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Eur J Cardiothorac Surg 2006;29:268-269
© 2006 Elsevier Science NL

Letters to the Editor

Reply to Tseng et al.

Kazuya Kondo *

Department of Oncological and Regenerative Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho, Tokushima 770-8503, Japan

Received 30 October 2005; accepted 31 October 2005.

* Tel.: +81 88 633 7143; fax: +81 88 633 7144. (Email: kondo{at}clin.med.tokushima-u.ac.jp).

Key Words: Thymoma • Myasthenia gravis • Thymectomy • Postoperative

It is a very rare and interesting case. There were a few case reports of patients with recurrent thymoma and myasthenia gravis (MG) after thymectomy like the Tseng's case. Shinkai et al. [1] and Shimizu et al. [2] reported recurrences of thymoma with myasthenia gravis 11 and 18 years, respectively, after surgery. Ito et al. [3] also proposed that delay type of postoperative MG is related to recurrence of thymoma. MG symptoms in both patients were controllable by MG and thymoma therapy.

It is unclear whether the interval between thymomectomy and the onset of postoperative MG influences prognosis of the patients with postoperative MG because of the rarity of postoperative MG cases. Namba et al. [4] reported that patients with a shorter onset of postoperative MG had a better prognosis, but both Ito's and our studies did not find this tendency. We speculate that this discrepancy may be due to the difference in the therapy for MG. The mortality of MG in Namba's report was worse than that in Ito's and our reports (10/33, 30% vs 1/15, 0/8, 7–0%) [3–5]. In the present study, the mortality of MG is almost zero by the improvement in the respiratory support and long-term medical care of MG patients.

Namba et al. reported that in patients with onset of MG after partial resection of thymoma, the interval between thymomectomy and the onset of postoperative MG varies (immediate–7 years) and that MG of these patients was severe and it responded poorly to management [4]. In general, the effect of thymectomy in patients with both thymoma and MG is less than that in MG patients without thymoma. The existence of thymoma influences the response of MG to therapy. In Tseng's case, not only a long interval but also recurrent thymoma may have influenced the worse clinical course of MG. We suspect that thymoma releases a number of mature T-cells into the peripheral blood and that the T-cells persist in the periphery, potentially stimulating autoantibody production and subsequent autoimmune disease. However, the trigger of MG in the MG patients with thymoma is a mystery.

References

  1. Shinkai T, Saijo N, Yoshioka S, Yoshioka S, Suemasu K, Hasegawa H, Miyazawa N, Nakajima T, Shimosato Y. Recurrence of thymoma with appearance of myasthenia gravis 18 years after surgery. Jpn J Clin Oncol 1985;15:567-575.[Abstract/Free Full Text]
  2. Shimuzu N, Nakata M, Date H, Kawata S, Kobashi Y, Miyake K, Moriyama S, Miyai Y, Kurita K, Teramoto S. Appearance of myasthenia gravis associating with recurrence of thymoma 11 years after surgery. Nippon Kyoubu Rinsho (Japanese) 1988;47:450-454.
  3. Ito M, Fujimura S, Monden Y, Watanabe Y, Shimizu N, Hirono T, Iuchi K, Tsubota N, Masaoka A. A retrospective group study on post-thymomectomy myasthenia gravis. Nippon Kyoubu Geka Gakkai Zasshi (Japanese) 1992;19:189-193.
  4. Namba T, Brunner NG, Grob D. Myasthenia gravis in patients with thymoma, with particular reference to onset after thymectomy. Medicine (Baltimore) 1978;57:411-433.[Medline]
  5. Kondo K, Monden Y. Myasthenia gravis appearing after thymectomy for thymoma. Eur J Cardiothorac Surg 2005;28:22-25.[Abstract/Free Full Text]




This Article
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