1
|
Nemiroff S, Chai R, Fan J, Ramer-Bass I. Ectopic Cervical Thymoma in a Patient Diagnosed With Graves Disease: A Systematic Literature Review. J Clin Endocrinol Metab 2024; 109:1198-1201. [PMID: 37897424 DOI: 10.1210/clinem/dgad635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
Thymomas are benign thymic epithelial neoplasms, rarely found outside the anterior mediastinum. Although hyperthyroid states have been associated with thymic hyperplasia, only 3 thymoma cases have been previously reported in patients with Graves disease (GD), all within the anterior mediastinum. Here, we report a case of ectopic cervical thymoma in a 22-year-old female patient previously treated for GD. The patient underwent ultrasonography, computed tomography, inconclusive fine-needle aspiration, and ultimately gross dissection for diagnostic workup and definitive treatment of an anterior neck mass, producing a 2.5 × 2.3 × 1.5-cm entity consistent with Masaoka stage I and type B2 thymoma per World Health Organization classification. The patient underwent an uncomplicated subsequent clinical course, with no adjuvant radiotherapy administered. After conducting a systematic literature review, we conclude that of the 109 cases of ectopic cervical thymoma reported, this is the first to describe a case of ectopic cervical thymoma in a patient with a past medical history of GD. For GD patients in stable euthyroid remission with the persistent or recurrent presence of an anterior neck mass, the extrathyroidal origin of the mass should always be considered, including the exceptional presence of a cervical ectopic thymoma.
Collapse
Affiliation(s)
- Samuel Nemiroff
- Internal Medicine Resident at Mount Sinai Morningside and West, New York, NY 10019, USA
| | - Raymond Chai
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jun Fan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ilana Ramer-Bass
- Division of Endocrinology at Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY 10019, USA
| |
Collapse
|
2
|
Wei Q, Bueso-Ramos CE. Thymoma with aberrant expression of CD20: a potential diagnostic pitfall of B-cell lymphoma. Blood 2024; 143:1551. [PMID: 38602694 DOI: 10.1182/blood.2023022586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Affiliation(s)
- Qing Wei
- The University of Texas M.D. Anderson Cancer Center
| | | |
Collapse
|
3
|
Su C, Zhu X, Wang Q, Zhang J. A basaloid carcinoma with multilocular thymic cyst mimicking a mediastinal teratoma. J Cardiothorac Surg 2024; 19:198. [PMID: 38600577 PMCID: PMC11007915 DOI: 10.1186/s13019-024-02712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/29/2024] [Indexed: 04/12/2024] Open
Abstract
This case report details a rare thymic basaloid carcinoma initially misinterpreted as a mediastinal teratoma, underscoring the diagnostic challenges posed by such tumors. A 71-year-old female presented with an asymptomatic anterior mediastinal tumor discovered incidentally during a routine health examination. Surgical intervention, followed by pathological and immunohistochemical analysis including CK-pan, p63, p40, and CD117 molecules, led to a definitive diagnosis of basaloid carcinoma of the thymus. This case highlights the critical importance of differential diagnosis in mediastinal lesions, especially those presenting with multilocular thymic cysts on chest CT. The subxiphoid video-assisted thoracoscopic surgery enabled complete tumor resection with minimal trauma and favorable postoperative outcomes. The patient opted against further radiotherapy or chemotherapy and she has survived for over eight months without recurrence. This case report contributes to the growing understanding of thymic basaloid carcinoma, a rare and potentially aggressive thymic carcinoma subtype. It emphasizes the necessity for precise surgical techniques and enhanced diagnostic acumen among cardiothoracic surgeons and oncologists.
Collapse
Affiliation(s)
- Chen Su
- Department of Cardiothoracic Surgery, Wujin Hospital Affiliated with Jiangsu University, No.2 North Yongning Road, Changzhou, 213000, China
- Department of Cardiothoracic Surgery, Wujin Clinical college of Xuzhou Medical University, No.2 North Yongning Road, Changzhou, Jiangsu Province, China
| | - Xiaobo Zhu
- Department of Cardiothoracic Surgery, Wujin Hospital Affiliated with Jiangsu University, No.2 North Yongning Road, Changzhou, 213000, China
- Department of Cardiothoracic Surgery, Wujin Clinical college of Xuzhou Medical University, No.2 North Yongning Road, Changzhou, Jiangsu Province, China
| | - Qiang Wang
- Department of Cardiothoracic Surgery, Wujin Hospital Affiliated with Jiangsu University, No.2 North Yongning Road, Changzhou, 213000, China
- Department of Cardiothoracic Surgery, Wujin Clinical college of Xuzhou Medical University, No.2 North Yongning Road, Changzhou, Jiangsu Province, China
| | - Junjie Zhang
- Department of Cardiothoracic Surgery, Wujin Hospital Affiliated with Jiangsu University, No.2 North Yongning Road, Changzhou, 213000, China.
- Department of Cardiothoracic Surgery, Wujin Clinical college of Xuzhou Medical University, No.2 North Yongning Road, Changzhou, Jiangsu Province, China.
| |
Collapse
|
4
|
Frost N, Wesseler C, Wörmann B, Eberhardt WEE. [Criteria for inpatient diagnostic and treatment of patients with lung cancer, mesothelioma or thymoma]. Pneumologie 2024; 78:233-235. [PMID: 38608657 DOI: 10.1055/a-2227-3775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- Nikolaj Frost
- Charité Universitätsmedizin Berlin, Fächerverbund für Infektiologie, Pneumologie und Intensivmedizin, Klinik für Infektiologie und Intensivmedizin, Klinik für Pneumologie, Beatmungsmedizin und Intensivmedizin mit dem Arbeitsbereich Schlafmedizin, Berlin, Deutschland
| | - Claas Wesseler
- Asklepios Klinikum Harburg, Klinik für Pneumologie, Hamburg, Deutschland
| | - Bernhard Wörmann
- Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie, Berlin, Deutschland
| | | |
Collapse
|
5
|
Molina TJ, Roden AC, Szolkowska M, Shimizu S, Moreira AL, Chalabreysse L, Besse B, de Montpréville V, Marom EM, Detterbeck F, Girard N, Nicholson AG, Marx A. International reproducibility study of thymic epithelial tumors staging: pT stage is an issue. proposals for improvement. A RYTHMIC/ITMIG study. Lung Cancer 2024; 189:107479. [PMID: 38306885 DOI: 10.1016/j.lungcan.2024.107479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Pathologists are staging thymic epithelial tumors (TET) according to the 8th UICC/AJCC TNM system. Within the French RYTHMIC network, dedicated to TET, agreement on pathologic tumor stage (pT) among the pathology panelists was difficult. The aim of our study was to determine the interobserver reproducibility of pT at an international level, to explore the source of discrepancies and potential interventions to address these. METHODS An international panel of pathologists was recruited through the International Thymic Malignancy Interest Group (ITMIG). The study focused on invasion of mediastinal pleura, pericardium, and lung. From a cohort of cases identified as challenging within the RYTHMIC network, we chose a series of test and validation cases (n = 5 and 10, respectively). RESULTS Reproducibility of the pT stage was also challenging at an international level as none of the 15 cases was classified as the same pT stage by all ITMIG pathologists. The agreement rose from slight (κ = 0.13) to moderate (κ = 0.48) between test and validation series. Discussion among the expert pathologists pinpointed two major reasons underlying discrepancies: 1) Thymomas growing with their "capsule" and adhering to the pleurae, pericardium, or lung were often misinterpreted as invading these structures. 2) Recognition of the mediastinal pleura was identified as challenging. CONCLUSION Our study underlines that the evaluation of the pT stage of TET is problematic and needs to be addressed in more detail in an upcoming TNM classification. The publication of histopathologic images of landmarks, including ancillary tests could improve reproducibility for future TNM classifications.
Collapse
Affiliation(s)
- Thierry J Molina
- Department of Pathology, Université Paris Cité, Hôpitaux Necker-Enfants Malades et Robert Debré, APHP, INSERM, U1163, Institut IMAGINE, Paris, France.
| | - Anja C Roden
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Malgorzata Szolkowska
- Department of Pathology, The Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Shigeki Shimizu
- Department of Laboratory Medicine and Pathology, NHO Kinki-chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Andre L Moreira
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lara Chalabreysse
- Department of Pathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Benjamin Besse
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France, Paris-Saclay University, Orsay, France
| | | | - Edith M Marom
- Department of Diagnostic Radiology, Tel Aviv University, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Frank Detterbeck
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Nicolas Girard
- Thorax Institute Curie Montsouris, Paris, France, Universite de Versailles Saint Quentin (UVSQ), Paris Saclay University, Versailles, France
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, and National Heart and Lung Institute, Imperial College, London, England
| | - Alexander Marx
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
6
|
Kabir A, Polito V, Tsoukas CM. Unraveling the Natural History of Good's Syndrome: A Progressive Adult Combined Immunodeficiency. J Allergy Clin Immunol Pract 2024; 12:744-752.e3. [PMID: 38122866 DOI: 10.1016/j.jaip.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/20/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Good's syndrome (GS) is a rare immune deficiency described almost 6 decades ago. Despite numerous published individual case reports and data collected in cross-sectional studies of small cohorts, the natural history and long-term outcomes of this disease remain unknown. OBJECTIVE We aimed to determine the clinical and laboratory evolution of 8 adults diagnosed with GS and consecutively evaluated between 1983 and 2023. METHODS In this prospective, longitudinal cohort study, newly diagnosed patients with GS were followed through repeated measures of clinical, immune, and hematologic changes, as well as targeted genetic screening. RESULTS All patients reported a healthy childhood and adolescence with symptom onset during the third or fourth decade of life. All presented to our center with recurrent bacterial sinopulmonary infections, thymoma, hypogammaglobulinemia, and absence of B cells. The median age of GS diagnosis was 57 years. During follow-up, immunoglobin replacement therapy effectively minimized sinopulmonary infections. However, the majority experienced severe and systemic viral or fungal infections, 3 developed basal cell carcinomas, and 5 had progressive bronchiectasis and persistent splenomegaly. The most notable clinical feature was opportunistic infections and in vitro evidence of cellular immune deficiency, which resulted in the death of 2 individuals. We also report a statistically significant, multidecade progressive decline in lymphocytes, platelets, hemoglobin, and red blood cells in our cohort, suggesting gradual bone marrow failure. CONCLUSIONS Knowledge of the unique phenotype and temporal evolution of GS has allowed us to develop a more comprehensive diagnostic framework. It can be investigated as part of broader research into disease pathophysiology.
