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Sathirareuangchai S, Mallick J, Hendricks AR, Torrealba JR. Type B3 thymoma associated membranous nephropathy: A rare case and review of the literature. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Zhao J, Bhatnagar V, Ding L, Atay SM, David EA, McFadden PM, Stamnes S, Lechtholz-Zey E, Wightman SC, Detterbeck FC, Kim AW. A systematic review of paraneoplastic syndromes associated with thymoma: Treatment modalities, recurrence, and outcomes in resected cases. J Thorac Cardiovasc Surg 2019; 160:306-314.e14. [PMID: 31982129 DOI: 10.1016/j.jtcvs.2019.11.052] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Paraneoplastic syndromes associated with thymomas remain incompletely understood. The objective was to examine the association between surgically resected thymomas and paraneoplastic syndromes over the past half century. METHODS A primary PubMed/MEDLINE search was used to identify published articles describing paraneoplastic syndromes associated with thymomas from 1960 to 2019. A secondary search identified additional articles referenced in the articles found in the primary search. Kaplan-Meier and log-rank test were used for time-to-event data analyses. RESULTS From 407 articles describing 507 patients, 123 different paraneoplastic syndromes were associated with thymoma. The 5 most common paraneoplastic syndromes were myasthenia gravis, pure red cell aplasia, lichen planus, Good syndrome, and limbic encephalitis. Complete or partial resolution of paraneoplastic syndrome symptoms after surgery was noted in 76% of patients, of whom 21% had a relapse or new paraneoplastic syndrome onset after surgery. The most common adjunctive therapy associated with resolution of paraneoplastic syndrome was corticosteroids (30%). For all patients after surgery, thymoma recurrence was observed in 17% of cases, whereas recurrence of paraneoplastic syndrome was observed in 34% of cases, and both were observed in approximately 11% of cases. The 5- and 10-year overall survivals were 78% and 66%, respectively. Improved overall survival was associated with patients who had total resolution from paraneoplastic syndrome. CONCLUSIONS A comprehensive assessment of publications over the past half century suggests that a multimodal treatment approach that includes surgical resection of thymomas is able to achieve paraneoplastic syndrome resolution in a majority of patients. Onset of new paraneoplastic syndromes after surgery is associated with the recurrence of the first paraneoplastic syndrome, and resolution of paraneoplastic syndrome is associated with improved overall survival.
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Affiliation(s)
- Jasmine Zhao
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Vikrant Bhatnagar
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Li Ding
- Division of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Scott M Atay
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Elizabeth A David
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - P Michael McFadden
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Stephanie Stamnes
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | | | - Sean C Wightman
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | | | - Anthony W Kim
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
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Hanna RM, Arman F, Selamet U, Wallace WD, Barsoum M, Rastogi A, Nobakht N, Shieh P. Secondary membranous nephropathy in a patient with myasthenia gravis without thymic disease, and partial remission induced by adrenocorticotropic hormone therapy. SAGE Open Med Case Rep 2019; 7:2050313X19869764. [PMID: 31448123 PMCID: PMC6689923 DOI: 10.1177/2050313x19869764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/23/2019] [Indexed: 11/27/2022] Open
Abstract
Membranous glomerulonephritis is the most common glomerular disease in adults. Its primary form has been characterized with formation of phospholipase A2 receptor antibodies. Malignancy, infections, and autoimmune disorders are the most common causes of secondary membranous glomerulonephritis. We present a case of a 55-year-old African American female who presented with nephrotic range proteinuria and diagnosed with secondary membranous glomerulonephritis based on distinct pathological features on kidney biopsy and absence of serum phospholipase A2 receptor antibodies. She initially underwent extensive workup for malignancies, infections, and common autoimmune disorders which were all negative. Her proteinuria remained resistant to steroid treatment and she was treated with subcutaneous adrenocorticotropic hormone injections. Meanwhile, she was also diagnosed with the anti-muscle specific kinase antibody variant of myasthenia gravis. In literature, there are few case reports of myasthenia gravis as a cause of secondary membranous glomerulonephritis. In our case, the lack of other inciting factors also suggested this association.
