectomy in 52 patientsSUMMARY -From 1971 to 1993, 52 myasthenics without thymomas ( 7 men and 45 women) were thymectomized.The results were categorized in remissions and non-remissions. The remission rate was 48%. In the remission group there were 5 men and 20 women and in the non-remission group 2 men and 25 women.The follow-up time was 5.5 years in both groups. There were 16 patients in Osserman category II A , 11 achieving remission; 36 patients were in categories IIB and III, and 14 achieved remission. The duration of disease was 1.8 years and 4.3 years in the remission and non-remission groups, respectively. All patients with remission had less than four years of disease but among the 43 patients with less than four years of symptoms, 42% did not achieve remission. Our data reinforce the need for early thymectomy in myasthenia gravis. KEY WORDS: myasthenia gravis, thymectomyA miastenia gravis (MG) é doença neurológica rara, com incidência de 4,4/1.000.000 25 e prevalência entre 50 a 125 casos por um milhão de habitantes 5,25 . Um neurologista, em média, verá um caso a cada três anos !fi , de modo que somente em centros especializados há oportunidade de se ver um número elevado de casos. A doença é caracterizada por fraqueza muscular flutuante que pode acometer a musculatura ocular, bulbar ou sistêmica. De acordo com Oosterhuis 17 , a história natural da MG , sem outro tratamento que anticolinesterásicos, apresenta uma remissão de 20% e uma mortalidade de 25%. As várias formas de terapia, como timectomia, imunossupressão, assistência respiratória e controle de infecções, afetaram sensivelmente a história natural da MG. Assim , no presente, a mortalidade é praticamente zero e a grande maioria dos pacientes tem vida normal 5 .

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Thymomas in Patients with Myasthenia Gravis

Cited by 50 publications

References 9 publications

Myasthenia gravis and thymoma: evaluation of 41 patients

Myasthenia gravis and thymoma: evaluation of 41 patients

Myasthenia Gravis and Invasive Thymoma

Miastenia gravis: resultados de timectomia em 52 pacientes

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