Collapse
Affiliation(s)
- Aunonna Kabir
- Department of Experimental Medicine, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Vanessa Polito
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada; Department of Medicine, Division of Allergy and Clinical Immunology, McGill University Health Centre, Montreal, QC, Canada
| | - Christos M Tsoukas
- Department of Experimental Medicine, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada; Department of Medicine, Division of Allergy and Clinical Immunology, McGill University Health Centre, Montreal, QC, Canada.
| |
Collapse
|
7
|
Feng GC, Liu Z, Li HQ, Zuo DH, Sun HL, Qiao LX, Yin DT. [Clinical diagnosis and treatment analysis of 21 cases of intrathyroid thymic carcinoma]. Zhonghua Yi Xue Za Zhi 2024; 104:440-444. [PMID: 38326056 DOI: 10.3760/cma.j.cn112137-20231008-00676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Objective: To analyze the clinical efficacy of intrathyroid thymic carcinoma (ITTC). Methods: This study retrospectively analyzed the clinical data of 21 patients with ITTC diagnosed and treated at the First Affiliated Hospital of Zhengzhou University from January 2018 to July 2023, including 9 males and 12 females, with a median age of 52 years (40-60 years old). Results: There is a correlation between the maximum diameter of the tumor (≥40 mm) and lymph node metastasis (P=0.044). Seventeen patients received surgical treatment, and 4 patients only received chemotherapy. During the follow-up period, a total of 4 patients experienced death or progression, with a 2-year mortality or progression free survival rate of 74.8%. Conclusions: The prognosis of ITTC is good, and surgical treatment is the preferred treatment option, lymph node metastasis is significantly correlated with prognosis. The radiotherapy and chemotherapy of ITTC need to be determined based on the patient's condition.
Collapse
Affiliation(s)
- G C Feng
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Engineering Research Center of Multidisciplinary Diagnosis and Treatment of Thyroid Cancer of Henan Province, Key Medicine Laboratory of Thyroid Cancer of Henan Province, Zhengzhou 450052, China
| | - Z Liu
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Engineering Research Center of Multidisciplinary Diagnosis and Treatment of Thyroid Cancer of Henan Province, Key Medicine Laboratory of Thyroid Cancer of Henan Province, Zhengzhou 450052, China
| | - H Q Li
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Engineering Research Center of Multidisciplinary Diagnosis and Treatment of Thyroid Cancer of Henan Province, Key Medicine Laboratory of Thyroid Cancer of Henan Province, Zhengzhou 450052, China
| | - D H Zuo
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Engineering Research Center of Multidisciplinary Diagnosis and Treatment of Thyroid Cancer of Henan Province, Key Medicine Laboratory of Thyroid Cancer of Henan Province, Zhengzhou 450052, China
| | - H L Sun
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Engineering Research Center of Multidisciplinary Diagnosis and Treatment of Thyroid Cancer of Henan Province, Key Medicine Laboratory of Thyroid Cancer of Henan Province, Zhengzhou 450052, China
| | - L X Qiao
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Engineering Research Center of Multidisciplinary Diagnosis and Treatment of Thyroid Cancer of Henan Province, Key Medicine Laboratory of Thyroid Cancer of Henan Province, Zhengzhou 450052, China
| | - D T Yin
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Engineering Research Center of Multidisciplinary Diagnosis and Treatment of Thyroid Cancer of Henan Province, Key Medicine Laboratory of Thyroid Cancer of Henan Province, Zhengzhou 450052, China
| |
Collapse
|
8
|
Miller JW, Faubert BM, Mathews TP, Waters JK, DeBerardinis RJ, Kernstine KH. Metabolic signatures of thymomas: potential biomarkers and treatment targets. Eur J Cardiothorac Surg 2024; 65:ezad394. [PMID: 38011656 PMCID: PMC10882262 DOI: 10.1093/ejcts/ezad394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/13/2023] [Accepted: 11/24/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES A study of tumour metabolic reprogramming has revealed disease biomarkers and avenues for therapeutic intervention. Metabolic reprogramming in thymoma is currently understudied and largely unknown. This study utilized metabolomics and isotope tracing with 13C-glucose to metabolically investigate thymomas, adjacent thymic tissue and benign thymic lesions. METHODS From 2017 to 2021, 20 patients with a suspected thymoma were recruited to this prospective Institutional Review Board approved clinical trial. At the time of surgery, 11 patients were infused with 13C-glucose, a stable, non-radioactive tracer which reports the flow of carbon through metabolic pathways. Samples were analysed by mass spectrometry to measure the abundance of >200 metabolites.13C enrichment was measured in patients who received 13C-glucose infusions. RESULTS Histological analysis showed that 9 patients had thymomas of diverse subtypes and 11 patients had benign cysts. In our metabolomic analysis, thymomas could be distinguished from both adjacent thymus tissue and benign lesions by metabolite abundances. Metabolites in pyrimidine biosynthesis and glycerophospholipid metabolism were differentially expressed across these tissues.13C-glucose infusions revealed differential labelling patterns in thymoma compared to benign cysts and normal thymus tissue. The lactate/3PG labelling ratio, a metabolic marker in aggressive lung tumours correlated with lactate uptake, was increased in thymomas (1.579) compared to normal thymus (0.945) and benign masses (0.807) (thymic tissue versus tumour P = 0.021, tumour versus benign P = 0.013). CONCLUSIONS We report metabolic biomarkers, including differential 13C labelling of metabolites from central metabolism, that distinguish thymomas from benign tissues. Altered glucose and lactate metabolism warrant further investigation and may provide novel therapeutic targets for thymoma.
Collapse
Affiliation(s)
- James W Miller
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brandon M Faubert
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Thomas P Mathews
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John K Waters
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ralph J DeBerardinis
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kemp H Kernstine
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
9
|
Chen JQ, Li W, Cai SQ. Erythroderma in a Patient With Thymoma-Associated Myasthenia Gravis. JAMA Dermatol 2024; 160:224-225. [PMID: 38170503 DOI: 10.1001/jamadermatol.2023.4228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
A woman in her 30s with myasthenia gravis diagnosed at age 27 years presented to the emergency department with severe erythroderma over the past 2 months. What is your diagnosis?
Collapse
Affiliation(s)
- Jia-Qi Chen
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Li
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sui-Qing Cai
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
10
|
Su M, Luo Q, Wu Z, Feng H, Zhou H. Thymoma-associated autoimmune encephalitis with myasthenia gravis: Case series and literature review. CNS Neurosci Ther 2024; 30:e14568. [PMID: 38421083 PMCID: PMC10850820 DOI: 10.1111/cns.14568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/20/2023] [Accepted: 12/02/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES This comprehensive review aimed to compile cases of patients with thymoma diagnosed with both autoimmune encephalitis (AE) and myasthenia gravis (MG), and describe their clinical characteristics. METHODS Clinical records of 3 AE patients in the first affiliated hospital of Sun Yat-sen University were reviewed. All of them were diagnosed with AE between 1 November 2021 and 1 March 2022, and clinical evidence about thymoma and MG was found. All published case reports were searched for comprehensive literature from January 1990 to June 2022. RESULTS A total of 18 cases diagnosed with thymoma-associated autoimmune encephalitis (TAAE) and thymoma-associated myasthenia gravis (TAMG) were included in this complication, wherein 3 cases were in the first affiliated hospital of Sun Yat-sen University and the other 15 were published case reports. 5/18 patients had alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antibody (AMPAR-Ab) in their serum and cerebrospinal fluid (CSF). All of them had positive anti-acetylcholine receptor antibody (AChR-Ab). And 12/18 patients showed a positive response to thymectomy and immunotherapy. Besides, thymoma recurrences were detected because of AE onset. And the shortest interval between operation and AE onset was 2 years in patients with thymoma recurrence. CONCLUSIONS There was no significant difference in the clinical manifestations between these patients and others with only TAMG or TAAE. TAAE was commonly associated with AMPAR2-Ab. Significantly, AE more commonly heralded thymoma recurrences than MG onset. And the intervals of thymectomy and MG or AE onset had different meanings for thymoma recurrence and prognoses of patients.
Collapse
Affiliation(s)
- Miao Su
- Department of NeurologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Qiuyan Luo
- Department of NeurologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
- Department of NeurologyGuangzhou Women and Children's Medical CenterGuangzhouChina
| | - Zichao Wu
- Department of NeurologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Huiyu Feng
- Department of NeurologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Hongyan Zhou
- Department of NeurologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| |
Collapse
|
11
|
Vega Prado I, Shymansky J, Apte A, Mortman K, Kaminski HJ, Barak S. A Rare Case of Metaplastic Thymoma Presenting With Myasthenia Gravis. Int J Surg Pathol 2024; 32:155-159. [PMID: 37093756 DOI: 10.1177/10668969231168344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Thymomas are tumors of the mediastinum often associated with autoimmune conditions, in particular myasthenia gravis. In contrast, among the fewer than 40 reports of metaplastic thymoma, myasthenia gravis is rarely found. We describe the fourth patient, and first man, with metaplastic thymoma and myasthenia gravis. A 34-year-old had acute onset of double vision with associated dysphagia and was found to have an elevation of serum acetylcholine receptor antibodies. He underwent a transsternal thymectomy. Tissue sections showed a biphasic proliferation of keratin-positive epithelial cells with a complement of spindle cells confirming the diagnosis of metaplastic thymoma. Terminal deoxynucleotidyl transferase (TDT)-positive T lymphocytes were rare and only found in the periphery of the tumor, consistent with thymic remnant. A YAP1::MAML2 gene fusion, with an in-frame fusion between genes YAP1 Exon5 (NM_001130145) and MAML2 Exon2 (NM_032427) was found, supporting further the diagnosis of metaplastic thymoma (Anchored multiplex RNA sequencing [Archer Dx, Boulder, CO] assay). The patient's gender and relatively young age, the presence of an autoimmune condition, and the lack of lymphocytic infiltrate all contribute unusual features to this case and suggest avenues for further exploration.