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Affiliation(s)
- Ramy M Hanna
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Division of Nephrology, Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Farid Arman
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Umut Selamet
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - William D Wallace
- Department of Pathology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Marina Barsoum
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Anjay Rastogi
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Niloofar Nobakht
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Perry Shieh
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Myoga H, Akimoto T, Mato N, Nakaya T, Murakami T, Yoshizawa H, Nakagawa S, Miki A, Masuda T, Kobayashi T, Ono Y, Saito O, Ueda Y, Muto S, Nagata D. Nephrotic Syndrome and a Retroperitoneal Mass: A Case Report of a Patient with Recurrent Invasive Thymoma. Intern Med 2017; 56:3317-3322. [PMID: 29021446 PMCID: PMC5790720 DOI: 10.2169/internalmedicine.9224-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 68-year-old man was admitted to our hospital to undergo an examination for nephrotic syndrome while concurrently complicated with recurrent thymoma in the parietal pleura and retroperitoneum. He had been diagnosed with invasive thymoma and had undergone thymo-thymectomy seven years previously. Based on the renal biopsy findings, his nephrotic syndrome was ascribed to minimal change disease. He was treated with corticosteroid monotherapy, which resulted in complete remission six months later, despite the fact that the recurrent thymoma remained. The role of thymoma in the pathogenesis of paraneoplastic glomerulopathy and the therapeutic concerns that emerged in this case are also discussed.
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Affiliation(s)
- Hiroaki Myoga
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Naoko Mato
- Division of Pulmonary Medicine, Department of Internal Medicine, Jichi Medical University, Japan
| | - Takakiyo Nakaya
- Division of Pulmonary Medicine, Department of Internal Medicine, Jichi Medical University, Japan
| | - Takuya Murakami
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Hiromichi Yoshizawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Saki Nakagawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Atsushi Miki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Takahiro Masuda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Takahisa Kobayashi
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Yuko Ono
- Department of Diagnostic Pathology, Dokkyo Medical University Koshigaya Hospital, Japan
| | - Osamu Saito
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Yoshihiko Ueda
- Department of Diagnostic Pathology, Dokkyo Medical University Koshigaya Hospital, Japan
| | - Shigeaki Muto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
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Yoo SH, Kim HJ, Kim JH, Lee GW, Lee JH, Kim SH, Kim JW, Kim JW, Lee JO, Kim YJ, Lee KW, Kim JH, Bang SM, Lee JS. Nephrotic syndrome associated with metastatic thymoma treated with chemotherapy. Medicine (Baltimore) 2017; 96:e5408. [PMID: 28072685 PMCID: PMC5228645 DOI: 10.1097/md.0000000000005408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
RATIONALE Nephropathy with concurrent invasive thymoma is a type of paraneoplastic syndrome. PATIENT CONCERNS AND DIAGNOSES We report a 32-year-old female with nephrotic syndrome that was first diagnosed along with invasive thymoma and treated by means of cisplatin-based chemotherapy for the thymoma. The patient initially presented with dyspnea and generalized edema. Chest radiography and computed tomography scans revealed right pleural effusion and a mass in the right middle lung field, which were confirmed by a percutaneous lung biopsy as metastatic invasive thymoma. Severe hypoalbuminemia, heavy proteinuria, hyponatremia, and hypercholesterolemia were features of the nephrotic syndrome. A kidney needle biopsy suggested focal segmental glomerulosclerosis. INTERVENTIONS AND OUTCOMES All of the symptoms of nephrotic syndrome were resolved simultaneously during the first 2 cycles of chemotherapy. The patient was on regular follow-up with no specific treatment for nephrotic syndrome and underwent successful resection of the left pleura and anterior thymoma. The patient has shown no evidence of recurrence for 2 years. LESSONS We conclude that chemotherapy for invasive thymoma is an effective treatment for nephrotic syndrome accompanying the thymoma.