Collapse
Affiliation(s)
- Ilianne Vega Prado
- Department of Pathology, The George Washington University, Washington, DC, USA
| | - John Shymansky
- Department of Neurology & Rehabilitation Medicine, The George Washington University, Washington, DC, USA
| | - Anisha Apte
- Department of Surgery, The George Washington University, Washington, DC, USA
| | - Keith Mortman
- Department of Surgery, The George Washington University, Washington, DC, USA
| | - Henry J Kaminski
- Department of Neurology & Rehabilitation Medicine, The George Washington University, Washington, DC, USA
| | - Stephanie Barak
- Department of Pathology, The George Washington University, Washington, DC, USA
| |
Collapse
|
12
|
Berry K, Cooper C. Disseminated thymoma in pleural fluid: An unusual case. Diagn Cytopathol 2024; 52:131-135. [PMID: 38102931 DOI: 10.1002/dc.25266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023]
Abstract
Thymic epithelial tumours show characteristic cytological features on fine-needle aspiration cytology, however the cytological features of thymoma in fluid cytology are not well described. We present the case of a 77 year-old-woman with known pleural dissemination of type B2/B3 thymoma presenting with shortness of breath and orthopnoea due to a pleural effusion. Cytological evaluation of the pleural fluid showed cellular smears composed of numerous small lymphocytes with small numbers of admixed mesothelial cells. There was no epithelial component. On immunohistochemical (IHC) staining the lymphocytes were T cells which were positive for CD3. CD1a and terminal deoxynucleotide transferase (TdT) were also positive, consistent with immature lymphocytes of thymic origin. Despite the lack of an epithelial component, this case was diagnosed as suspicious for recurrent/ metastatic thymoma. This is only the second published case of thymoma identified on pleural fluid cytology, and to our knowledge the first case describing thymoma in pleural fluid with no epithelial component, a potential pitfall with the more common differential diagnosis of a reactive lymphocytic effusion.
Collapse
Affiliation(s)
- Kate Berry
- Pathology Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Caroline Cooper
- Pathology Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
13
|
Yang Y, Chen C, Zheng B, Fan L, Chen X, Hu M. Pure white cell aplasia before and after thymectomy in the rare conundrum of thymoma: A case report and review of the literature. Medicine (Baltimore) 2024; 103:e36920. [PMID: 38241556 PMCID: PMC10798751 DOI: 10.1097/md.0000000000036920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024] Open
Abstract
RATIONALE Pure white cell aplasia (PWCA) is a rare paraneoplastic syndrome that occurs in patients with thymomas. Currently, the pathogenesis and treatment of this disease remain in the exploratory stage. PATIENT CONCERNS We report a 68-year-old woman with thymoma experienced PWCA involvement as her first presentation. The patient had high fever and agranulocytosis at the onset of the disease. The white blood cell count in the complete blood count was 1.9 × 109/L with a neutrophil of 0.1 × 109/L. The bone marrow aspirates showed decreased granulocyte proliferation. Computed tomography showed a large mass in the anterior mediastinum. DIAGNOSES The final diagnosis of our patient was PWCA and thymoma. INTERVENTIONS She underwent a thymectomy and cyclosporine A administration during first remission. OUTCOMES Long-term remission was achieved following the readministration of cyclosporine A after the disease recurrence. LESSONS PWCA or agranulocytosis with thymoma has been confirmed to be an extremely rare disease. Thymomas with PWCA correlate with autoimmunity. From this case study and the literature review, we concluded that the pathogenesis of thymomas in PWCA is mainly related to the activation of autoreactive T cells. Thymectomy and the immunosuppressive drug, cyclosporine A, were chosen for treatment. The patient's granulocyte levels were unable to recover after surgery because of the inability to promptly clear activated T cells. After surgery, cyclosporine A continued to take for a long time. Thymectomy combined with prolonged cyclosporine A administration may be an effective method for treating this rare disease.
Collapse
Affiliation(s)
- Yang Yang
- Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chunmei Chen
- Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Bingrong Zheng
- Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Liping Fan
- Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xiajun Chen
- Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Meiwei Hu
- Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| |
Collapse
|
14
|
Ying J, Huang Y, Ye X, Zhang Y, Yao Q, Wang J, Yang X, Yu C, Guo Y, Zhang X, Lv Q, Wang C, Mao W, Zhao A. Comprehensive study of clinicopathological and immune cell infiltration and lactate dehydrogenase expression in patients with thymic epithelial tumours. Int Immunopharmacol 2024; 126:111205. [PMID: 38029550 DOI: 10.1016/j.intimp.2023.111205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Lactate dehydrogenase (LDH) has emerged as a promising biomarker for cancer. However, the current understanding of LDH and circulating LDH expression in thymic epithelial tumour (TET) is lacking. METHODS A comprehensive literature review and meta-analysis were performed to evaluate the clinical significance of circulating LDH levels in patients with TET. Circulating LDH levels were measured using a laboratory analyser (Cobas8000, Roche, Basel, Switzerland). The maximum standardised uptake value (SUVmax) was determined in patients who underwent whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). Multiplex immunohistochemistry (IHC) was performed using a commercially available kit (Opal 6-plex Detection Kit, Akoya Biosciences, Marlborough, MA, USA) and slide scanner (Slideview VS200, Olympus, Tokyo, Japan). All statistical analyses were performed using SPSS (IBM Corp., Armonk, NY, USA) and Prism version 9.0 (GraphPad Inc., San Diego, CA, USA). Differences with p < 0.05 were considered to be statistically significant. RESULTS Meta-analysis revealed that elevated circulating serum levels of LDH predicted poor prognosis in patients with TET. Circulating levels of LDH were analysed in the serum of 313 patients with TET and 87 with benign mediastinal mass. The mean circulating LDH level in patients with thymic carcinoma (TC) was significantly higher than that in those with thymoma (TM) and the benign group (p < 0.001). Expression levels of circulating LDH were significantly reduced in postoperative samples compared with that in preoperative samples (p < 0.05). Receiver operating characteristic (ROC) curve analysis for diagnosing TC yielded an area under the curve of 0.74, with a sensitivity of 54 % and specificity of 86 %. Furthermore, patients with TC exhibited higher 18F-FDG PET/CT SUVmax values compared to those with TM. Correlation analysis demonstrated a positive association between SUVmax values and circulating LDH levels. In addition, the percentages of LDH-positive cells in TC and type B1 TM tissues were higher than those in other subtypes of TM, and a significant positive correlation between the percentages of LDH-positive and CD20-positive cells was detected in patients with TET (p < 0.05). CONCLUSION Circulating serum LDH level may serve as a non-invasive biomarker for the diagnosis and prognosis of TET. The relationship between LDH expression and immune cell infiltration merits further regarding its application in companion diagnosis for immunotherapy.
Collapse
Affiliation(s)
- Jianghua Ying
- Zhejiang Cancer Institute, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou 310000, Zhejiang, China
| | - Yueyu Huang
- Zhejiang Cancer Institute, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou 310000, Zhejiang, China; The Second Clinical Medical College, Zhejiang Traditional Chinese Medicine University, Hangzhou 310000, Zhejiang, China
| | - Xuemei Ye
- Department of Nuclear Medicine, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou 310000, Zhejiang, China
| | - Yimin Zhang
- Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou 310000, Zhejiang, China
| | - Qifeng Yao
- Zhejiang Cancer Institute, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou 310000, Zhejiang, China
| | - Jiahui Wang
- Zhejiang Cancer Institute, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou 310000, Zhejiang, China
| | - Xuping Yang
- Zhejiang Cancer Institute, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou 310000, Zhejiang, China
| | - Chang Yu
- Department of Pathology, Zhejiang Cancer Hospital, Chinese Academy of Sciences, Hangzhou 310000, Zhejiang, China
| | - Yangzhong Guo
- Thoracic Oncology Laboratory, Jiangxi Cancer Hospital, Nanchang 330006, Jiangxi, China
| | - Xiaofang Zhang
- Thoracic Oncology Laboratory, Jiangxi Cancer Hospital, Nanchang 330006, Jiangxi, China
| | - Qiaoli Lv
- Thoracic Oncology Laboratory, Jiangxi Cancer Hospital, Nanchang 330006, Jiangxi, China
| | - Changchun Wang
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Chinese Academy of Sciences, Hangzhou 310000, Zhejiang, China; Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (Lung and Esophagus), Hangzhou 310000, Zhejiang, China
| | - Weimin Mao
- Thoracic Oncology Laboratory, Jiangxi Cancer Hospital, Nanchang 330006, Jiangxi, China; Department of Thoracic Surgery, Zhejiang Cancer Hospital, Chinese Academy of Sciences, Hangzhou 310000, Zhejiang, China; Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (Lung and Esophagus), Hangzhou 310000, Zhejiang, China.
| | - An Zhao
- Zhejiang Cancer Institute, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou 310000, Zhejiang, China; Thoracic Oncology Laboratory, Jiangxi Cancer Hospital, Nanchang 330006, Jiangxi, China; Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (Lung and Esophagus), Hangzhou 310000, Zhejiang, China.
| |
Collapse
|
15
|
Abstract
The epithelial and lymphoid compartments of the thymus can give rise to a wide variety of tumours, including thymomas, thymic carcinomas, lymphoreticular proliferations, germ cell tumours, and sarcomas. While some of these have close similarity to their counterparts in other organs, both in terms of histology and immunohistochemistry, as well as molecular features, others are unique to the thymus. The epithelial tumours, which can develop in the thymus, will be discussed in this review, with a particular emphasis on resolving differential diagnosis by means of morphology, immunohistochemical profiles, and molecular diagnostics.
Collapse
Affiliation(s)
- Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
16
|
Jin M, Liu P, Qi G. Exploring Potential Biomarkers of Early Thymoma based on Serum Proteomics. Protein Pept Lett 2024; 31:74-83. [PMID: 38053354 DOI: 10.2174/0109298665275655231103105924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/25/2023] [Accepted: 10/06/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Early diagnosis remains difficult because the early symptoms of thymoma are atypical. OBJECTIVES This study aimed to analyze the changes of serum proteins in the early stage of thymoma (stage I/II) by proteomics method and to screen and validate candidate biomarkers. METHODS Proteins were extracted from 8 sera patients with stage I/II thymoma and 9 healthy controls. The levels of serum proteins were detected by data-independent acquisition (DIA) quantitative proteomics techniques, and the differential proteins were identified. The proteomic results were verified by enzyme-linked immunosorbent assay. Additionally, differentially expressed proteins were analyzed using receiver operating characteristic curves (ROC). RESULTS There were 80 differentially expressed proteins between the patients with thymoma and the healthy control group, among which 39 were up-regulated and 41 were down-regulated. Differential protein enrichment is involved in environmental information processing, signaling molecules and interactions, and in the body system and the immune system. The analysis of receptor working characteristic curves showed that the areas under the curve of CORO1A, SAA1 and LTA4H were all larger than 0.8, indicating that these proteins had good diagnostic value. CONCLUSION CORO1A, SAA1 and LTA4H may be new biomarkers for early screening of thymoma.
Collapse
Affiliation(s)
- Min Jin
- Department of Oncology, Hebei Medical University, Hebei, China
- People's Hospital of Shijiazhuang Affiliated to Hebei Medical University, Hebei, China
| | - Peng Liu
- People's Hospital of Shijiazhuang Affiliated to Hebei Medical University, Hebei, China
| | - Guoyan Qi
- Department of Oncology, Hebei Medical University, Hebei, China
- People's Hospital of Shijiazhuang Affiliated to Hebei Medical University, Hebei, China
- Hebei Provincial Key Laboratory of Myasthenia Gravis, Hebei, China
- Hebei Provincial Clinical Research Center for Myasthenia Gravis, Hebei, China
| |
Collapse
|
17
|
Sugai K, Nakaoka K, Tobita R, Kikuchi S, Inoue K, Enokido M, Kiyoshima M. A case of a shrunken multilocular mediastinal cyst that developed into thymic carcinoma with lung metastases 13 years later. Thorac Cancer 2024; 15:94-97. [PMID: 38018322 PMCID: PMC10761612 DOI: 10.1111/1759-7714.15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
Multilocular thymic cysts (MTC) are acquired multilocular cysts caused by inflammation. The rarity of such lesions and a lack of recognition make diagnosis and treatment difficult. Herein, we present our experience with a multilocular mediastinal cyst that resulted in the development of thymic cancer with metastasis over a period of 13 years. Computed tomography findings revealed an anterior mediastinal mass that was suspected to be an MTC in a 49-year-old man. The mass shrank gradually over a period of 7 years; however, growth was observed at 10 years after initial detection. At 13 years after detection, thymic carcinoma with multiple lung metastases was diagnosed. Resection was recommended during the follow-up period, but the patient refused treatment. A multilocular wall and location are factors that indicate MTC. However, even if a definitive diagnosis is not made, resection of multilocular anterior mediastinal cysts should be considered as determining the preoperative diagnosis is difficult. Nevertheless, our case suggests that the coexistence of tumors with cysts is possible, and the potential for malignant tumor development exists.
Collapse
Affiliation(s)
- Kazuto Sugai
- Department of Thoracic SurgeryIbaraki Prefectural Central HospitalKasamaJapan
| | - Kojiro Nakaoka
- Department of Thoracic SurgeryIbaraki Prefectural Central HospitalKasamaJapan
| | - Rika Tobita
- Department of Thoracic SurgeryIbaraki Prefectural Central HospitalKasamaJapan
| | - Shinji Kikuchi
- Department of Thoracic SurgeryIbaraki Prefectural Central HospitalKasamaJapan
- Department of Thoracic SurgeryUniversity of TsukubaTsukubaJapan
| | - Kei Inoue
- Department of Diagnostic RadiologyIbaraki Prefectural Central HospitalKasamaJapan
| | - Midori Enokido
- Department of Diagnostic RadiologyIbaraki Prefectural Central HospitalKasamaJapan
| | - Moriyuki Kiyoshima
- Department of Thoracic SurgeryIbaraki Prefectural Central HospitalKasamaJapan
| |
Collapse
|
18
|
Bansal D, Pasricha S, Gupta G, Sharma A, Durga G, Kamboj M, Mehta A. Diagnostic utility of LMO2 immunohistochemistry in distinguishing T-lymphoblastic leukemia/lymphoma from thymoma. INDIAN J PATHOL MICR 2024; 67:141-144. [PMID: 38358204 DOI: 10.4103/ijpm.ijpm_111_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Distinguishing T-lymphoblastic leukemia/lymphoma (T-ALL/T-LBL) from thymomas (especially B1 or B2 type) can be challenging particularly in limited trucut biopsy material where appreciating architecture is difficult or the background epithelial component does not provide tangible evidence for definite diagnosis. As a pathologist, it is important to accurately diagnose these neoplasms because they have entirely distinct management protocols. Recent studies have reported that LIM Domain Only 2 (LMO2) is expressed in neoplastic lymphoblasts of T-ALL/T-LBL and is absent in thymocytes of normal thymuses or thymomas. An observational study was done to test the sensitivity and specificity of LMO2 in differentiating neoplastic lymphoblasts from thymocytes of thymomas/normal thymuses. Our study showed that LMO2 had sensitivity of 70% and specificity of 100% in diagnosing LBL. None of the thymomas (B1 or B2 type) showed expression of LMO2 in the neoplastic cells. LMO2 is a reliable marker of transformed T-cell precursors and should be routinely included in immunohistochemical panel when evaluating thymic/mediastinal neoplasms.
Collapse
Affiliation(s)
- Divya Bansal
- Department of Pathology, Molecular Diagnostics and Transfusion Services, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India Department of Laboratory Services, Molecular Diagnostics and Transfusion Services, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | | | | | | | | | | | | |
Collapse
|
19
|
Baquero-Ospina P, Cantu-Rosales C, Concha-Del-Rio LE. GOOD SYNDROME: CYTOMEGALOVIRUS RETINITIS CASE CHALLENGE. Retin Cases Brief Rep 2024; 18:112-115. [PMID: 36731097 DOI: 10.1097/icb.0000000000001316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/31/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To describe cytomegalovirus retinitis in a patient with Good syndrome (hypogammaglobulinemia and thymoma), ocular progression despite treatment and fatal outcome. METHODS A 71-year-old woman with unilateral panuveitis of unknown cause and a history of thymoma resection was referred to the clinic. Visual acuity was 20/100 in her right eye and light perception in her left eye. In slit-lamp examination, the right eye had inferior, fine, pigmented keratic precipitates, 2+ anterior chamber cells, cataract, and 2+ vitreous cells, with no fundus detail and normal ocular ultrasound results. Left eye presented a white cataract, chronic hypotony, and increased choroidal thickness with calcifications. Laboratory evaluations showed normal or negative results for common causes of infection and inflammation. Prednisolone acetate eye drops were started, with improvement of AC inflammation. Cataract surgery was performed, reaching visual acuity of 20/30. Two years later, visual acuity had decreased and 2+ vitritis and retinitis were found. On clinical suspicion of masquerade syndrome, a vitrectomy biopsy was performed; pathologic assessments reported no data on ocular lymphoma. Leukopenia and lymphopenia were found: immunoglobulin levels, CD4 count, and viral load revealed systemic immunosuppression. The aqueous tap was positive for cytomegalovirus. Oral valganciclovir and intravitreal ganciclovir were initiated. RESULTS In a patient with previous resection of thymoma and hypogammaglobulinemia, final diagnosis was Good syndrome, with cytomegalovirus retinitis being secondary to immunosuppression. Despite treatment, cytomegalovirus retinitis progressed and systemic deterioration resulted in mortal outcome. CONCLUSION Good syndrome is an extremely rare disease, and association with cytomegalovirus retinitis is uncommon. To the authors' knowledge, only 14 cases exist in the literature.
Collapse
Affiliation(s)
- Pablo Baquero-Ospina
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México I.A.P, Mexico; and
| | | | | |
Collapse
|
20
|
Iorio R, Lennon VA. Paraneoplastic autoimmune neurologic disorders associated with thymoma. Handb Clin Neurol 2024; 200:385-396. [PMID: 38494291 DOI: 10.1016/b978-0-12-823912-4.00008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Thymoma is often associated with paraneoplastic neurologic diseases. Neural autoantibody testing is an important tool aiding diagnosis of thymoma and its autoimmune neurologic complications. Autoantibodies specific for muscle striational antigens and ion channels of the ligand-gated nicotinic acetylcholine receptor superfamily are the most prevalent biomarkers. The autoimmune neurologic disorders associating most commonly with thymoma are myasthenia gravis (MG), peripheral nerve hyperexcitability (neuromyotonia and Morvan syndrome), dysautonomia, and encephalitis. Patients presenting with these neurologic disorders should be screened for thymoma at diagnosis. Although they can cause profound disability, they usually respond to immunotherapy and treatment of the thymoma. Worsening of the neurologic disorder following surgical removal of a thymoma may herald tumor recurrence. Prompt recognition of paraneoplastic neurologic disorders is critical for patient management. A multidisciplinary approach is required for optimal management of neurologic autoimmunity associated with thymoma.
Collapse
Affiliation(s)
- Raffaele Iorio
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Vanda A Lennon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States; Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Immunology, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
21
|
Jin ZS, Tao XR, Wang ZX. A case report of dermatomyositis mimicking myasthenia gravis. Medicine (Baltimore) 2023; 102:e36234. [PMID: 38115296 PMCID: PMC10727607 DOI: 10.1097/md.0000000000036234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/31/2023] [Indexed: 12/21/2023] Open
Abstract
RATIONALE Patients who have myasthenia gravis or dermatomyositis show clinical signs of muscular weakening. Ocular muscle involvement is uncommon, and symmetrical proximal limb weakness is the typical presentation of dermatomyositis. However, the earliest and most noticeable sign in those with myasthenia gravis is extraocular muscular paralysis. Dermatomyositis is frequently complicated by malignancy, and the common malignancies associated with dermatomyositis vary by region and ethnicity, while thymoma is relatively rare. About 10% to 15% of people with myasthenia gravis have thymoma, which is involved in the etiology of the disease. PATIENT CONCERNS A 68-year-old female presented with ocular muscle weakness for 10 days that manifested as bilateral blepharoptosis with the phenomenon of "light in the morning and heavy in the evening." Imaging examination showed anterior mediastinal thymic tumor with metastasis. DIAGNOSES After a thorough physical examination, we discovered bilateral upper limbs with grade IV muscle strength and the typical rash of dermatomyositis. In combination with elevated serum kinase levels and electromyography suggesting myogenic damage, the patient was finally diagnosed as dermatomyositis with multiple metastases of thymoma. INTERVENTIONS The patient received oral hydroxychloroquine sulfate, topical corticosteroids, and tacrolimus ointment, but these did not work very well. Subsequently, the patient underwent surgery combined with radiotherapy for the thymoma. OUTCOMES Muscle weakness in the patient improved after effective treatment of tumor, and the rash mostly disappeared. CONCLUSION Ocular muscle weakness and thymoma are more common in myasthenia gravis, but we cannot ignore the possibility of dermatomyositis. To further establish the diagnosis, a thorough physical examination and laboratory findings are required. Further tumor screening should be performed for patients with dermatomyositis. Early detection and management of possible tumors are essential to the treatment of dermatomyositis linked to malignancies.