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Affiliation(s)
- Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul
| | - Hyean-Ji Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul
| | - Jeong-Han Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul
| | - Gyeong-Won Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju
| | - Jeong Hee Lee
- Department of Pathology, Gyeonsang National University College of Medicine, Jinju, Korea
| | - Se Hyun Kim
- Division of Hemato-medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeong-gi
| | - Ji-Won Kim
- Division of Hemato-medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeong-gi
| | - Jin Won Kim
- Division of Hemato-medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeong-gi
| | - Jeong-Ok Lee
- Division of Hemato-medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeong-gi
| | - Yu Jung Kim
- Division of Hemato-medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeong-gi
| | - Keun-Wook Lee
- Division of Hemato-medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeong-gi
| | - Jee Hyun Kim
- Division of Hemato-medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeong-gi
| | - Soo-Mee Bang
- Division of Hemato-medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeong-gi
| | - Jong Seok Lee
- Division of Hemato-medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeong-gi
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Seguier J, Guillaume-Jugnot P, Ebbo M, Daniel L, Jourde-Chiche N, Burtey S, Bernit E, Thomas P, Harlé JR, Schleinitz N. [Thymic disease associated with nephrotic syndrome: a new case with membranous nephropathy and literature review]. Rev Med Interne 2014; 36:487-90. [PMID: 25172778 DOI: 10.1016/j.revmed.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/02/2014] [Accepted: 07/22/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Malignant thymoma or thymic hyperplasia is associated with various autoimmune diseases. Renal disease has rarely been reported in this condition. We report a new case with improvement of renal disease after thymectomy. CASE REPORT A 77-year-old-women with nephritic syndrome was found to have associated thymic mass. Renal pathology showed membranous nephropathy. The thymic mass pathology showed a B2 type thymoma. After thymectomy the nephrotic syndrome improved. CONCLUSION Glomerulopathy can be secondary to an acquired thymic disease. Membranous nephropathy but also other glomerular diseases can be observed often presenting with nephritic syndrome. Despite the rarity of this association this clinical observation underlines that a thymoma should be searched in the presence of a glomerulopathy. The glomerulopathy can be improved by the treatment of the thymoma.
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Affiliation(s)
- J Seguier
- Service de médecine interne, Aix Marseille université, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 5, France.
| | - P Guillaume-Jugnot
- Service de médecine interne, Aix Marseille université, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 5, France
| | - M Ebbo
- Service de médecine interne, Aix Marseille université, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 5, France
| | - L Daniel
- Service d'anatomopathologie, Aix Marseille université, AP-HM, 13385 Marseille cedex 5, France
| | - N Jourde-Chiche
- Service de néphrologie et transplantation rénale, Aix Marseille université, AP-HM, 13385 Marseille cedex 5, France
| | - S Burtey
- Service de néphrologie et transplantation rénale, Aix Marseille université, AP-HM, 13385 Marseille cedex 5, France
| | - E Bernit
- Service de médecine interne, Aix Marseille université, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 5, France
| | - P Thomas
- Service de chirurgie thoracique, Aix Marseille université, AP-HM, 13385 Marseille cedex 5, France
| | - J-R Harlé
- Service de médecine interne, Aix Marseille université, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 5, France
| | - N Schleinitz
- Service de médecine interne, Aix Marseille université, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 5, France
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Yoshidome Y, Hayashi S, Maruyama Y, Yoneda T, Matsuzoe D, Kawakami T, Shirahama H, Tashiro Y, Eiraku N. A case of mixed connective tissue disease complicated with thymic carcinoma and Hashimoto's thyroiditis. Mod Rheumatol 2007; 17:63-6. [PMID: 17278025 DOI: 10.1007/s10165-006-0535-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 09/27/2006] [Indexed: 10/23/2022]
Abstract
We report the case of a 63-year-old woman who suffered from mixed connective tissue disease (MCTD) complicated with thymic carcinoma and Hashimoto's thyroiditis. Although many systemic syndromes associated with thymoma and thymic carcinoma, i.e., myasthenia gravis, pure red cell aplasia, hypogammaglobulinemia, and Hashimoto's thyroiditis, are known, this is the first report of MCTD complicated with thymic carcinoma. It was suggested that MCTD may be a paraneoplastic syndrome associated with thymic carcinoma.
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Affiliation(s)
- Yoshito Yoshidome
- Department of Neurology, Imakiire General Hospital, Kagoshima, Japan.