Collapse
Affiliation(s)
- Zhang-Si Jin
- Department of Dermatovenereology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiao-Ran Tao
- Department of Dermatovenereology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zai-Xing Wang
- Department of Dermatovenereology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| |
Collapse
|
22
|
Al-Chalabi M, Hegde P, Moore SR, Abouainain Y, Keener M, Parvez H, Eid J, Saleem S, Sheikh A. Systematic Review of the Clinical Characteristics and Management of Isaac Syndrome. J Clin Neuromuscul Dis 2023; 25:94-106. [PMID: 37962197 DOI: 10.1097/cnd.0000000000000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVES Isaac syndrome (IS) is a condition characterized by peripheral nerve hyperexcitability caused by voltage-gated potassium channel (VGKC)-complex antibodies. Muscle twitching, stiffness, hypertrophy, and dysautonomic characteristics, such as hyperhidrosis, are common manifestations. The syndrome can be autoimmune or paraneoplastic, with thymoma being a common cause of paraneoplastic IS. Furthermore, this condition could be handed down from one generation to another. However, there is limited information regarding outcomes, relapses, associated syndromes, associated malignancies (other than thymoma), and treatment options. Despite its rarity, there remains a need for effective management strategies for patients with IS. To address this gap, we conducted a systematic review to summarize the most common and effective treatments of IS in immunomodulatory agents and symptomatic medications, as well as to describe outcomes, relapses, and associated malignancies. Altogether, this review serves to guide clinical practice recommendations for IS and highlight areas for further research. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol to conduct a systematic review of cases reposted through the PubMed and Google Scholar databases. The terms "Isaac Syndrome" and "Acquired Neuromyotonia" were used. The Joanna Briggs Institute's critical appraisal tool was used to evaluate the quality of the included studies. RESULTS We identified 61 case reports and 4 case series, comprising a total of 70 patients with IS (mean age at onset: 42.5 ± 18 years, and 69% were males). Fourteen cases reported relapses. Thymoma was the most common malignancy associated with IS, followed by lymphoma. Among various serum antibodies, voltage-gated potassium channel-complex antibodies were the most reported antibodies elevated in IS (reported in 38 patients and elevated in 21 patients [55.2%]), followed by acetylcholine ganglionic receptor antibodies, which were reported in 30% of patients (n = 21) and were elevated in 5 cases. The most common electromyography findings were myokymic discharges (n = 22), followed by fasciculations (n = 21) and neuromyotonia (n = 19). For treatment, combining anticonvulsants such as carbamazepine with immunotherapy therapy showed the best results in controlling the symptoms. Among immunotherapy therapies, the combination of plasma exchange plus intravenous high-dose steroids achieved the best results in the acute treatment of IS ([n = 6], with improvement noted in 83.3% [n = 5] of cases). Among the symptomatic treatments with anticonvulsants, carbamazepine was the most efficacious anticonvulsant in treatment of IS, with an average effective dosing of 480 mg/day (carbamazepine was used in 32.3% of acute treatment strategies [n = 23], with improvement noted in 73.9% [n = 17] of cases). CONCLUSIONS IS a rare neuromuscular syndrome that tends to affect middle-aged men. These patients should be screened for thymoma and other malignancies such as lymphomas. The management of IS symptoms can be challenging, but based on our review, the combination of multiple immunosuppressives such as IV steroids and plasmapheresis with anticonvulsants such as carbamazepine seems to achieve the best results.
Collapse
Affiliation(s)
| | - Prajwal Hegde
- College of Medicine and Life Sciences, University of Toledo, OH; and
| | - Sara R Moore
- College of Medicine and Life Sciences, University of Toledo, OH; and
| | | | - Myles Keener
- College of Medicine and Life Sciences, University of Toledo, OH; and
| | - Hira Parvez
- Department of Neurology, University of Toledo, Toledo, OH
| | - Jeremy Eid
- College of Medicine and Life Sciences, University of Toledo, OH; and
| | - Sidra Saleem
- Department of Neurology, University of Toledo, Toledo, OH
| | - Ajaz Sheikh
- Department of Neurology, University of Toledo, Toledo, OH
- College of Medicine and Life Sciences, University of Toledo, OH; and
| |
Collapse
|
23
|
Sipos F, Műzes G. Good's syndrome: brief overview of an enigmatic immune deficiency. APMIS 2023; 131:698-704. [PMID: 37729389 DOI: 10.1111/apm.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
Good's syndrome, an infrequent adult-onset immunodeficiency is characterized by the triad of thymoma, hypogammaglobulinemia, and increased susceptibility to recurrent infections. The clinical presentation is highly variable, with a spectrum ranging from recurrent bacterial and opportunistic infections to concomitant autoimmune diseases and, sometimes malignant pathologies. Due to heterogeneous clinical phenotypes and the lack of adequate diagnostic criteria, its recognition is often challenging, even delaying it by years. It is one of the most unusual, less studied form of the immune deficiency syndromes with a still unknown pathophysiology. It was initially considered a thymoma-associated variant of primary antibody deficiencies with a reduced or absent number of mature B cells, but it later emerged that significant defects of T cell-mediated immune functions are the underlying cause of opportunistic infections. On the basis of current evidence, Good's syndrome is evaluated as a distinct acquired form of combined immunodeficiency states and classified as a phenocopy of primary immunodeficiency diseases. Epigenetic and acquired genetic factors can play an ultimate role in its evolution.
Collapse
Affiliation(s)
- Ferenc Sipos
- Division of Immunology, Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
| | - Györgyi Műzes
- Division of Immunology, Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
| |
Collapse
|
24
|
Kline S, Manley SR, Timothy C, Jennings SH, Nolen-Walston R, Conrado FO. Spindle-cell thymoma colliding with a bronchogenic cyst in a Yorkshire terrier. Vet Clin Pathol 2023; 52:709-715. [PMID: 37914539 DOI: 10.1111/vcp.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/31/2023] [Accepted: 07/28/2023] [Indexed: 11/03/2023]
Abstract
An 8-year-old male Yorkshire terrier was presented to the Tufts Veterinary Hospital for evaluation of increased respiratory effort. A mediastinal mass composed of a spindle-cell thymoma within a bronchogenic cyst was diagnosed with computed tomography thoracic imaging, ultrasound-guided fine-needle aspirate biopsy, and histopathologic evaluation after surgical removal. Histologic evaluation showed a multilocular cyst structure as well as a mass characterized by spindle to polygonal thymic epithelial cells. The cyst was characterized by a lining of ciliated pseudostratified respiratory epithelium. To the authors' knowledge, this is the first report of a spindle-cell thymoma being associated with a mediastinal bronchogenic cyst in a dog.
Collapse
Affiliation(s)
- Stephanie Kline
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Sabrina R Manley
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Clare Timothy
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | | | - Rose Nolen-Walston
- Department of Comparative Pathobiology, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Francisco O Conrado
- Department of Comparative Pathobiology, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| |
Collapse
|
25
|
Almuqbil S, AlHarbi A, Alzouri FS, Elbawab HY, Alsafwani NS, Alkhunaizy Z. Primary Thymic Hodgkin Lymphoma Coexisting with Thymoma and Myasthenia Gravis: A Case Report. Am J Case Rep 2023; 24:e941792. [PMID: 38006204 PMCID: PMC10687740 DOI: 10.12659/ajcr.941792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/23/2023] [Accepted: 10/06/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Myasthenia gravis is a neuromuscular disorder that is strongly associated with thymoma. Although the presence of myasthenia gravis with other tumors is uncommon, approximately 50% of patients with thymoma have myasthenia gravis. Thymic Hodgkin lymphoma should be considered due to the multiple reported cases of patients with myasthenia gravis and Hodgkin lymphoma. In this report, we present the case of 24-year-old woman with myasthenia gravis who was incidentally found to have coexisting thymoma with thymic Hodgkin lymphoma. CASE REPORT A 24-year-old woman with a known case of vitiligo presented with a 2-year history of diplopia and incidental anterior mediastinal mass. Following investigations, myasthenia gravis was diagnosed and managed by pyridostigmine, prednisolone, and azathioprine. Regarding the anterior mediastinal mass, thymoma was suspected based on the presence of myasthenia gravis and radiological findings. She underwent extended transsternal thymectomy. The final histopathological report of the dissected thymus disclosed Hodgkin lymphoma pathology coexisting with thymoma. After the diagnosis of Hodgkin lymphoma nodular sclerosis type IIA was confirmed, 6 cycles of chemotherapy were administered. Four years of follow-up revealed no evidence of Hodgkin lymphoma. However, her symptoms of myasthenia gravis persisted despite Hodgkin lymphoma remission. CONCLUSIONS There is an unclear association between myasthenia gravies and Hodgkin lymphoma. Prior reports revealed regression of myasthenia gravies following Hodgkin lymphoma management, which suggests that myasthenia could be a complication of Hodgkin lymphoma. However, in our case, myasthenia gravis persisted after Hodgkin lymphoma management; therefore, further studies are needed to explore this association.
Collapse
Affiliation(s)
- Sarah Almuqbil
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Amal AlHarbi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah S. Alzouri
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hatem Yazeed Elbawab
- Thoracic Surgery Division, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Noor S. Alsafwani
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zahra Alkhunaizy
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
26
|
Naganuma R, Amino I, Miyazaki Y, Akimoto S, Niino M, Minami N, Honma N, Kikuchi S. [Thymoma-associated generalized myasthenia gravis complicated with anti-VGKC complex antibody-associated limbic encephalitis: a case report]. Rinsho Shinkeigaku 2023; 63:754-759. [PMID: 37880113 DOI: 10.5692/clinicalneurol.cn-001896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
We present a case of a 54-year-old woman. She was attending our department for thymoma-associated generalized myasthenia gravis. While she was treated with intravenous immunoglobulins for the exacerbation of myasthenic symptoms, she suddenly lost her consciousness for the first time and continued to have mild disorientation along with anterograde and retrograde amnesia afterwards. The symptoms improved after steroid pulse therapy. After searching for autoantibodies, she was diagnosed with anti-VGKC complex antibody-associated limbic encephalitis. As one-third of cases are complicated by thymoma, anti-VGKC complex antibody-positive limbic encephalitis has the aspect of a paraneoplastic neurological syndrome. In this case, masses suspected to be a recurrence of thymoma were found. In cases of thymoma, involvement of anti-VGKC complex antibodies should be considered when central nervous system symptoms appear, and when anti-VGKC complex antibodies are positive, recurrence or exacerbation of thymoma should be considered.
Collapse
Affiliation(s)
- Ryoji Naganuma
- Department of Neurology, National Hospital Organization Hokkaido Medical Center
| | - Itaru Amino
- Department of Neurology, National Hospital Organization Hokkaido Medical Center
| | - Yusei Miyazaki
- Department of Neurology, National Hospital Organization Hokkaido Medical Center
| | - Sachiko Akimoto
- Department of Neurology, National Hospital Organization Hokkaido Medical Center
| | - Masaaki Niino
- Department of Clinical Research, National Hospital Organization Hokkaido Medical Center
| | - Naoya Minami
- Department of Neurology, National Hospital Organization Hokkaido Medical Center
| | - Naotake Honma
- Department of Respiratory Surgery, National Hospital Organization Hokkaido Medical Center
| | - Seiji Kikuchi
- Department of Neurology, National Hospital Organization Hokkaido Medical Center
| |
Collapse
|
27
|
Shatila M, Hemead H, Murukesh N, Taniere P, Russell C, Menon A, Patel AJ. Adenoid cystic carcinoma of the thymus gland. J Cardiothorac Surg 2023; 18:307. [PMID: 37946236 PMCID: PMC10634110 DOI: 10.1186/s13019-023-02432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Thymic carcinomas are rare and aggressive tumours. They constitute a heterogeneous group of tumours with various histological patterns and subtypes resembling epithelial tumours arising from other organs. CASE PRESENTATION We hereby represent a case of primary thymic carcinoma with adenoid cystic carcinoma-like features (TCACC) which is an extremely rare variant of thymic adenocarcinoma. To date and to the best of our knowledge, there are nine reported cases in literature and ours is the tenth. Our case was treated surgically but the implementation of adjuvant chemoradiotherapy has been reported in few of the published cases. CONCLUSIONS TCACC constitutes a rare entity of thymic adenocarcinoma with limited available literature. The current data is derived from few case reports and case series. The histological overlap of these tumours and primary ACC of salivary glands poses a diagnostic challenge. Radiological investigations, immunohistochemical phenotyping and genetic analysis are crucial in establishing the diagnosis.
Collapse
Affiliation(s)
- Mohamed Shatila
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
- Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University Hospital, Alexandria, Egypt
| | - Hanan Hemead
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Nishanth Murukesh
- Department of Medical Oncology, Worcestershire Royal Hospitals NHS Trust, Worcester, UK
| | - Philippe Taniere
- Department of Cellular Histopathology, University Hospitals Birmingham, NHS Trust, Birmingham, UK
| | - Caroline Russell
- Department of Cellular Histopathology, University Hospitals Birmingham, NHS Trust, Birmingham, UK
| | - Ashvini Menon
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Akshay J Patel
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK.
- Institute of Immunology and Immunotherapy, University of Birmingham, Vincent Drive, Edgbaston, B15 2TT, UK.
| |
Collapse
|
28
|
Wang X, Liu LL, Li Q, Xia QY, Li R, Ye SB, Zhang RS, Fang R, Chen H, Wu N, Rao Q. Loss of YAP1 C-terminus expression as an ancillary marker for metaplastic thymoma: a potential pitfall in detecting YAP1::MAML2 gene rearrangement. Histopathology 2023; 83:798-809. [PMID: 37565303 DOI: 10.1111/his.15024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/11/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023]
Abstract
AIMS Metaplastic thymoma is a rare thymic tumour characterized by Yes Associated Protein 1 (YAP1) and Mastermind Like Transcriptional Coactivator 2 (MAML2) gene fusions resulting from an intrachromosomal inversion of chromosome 11. Immunohistochemistry with an antibody directed against the C-terminus of YAP1 has shown loss of expression in YAP1-rearranged vascular neoplasms, poromas, and porocarcinomas. This study aimed to validate an anti-YAP1 C-terminal antibody as an ancillary immunohistochemical marker for the diagnosis of metaplastic thymoma. MATERIALS AND METHODS Ten metaplastic thymomas were selected for the current study. Fluorescence in situ hybridization (FISH), next-generation sequencing (NGS), and reverse transcription-polymerase chain reaction (RT-PCR) analyses were performed to detect YAP1::MAML2 fusions. We then performed immunohistochemistry to detect YAP1 C-terminus expression in 10 metaplastic thymomas, 50 conventional thymomas (10 each of type A thymoma, type AB thymoma, type B1 thymoma, type B2 thymoma, and type B3 thymoma) and seven thymic carcinomas. RESULTS All 10 cases showed narrow split signals with a distance of nearly two signal diameters and sometimes had false-negative results in YAP1 and MAML2 break-apart FISH (BA-FISH). Abnormal colocalized signals of the YAP1::MAML2 fusion were observed in all 10 cases using fusion FISH (F-FISH) assays. Eight of 10 cases with adequate nucleic acids were successfully sequenced and all showed YAP1::MAML2 fusions; in two cases the fusions were detected by both DNA and RNA sequencing and in six cases by RNA sequencing only. YAP1::MAML2 fusion transcripts were identified in four cases by RT-PCR. Metaplastic thymoma showed loss of YAP1 C-terminus expression in all 10 (100%) cases. All other thymic neoplasms showed retained YAP1 C-terminus expression. CONCLUSION YAP1 C-terminus immunohistochemistry is a highly sensitive and specific ancillary marker that distinguishes metaplastic thymoma from its mimics. BA-FISH assays could not effectively detect YAP1::MAML2 fusions due to the proximity of the two genes. Loss of YAP1 C-terminus expression is a reliable surrogate for the detection of YAP1::MAML2 fusions in metaplastic thymoma.
Collapse
Affiliation(s)
- Xuan Wang
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Lei-Lei Liu
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qing Li
- Department of Pathology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Qiu-Yuan Xia
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Rui Li
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Sheng-Bing Ye
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ru-Song Zhang
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ru Fang
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Hui Chen
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Nan Wu
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qiu Rao
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| |
Collapse
|
29
|
Norman J, Leclair B, Clua M, Aubert L, Toldas J, Cudennec T. [Suspicion of thymoma]. Soins Gerontol 2023; 28:47-48. [PMID: 37977765 DOI: 10.1016/j.sger.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Juliette Norman
- Service de gériatrie, AP-HP, Université Paris-Saclay, Site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - Bathilde Leclair
- Service de gériatrie, AP-HP, Université Paris-Saclay, Site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Morane Clua
- Service de gériatrie, AP-HP, Université Paris-Saclay, Site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Lucie Aubert
- Service de gériatrie, AP-HP, Université Paris-Saclay, Site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Jacob Toldas
- Service de gériatrie, AP-HP, Université Paris-Saclay, Site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Tristan Cudennec
- Service de gériatrie, AP-HP, Université Paris-Saclay, Site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| |
Collapse
|
30
|
Magiel E, Klein CJ, Shelly S. Immediate Improvement after Thymoma Resection in a Young Refractory Myasthenia Gravis Patient: A Case Report. Isr Med Assoc J 2023; 25:760-762. [PMID: 37980623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Erez Magiel
- Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Shahar Shelly
- Department of Neurology, Mayo Clinic, Rochester, MN, USA, Department of Neurology, Rambam Health Care Campus, Haifa, Israel, Neuroimmunology Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
31
|
Pinto P, Castro J, Leite F, Cunha AL, Lopes S, Paupério G. Not Always a Thymoma - About a Mediastinal Cavernous Hemangioma. Port J Card Thorac Vasc Surg 2023; 30:85-88. [PMID: 38499033 DOI: 10.48729/pjctvs.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/31/2023] [Indexed: 03/20/2024]
Abstract
A mediastinal cavernous hemangioma is difficult to distinguish from other types of mediastinal tumours. They are usually asymptomatic and incidentally discovered in an imaging study but can present with compressive symptoms or by infiltration of adjacent structures. A 64-year-old woman with a prior history of triple negative invasive carcinoma of the breast, under surveillance was referred after a Chest CT-scan showed a soft tissue 40x20 mm mediastinal mass, suggestive of a thymoma, and as such no tissue biopsy was obtained. A right-side uniportal VATS was performed, the anterior mediastinum dissected and the mass was exposed, and several anomalous veins were identified. Histopathology showed 36x31x15 mm mass, compatible with a cavernous hemangioma of the anterior mediastinum. This case, whilst not questioning the NCCN statement suggesting not doing a tissue biopsy, points to the fact that rare differential diagnosis, like a Cavernous Hemangioma do exist, and a careful and sound judgement is needed at all times.
Collapse
Affiliation(s)
- Paula Pinto
- Instituto Português de Oncologia do Porto Francisco Gentil - Serviço de Cirurgia Geral. Portugal
| | - João Castro
- Instituto Português de Oncologia do Porto Francisco Gentil - Serviço de Anatomia Patológica. Portugal
| | - Filipe Leite
- Instituto Português de Oncologia do Porto Francisco Gentil - Serviço de Cirurgia Cardiotorácica. Portugal
| | - Ana Luísa Cunha
- Instituto Português de Oncologia do Porto Francisco Gentil - Serviço de Anatomia Patológica. Portugal
| | - Sara Lopes
- Instituto Português de Oncologia do Porto Francisco Gentil - Serviço de Cirurgia Cardiotorácica. Portugal
| | - Gonçalo Paupério
- Instituto Português de Oncologia do Porto Francisco Gentil - Serviço de Cirurgia Cardiotorácica. Portugal
| |
Collapse
|
32
|
Zhang X, Zhang P, Cong A, Feng Y, Chi H, Xia Z, Tang H. Unraveling molecular networks in thymic epithelial tumors: deciphering the unique signatures. Front Immunol 2023; 14:1264325. [PMID: 37849766 PMCID: PMC10577431 DOI: 10.3389/fimmu.2023.1264325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
Thymic epithelial tumors (TETs) are a rare and diverse group of neoplasms characterized by distinct molecular signatures. This review delves into the complex molecular networks of TETs, highlighting key aspects such as chromosomal abnormalities, molecular subtypes, aberrant gene mutations and expressions, structural gene rearrangements, and epigenetic changes. Additionally, the influence of the dynamic tumor microenvironment on TET behavior and therapeutic responses is examined. A thorough understanding of these facets elucidates TET pathogenesis, offering avenues for enhancing diagnostic accuracy, refining prognostic assessments, and tailoring targeted therapeutic strategies. Our review underscores the importance of deciphering TETs' unique molecular signatures to advance personalized treatment paradigms and improve patient outcomes. We also discuss future research directions and anticipated challenges in this intriguing field.