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Frange P, Frey MA, Deschênes G. [Immunity and immunosuppression in childhood idiopathic nephrotic syndrome]. Arch Pediatr 2005; 12:305-15. [PMID: 15734130 DOI: 10.1016/j.arcped.2004.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Accepted: 12/15/2004] [Indexed: 10/25/2022]
Abstract
Steroid sensitive idiopathic nephrotic syndrome is a T-cell disorder characterized by a functional renal impairment. Concluding a still relevant demonstration involving cellular immunity in the pathogenesis of the disease, R. Shalhoub in 1974 suggested a "special role for the thymus" based on the efficiency of steroids and alkylating agents, dramatic recoveries following measles, sensibility to bacterial infection due to a lack of cooperation between T and B cell and association to Hodgkin disease. As a matter of fact, the selected drugs based on medical empirism somehow enhance thymocytes apoptosis and negative selection of T cell, except cyclosporin. Steroids have been the first historical treatment of idiopathic nephrotic syndrome and have steadily been the first-line treatment for 50 years. Their unavoidable ability to induce rapid recovery of proteinuria and long-lasting or definite remission are dependent to a strict compliance to treatment. Indications of steroids-sparing treatments are not that clearcut in patients with steroids intoxication. Objectively, efficiency of levamisole and cyclophosphamide are much more limited than previously reported and cyclosporin nephrotoxicity might severely impair renal function following long-lasting treatment as well as it may paradoxically increase the activity of the disease. An alternate strategy to those currently adopted would use cyclosporin as the first-line steroids-sparing treatment during a very limited period, awaiting favourable ageing of patients and natural dampening activity of the disease to a full efficiency of alkylating agents. Compared to cyclophosphamide and cyclosporin, the relative safety of levamisole is encouraging to a more frequent uses. Its association to a full dose of prednisone in the treatment of the inaugural episode should be investigated. According to the limitations of those therapies, emerging drugs as mycophenolate might be worthwhile in the treatment of nephrotic patients.
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Affiliation(s)
- P Frange
- Hôpital Armand-Trousseau, assistance-publique-hôpitaux de Paris, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France
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Karras A, de Montpreville V, Fakhouri F, Grünfeld JP, Lesavre P. Renal and thymic pathology in thymoma-associated nephropathy: report of 21 cases and review of the literature. Nephrol Dial Transplant 2005; 20:1075-82. [PMID: 15788438 DOI: 10.1093/ndt/gfh615] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acquired thymic disease (malignant thymoma or thymic hyperplasia) is associated with various autoimmune diseases, such as myasthenia gravis (MG), pure red-cell aplasia (PRCA), pemphigus vulgaris or systemic lupus erythematosus (SLE). Renal disease has rarely been observed in association with thymoma. METHODS This retrospective, multicentric study collected data on patients with thymic disease and biopsy-proven renal involvement. RESULTS Twenty-one patients were studied (age: 49+/-14 years; male/female ratio: 8/13). Thymic pathology revealed mostly high-grade malignant thymoma (B2 and AB type); two cases were associated with non-malignant thymic hyperplasia. MG was found in nine out of 21 cases, SLE in three, PRCA in three and pemphigus in two. In 47% of these cases, nephropathy occurred after curative treatment of thymoma (108+/-83 months; range: 8-180 months), mainly based on surgical thymectomy associated with radiotherapy. Clinical and laboratory findings included nephrotic syndrome (75%), renal failure (50%), frequent presence of antinuclear antibodies and hypogammaglobulinaemia. Renal pathology showed minimal change disease in 14 patients and focal segmental glomerulosclerosis (FSGS) in one. Membranous nephropathy was observed in four cases, ANCA-associated glomerulonephritis in two and thrombotic microangiopathy in one. Most patients with minimal change disease or FSGS (11/13) were steroid-sensitive. Despite good response to steroids, 38% of patients died from thymoma and 17% developed end-stage renal failure. CONCLUSIONS Glomerulopathy can be associated with thymoma or thymic hyperplasia. The present series shows that minimal change disease is the most frequent thymoma-associated glomerular lesion and that it may occur several years after thymectomy.
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Lasseur C, Combe C, Deminière C, Pellegrin JL, Aparicio M. Thymoma associated with myasthenia gravis and minimal lesion nephrotic syndrome. Am J Kidney Dis 1999; 33:e4. [PMID: 10213666 DOI: 10.1016/s0272-6386(99)70444-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A nephrotic syndrome has been observed rarely in association with thymoma. In most of the reported cases, it occurs when the thymoma is in remission; histological examination generally shows minimal change disease. We report a case of a 43-year-old man presenting with minimal lesion nephrotic syndrome at the time of the diagnosis of thymoma and myasthenia gravis, which persists despite remission of the thymoma. The role of a disorder of T-cell function and of circulating cytokines is discussed.
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Affiliation(s)
- C Lasseur
- Service de Néphrologie et d'Hémodialyse, Hôpital Saint-André, Bordeaux Cedex, France.
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