Collapse
Affiliation(s)
- Xiao Zhang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengpeng Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ansheng Cong
- Division of Nephrology, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Yanlong Feng
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Chi
- School of Clinical Medical Sciences, Southwest Medical University, Luzhou, China
| | - Zhijia Xia
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians University Munich, Munich, Germany
| | - Hailin Tang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| |
Collapse
|
33
|
Bremmer F, Bohnenberger H, Findeisen P, Welter S, von Hammerstein-Equord A, Hinterthaner M, Müller D, Küffer S, Okada S, Marx A, Ströbel P. Proteomic analysis identifies argininosuccinate synthetase 1 and special AT-rich sequence binding protein 1 as reliable markers for the immunohistochemical distinction between WHO types A and B3 thymomas. Histopathology 2023; 83:607-616. [PMID: 37308176 DOI: 10.1111/his.14972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Abstract
AIMS The reliable classification of type A versus type B3 thymomas has prognostic and therapeutic relevance, but can be problematic due to considerably overlapping morphology. No immunohistochemical markers aiding in this distinction have been published so far. METHODS AND RESULTS We identified and quantified numerous differentially expressed proteins using an unbiased proteomic screen by mass spectrometry in pooled protein lysates from three type A and three type B3 thymomas. From these, candidates were validated in a larger series of paraffin-embedded type A and B3 thymomas. We identified argininosuccinate synthetase 1 (ASS1) and special AT-rich sequence binding protein 1 (SATB1) as highly discriminatory between 34 type A and 20 type B3 thymomas (94% sensitivity, 98% specificity and 96% accuracy). Although not the focus of this study, the same markers also proved helpful in the diagnosis of type AB (n = 14), B1 (n = 4) and B2 thymomas (n = 10). CONCLUSIONS Mutually exclusive epithelial expression of ASS1 in 100% of type B3 thymomas and ectopic nuclear expression of SATB1 in 92% of type A thymomas support the distinction between type A and type B3 thymomas with 94% sensitivity, 98% specificity and 96% accuracy.
Collapse
Affiliation(s)
- Felix Bremmer
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | | | | | - Stefan Welter
- Thoracic Surgery Department, Lung Clinic Hemer, Hemer, Germany
| | | | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Göttingen, Germany
| | - Denise Müller
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Stefan Küffer
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Satoru Okada
- Institute of Pathology, University Medical Center, Göttingen, Germany
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Prefectural University of Medicine, Kyoto, Japan
| | - Alexander Marx
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center, Göttingen, Germany
| |
Collapse
|
34
|
Xu W, Wang L, Tang H, Luo L, Xu Y, Guo D. Thymic hyperplasia with lymphoepithelial sialadenitis (LESA)-like features: a case report and literature review. Diagn Pathol 2023; 18:102. [PMID: 37697376 PMCID: PMC10494424 DOI: 10.1186/s13000-023-01391-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Thymic hyperplasia with lymphoepithelial sialadenitis-like features (LESA-like TH) is a rare form of thymic hyperplasia, characterized by a prominent expansion of the thymic medulla containing hyperplastic lymphoid follicles with germinal centers, while an almost total absence of thymic cortex. Since the first report in 2012, only a few cases of LESA-like TH have been reported in the literature to date. Due to the rarity of LESA-like TH and the tumor-like morphology, it is easy to be misdiagnosed as other common diseases of the thymus in routine practice, such as thymoma and lymphoma. CASE PRESENTATION Herein, we present a case report of a 52-year-old Chinese female patient with LESA-like TH, without any discomforting symptoms. Computer-tomography imaging revealed a cystic solid mass in the anterior mediastinum, with well-defined boundaries and multiple internal septa. Histologically, prominent features were florid lymphoid follicles containing germinal centers, as well as hyperplasia of thymic epithelial cells and proliferation of Hassall bodies. However, the thymic cortex rich in immature T cells was almost completely absent. Furthermore, mature plasma cells, lymphoepithelial lesions, and cholesterol clefts were frequently seen. CONCLUSION We made a diagnosis of LESA-like TH and performed a literature review to better understand the clinicopathological features of LESA-like TH and reduce misdiagnosis.
Collapse
Affiliation(s)
- Wenfeng Xu
- Department of Pathology, Guiqian International General Hospital, Guiyang City, Guizhou Province, China
| | - Long Wang
- Department of Pathology, Guiqian International General Hospital, Guiyang City, Guizhou Province, China
| | - Hao Tang
- Department of Pathology, Guiqian International General Hospital, Guiyang City, Guizhou Province, China
| | - Ling Luo
- Department of Radiology, Guiqian International General Hospital, Guiyang City, Guizhou Province, China
| | - Yujuan Xu
- Department of Pathology, Guiqian International General Hospital, Guiyang City, Guizhou Province, China
| | - Deyu Guo
- Department of Pathology, Guiqian International General Hospital, Guiyang City, Guizhou Province, China.
| |
Collapse
|
35
|
Affiliation(s)
- Rei Yamakawa
- Department of Cardiology, Aso Iizuka Hospital, Japan
| | | | | | - Shujiro Inoue
- Department of Cardiology, Aso Iizuka Hospital, Japan
| |
Collapse
|
36
|
Weissferdt A. Combined Thymic Epithelial Neoplasms - a Review. Int J Surg Pathol 2023; 31:917-926. [PMID: 36036356 DOI: 10.1177/10668969221118324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thymic epithelial neoplasms are the most common tumors of thymic origin but are overall rare in the general population. Their morphologic diversity, ranging from low grade to overtly malignant lesions, along with various histologic growth patterns make them a diagnostically challenging group of tumors. Very occasionally, thymomas and thymic carcinomas may develop in combination with other benign or malignant lesions of thymic origin, further complicating the diagnostic process. The focus of this review lies on the spectrum of thymic epithelial tumors that present with other thymic lesions in the same tumor mass, such as multilocular thymic cysts, neuroendocrine neoplasms, lymphomas, and germ cell tumors among others. Awareness of the existence of such unusual tumors may not only aid in their diagnosis but may also have implications for prognostic and therapeutic purposes.
Collapse
Affiliation(s)
- Annikka Weissferdt
- Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
37
|
Liang J, Huang M, Huang H, Li L, Luo H, Mao W, Gao S, Xu H. Intrathyroidal Thymic Carcinoma: A Retrospective Case Series Study. Ear Nose Throat J 2023; 102:584-589. [PMID: 36408572 DOI: 10.1177/01455613221141225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Intrathyroidal thymic carcinoma (ITC) is a rare low-grade malignant thyroid tumor. There is neither sufficient understanding of this tumor nor its clinical treatment. This study is to explore the clinicopathological features, treatment, and prognosis of ITC and thereby provide a reference for the diagnosis and treatment of the disease. METHODS The clinical, pathological, therapeutic, and prognostic data of 13 patients with ITC were retrospectively analyzed. RESULTS The case series comprised 7 males and 6 females, with an average age of 51.9 ± 10.1 years. After surgical resection, all patients received post-operative neck radiotherapy at dosages of 60-66 Gy. Five patients with level VI lymph node metastasis additionally received 6 courses of cisplatin chemotherapy. All patients were followed-up for 21-132 months (median = 66 months), and all of them survived without recurrence or metastasis. CONCLUSIONS The diagnosis of ITC depends mainly on pathological and immunohistochemical results, particularly CD5 positive staining. Surgical resection is the preferred primary treatment modality which can be supplemented with radiotherapy and chemotherapy to reduce the risk of recurrence and metastasis.
Collapse
Affiliation(s)
- Jinhui Liang
- Department of Otorhinolaryngology and Head & Neck Surgery, Hanzhong Central Hospital, Hanzhong, China
| | - Mei Huang
- Department of Otorhinolaryngology and Head & Neck Surgery, Hanzhong Central Hospital, Hanzhong, China
| | - Helang Huang
- Department of Otorhinolaryngology and Head & Neck Surgery, Hanzhong Central Hospital, Hanzhong, China
| | - Li Li
- Department of Otorhinolaryngology and Head & Neck Surgery, Hanzhong Central Hospital, Hanzhong, China
| | - Hailin Luo
- Department of Otorhinolaryngology and Head & Neck Surgery, Hanzhong Central Hospital, Hanzhong, China
| | - Weidong Mao
- Department of Pathology, Hanzhong Central Hospital, Hanzhong, China
| | - Shan Gao
- Department of Radiotherapy, Hanzhong Central Hospital, Hanzhong, China
| | - Haoxiang Xu
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| |
Collapse
|
38
|
Pagliaro T, Yau B, Mortimore R, Butler G. Severe oral ulceration with lichen planus-like histology associated with thymoma and delayed antibody detection-A late diagnosis of paraneoplastic pemphigus. Australas J Dermatol 2023; 64:450-451. [PMID: 37052268 DOI: 10.1111/ajd.14053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Thomas Pagliaro
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Benny Yau
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | | | - Gregory Butler
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| |
Collapse
|
39
|
Koo CW, Lo YC. Good's Syndrome: Thymoma with Acquired Immunodeficiency. Am J Respir Crit Care Med 2023; 208:322-324. [PMID: 37071872 DOI: 10.1164/rccm.202211-2159im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Affiliation(s)
| | - Ying-Chun Lo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
40
|
Nabel CS, Hung YP, Kurilovich A, Lopareva A, Dias-Santagata D, Batashkov N, Tabakov D, Sorokina M, Makarov A, Sagaradze G, Butusova A, Kudryashova O, Bedniagin L, Wright CD, Shin N, Bagaev A, Postovalova E, Louissaint A. Longitudinal Molecular Analysis of Tumor Exome and Transcriptome to Evaluate Clonal Evolution and Identify Novel Therapeutic Targets in Thymoma. JCO Precis Oncol 2023; 7:e2300107. [PMID: 37437230 PMCID: PMC10581621 DOI: 10.1200/po.23.00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 07/14/2023] Open
Affiliation(s)
- Christopher S. Nabel
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA
| | - Yin P. Hung
- Harvard Medical School, Boston, MA
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | | | | | - Dora Dias-Santagata
- Harvard Medical School, Boston, MA
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | | | | | | | | | | | | | | | | | - Cameron D. Wright
- Harvard Medical School, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | | | - Abner Louissaint
- Harvard Medical School, Boston, MA
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
41
|
Leroy C, Lesclous P, Dutot N, Anquetil M, Tessier MH. Erosive oral lichen planus: Think thymoma. Ann Dermatol Venereol 2023; 150:152-154. [PMID: 36653225 DOI: 10.1016/j.annder.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/19/2022] [Accepted: 11/25/2022] [Indexed: 01/18/2023]
Affiliation(s)
- C Leroy
- Department of Oral Surgery, Nantes University, Nantes University Hospital, Nantes, France.
| | - P Lesclous
- Department of Oral Surgery, Nantes University, Nantes University Hospital, Nantes, France; INSERM UMR-S 1229, RMeS; Nantes, France
| | - N Dutot
- Department of Oral and Maxillofacial Surgery, Nantes University Hospital, Nantes, France
| | - M Anquetil
- Department of Oral and Maxillofacial Surgery, Nantes University Hospital, Nantes, France
| | - M-H Tessier
- Department of Oral and Maxillofacial Surgery, Nantes University Hospital, Nantes, France
| |
Collapse
|
42
|
Wee LE, Tan JY, Oon LLE, Pena AMT, Quek JKS, Venkatachalam I, Ko KKK, Wijaya L. Relapsing COVID-19 infection as a manifestation of Good syndrome: a case report and literature review. Int J Infect Dis 2023; 129:236-239. [PMID: 36608786 PMCID: PMC9809144 DOI: 10.1016/j.ijid.2022.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023] Open
Abstract
Good syndrome (GS) is a rare acquired immunodeficiency disease characterized by the presence of thymoma with combined B and T cell immunodeficiency in adults. Recurrent bacterial infections, particularly sinopulmonary infections caused by encapsulated bacteria, remain the most common infective presentation of GS; however, relapsing viral infections have also been reported, likely due to impaired T cell-mediated immunity. Relapsing COVID-19 infection, however, has not been previously reported as a manifestation of GS. We present two cases of relapsing COVID-19 infection in patients with GS; in one case, relapsing COVID-19 was the first manifestation of newly diagnosed GS.
Collapse
Affiliation(s)
- Liang En Wee
- Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - Jing Yuan Tan
- Department of Haematology, Singapore General Hospital, Singapore
| | - Lynette Lin Ean Oon
- Department of Molecular Pathology, Singapore General Hospital, Singapore; Department of Microbiology, Singapore General Hospital, Singapore
| | | | | | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Karrie Kwan-Ki Ko
- Department of Molecular Pathology, Singapore General Hospital, Singapore; Department of Microbiology, Singapore General Hospital, Singapore
| | - Limin Wijaya
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| |
Collapse
|
43
|
Altshuler E, Mathavan A, Mathavan A, Krekora U, Mathavan M, Hones K, Daily K. Clinical characteristics, prognostic factors, and long-term outcomes associated with epithelial malignancies of the thymus: A 20-year single-institution experience. Cancer Rep (Hoboken) 2023; 6:e1750. [PMID: 36369906 PMCID: PMC10026295 DOI: 10.1002/cnr2.1750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/17/2022] [Accepted: 10/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Thymic epithelial tumors are rare and include thymomas and thymic carcinomas. There is scarce literature characterizing prognostic factors and long-term outcomes in these tumors. AIMS This review aims to describe disease features of thymomas and thymic carcinomas and to report clinical differences among thymoma histological subtypes. METHODS AND RESULTS A retrospective chart review was performed at the University of Florida Shands Hospital, a tertiary care academic medical center in Gainesville, Florida, USA. The review included clinical data of adults with thymic epithelial tumors diagnosed between 2001 and 2021. Significant associations among demographics, histology, stage, and outcomes were investigated. Thymoma subgroup analysis was performed using histological subtype and sex. Forty patients with thymoma and seven patients with thymic carcinoma were included in the final analysis. Among those with thymomas, patients with subtype B1, B2, or B3 tumors were younger, had larger tumors, and presented with higher stage disease when compared to those with subtypes A or AB. Tumor recurrence was most common in subtype B2 and B3 tumors (50.0% and 16.7% vs. 0%; p < .01). However, there was no significant difference in overall survival between histologic subtypes. Compared to females, males with thymomas had superior overall survival (103.0 vs. 62.9 months; p = .021) despite presenting with larger tumors (9.8 vs. 5.8 cm; p = .041). Concomitant myasthenia gravis was associated with increased recurrence but not worsened mortality. Compared to thymomas, patients with thymic carcinoma presented with higher-stage disease and had poorer 5-year survival (50.0% vs. 93.1%; p < .01). CONCLUSION This study affirmed pathologic stage and resectability as prognostic factors for thymic epithelial tumors. New findings include inferior overall survival in female patients and higher recurrence rates in those with thymomas and concomitant myasthenia gravis.
Collapse
Affiliation(s)
- Ellery Altshuler
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Akash Mathavan
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Akshay Mathavan
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Urszula Krekora
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Mohit Mathavan
- Department of Internal Medicine, St George's University School of Medicine, Great River, New York, USA
| | - Keegan Hones
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Karen Daily
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
- Division of Hematology and Oncology, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
44
|
Perri M, Pellegrini D, Uribe Roca C, Gonzalez F, Buero A, Chimondeguy D, Bruetman JE. [Stiff person syndrome associated with thymoma]. Medicina (B Aires) 2023; 83:626-630. [PMID: 37582138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Stiff-person syndrome is a rare neurological condition characterized by muscular rigidity of the trunk and extremities and muscle spasms triggered by sensory or emotional stimuli, which progresses towards prostration. It has a pathophysiogenic mechanism with an immunological basis, in which autoantibodies, such as antiGAD65, play a central role. Likewise, the detection of these antibodies corroborates the diagnosis in a patient with a suggestive clinical picture. Four to 6% of cases have underlying neoplasms. Treatment is based on symptomatic, immunomodulatory, and underlying disease management in paraneoplastic cases. We report a case of classic stiff person syndrome associated with thymoma and review the main characteristics of this entity.
Collapse
Affiliation(s)
- Marcella Perri
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina
| | - Debora Pellegrini
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina. E-mail:
| | | | - Fabio Gonzalez
- Servicio de Neurología, Hospital Británico de Buenos Aires, Argentina
| | - Agustín Buero
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
| | | | - Julio E Bruetman
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina
| |
Collapse
|
45
|
Stopschinski BE, Fredrich S, Vernino S, Phillips L, Blackburn KM. Clinical Reasoning: A 59-Year-Old Man With Thymoma and Constitutional Symptoms, Seizures, and Multifocal CNS Lesions. Neurology 2022; 99:1115-1121. [PMID: 36180243 DOI: 10.1212/wnl.0000000000201381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/24/2022] [Indexed: 11/15/2022] Open
Abstract
A 59-year-old man first presented for an episode of left arm numbness. During workup, a thymoma was incidentally discovered and resected. The symptoms in his left arm were attributed to a cardiac pathology. One month later, he began to experience fatigue, weight loss, and anorexia, followed by one generalized tonic-clonic seizure. Workup including toxic and metabolic screening and MRI of the brain were unremarkable. He was started on an antiseizure medication and did well for 2 years, when his symptoms recurred. Repeat MRI of the brain showed multiple cortical T2-weighted fluid-attenuated inversion recovery (T2/FLAIR) hyperintense lesions without enhancement or diffusion restriction. Further workup included spinal MRI, CT of the chest/abdomen/pelvis, CSF studies, and autoimmune/paraneoplastic panels in CSF and serum, all of which were unremarkable. Serum testing was positive for striational antibodies, acetylcholine receptor (AChR)-binding antibodies, and AChR-modulating antibodies. He received high-dose steroids and plasma exchange with resolution of his symptoms and has since been stable on mycophenolate mofetil. This presentation highlights the rare association between thymoma and encephalitis. Prompt identification and treatment is critical. This article discusses the diagnostic approach to this rare presentation including essential features of the clinical presentation, appropriate workup, pertinent differential diagnoses, and key points for the treatment of these patients.
Collapse
Affiliation(s)
- Barbara E Stopschinski
- From the University of Texas Southwestern Medical Center (B.E.S., S.V., L.P., K.M.B.); and University of Maryland School of Medicine (S.F.).
| | - Sarah Fredrich
- From the University of Texas Southwestern Medical Center (B.E.S., S.V., L.P., K.M.B.); and University of Maryland School of Medicine (S.F.)
| | - Steven Vernino
- From the University of Texas Southwestern Medical Center (B.E.S., S.V., L.P., K.M.B.); and University of Maryland School of Medicine (S.F.)
| | - Lauren Phillips
- From the University of Texas Southwestern Medical Center (B.E.S., S.V., L.P., K.M.B.); and University of Maryland School of Medicine (S.F.)
| | - Kyle M Blackburn
- From the University of Texas Southwestern Medical Center (B.E.S., S.V., L.P., K.M.B.); and University of Maryland School of Medicine (S.F.)
| |
Collapse
|
46
|
Zhang H, Chen T, Zhang X, Zhang P, Chen Y. Thymoma with systemic lupus erythematosus and immune-related anemia: A case of thymoma with SLE and IRA. Medicine (Baltimore) 2022; 101:e32077. [PMID: 36626535 PMCID: PMC9750555 DOI: 10.1097/md.0000000000032077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Thymic epithelial tumors (TETs), including thymomas and thymic carcinomas. Thymomas are rare tumors, but are one of the most common mediastinal neoplasms in adults. The pathology of thymoma with Systemic Lupus Erythematosus (SLE) and severe pancytopenia is rarely reported. Thus, the current study demonstrates a case of thymoma with SLE and immune-related anemia with unique clinical manifestation. PATIENT CONCERNS A 27-year-old woman suffered from abdominal pain, arthralgia, intermittent high fever for a long time. DIAGNOSIS Based on the clinical and histopathological manifestations, diagnosis of thymoma with SLE and immune-related anemia was established. INTERVENTIONS Patient was treated with methylprednisolone and a complete thymectomy and thymomectomy, the CAP regimen was given 4 times of adjuvant chemotherapy after the operation. OUTCOMES After inter-disciplinary consultation as well as extensive discussion and steroid pulse therapy underwent surgery, the patient's blood count and immune function gradually entry sent back to normal. CONCLUSION we present the diagnosis and treatment of a case of thymoma with SLE and immune-related anemia, and provides references for the clinical diagnosis and treatment of thymoma combined with SLE, and attempts to explain that SLE patients with thymoma may contribute to the clinical remission of SLE after thymoma resection. It should arouse the attention of clinicians when diagnosing and treating related diseases.
Collapse
Affiliation(s)
- Huayang Zhang
- Department of Cardiothoracic Surgery, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Ting Chen
- Department of Pharmacy, Tianjin First Center Hospital, Tianjin, China
| | - Xuesong Zhang
- Department of Cardiothoracic Surgery, Tianjin Medical University, Tianjin, China
| | - Peng Zhang
- Department of Cardiothoracic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Chen
- Department of Cardiothoracic Surgery, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Yuan Chen, Department of Cardiothoracic Surgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, China (e-mail: )
| |
Collapse
|
47
|
Lau J, Ioan Cvasciuc T, Simpson D, C de Jong M, Parameswaran R. Continuing challenges of primary neuroendocrine tumours of the thymus: A concisereview. Eur J Surg Oncol 2022; 48:2360-2368. [PMID: 35922282 DOI: 10.1016/j.ejso.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 12/14/2022]
Abstract
Primary neuroendocrine tumours of the thymus (NETTs) are exceedingly rare tumours, usually presenting around mid-life, which have a propensity towards males and smokers. They are seen more often in those with MEN-1, but multiple different genetic mutations have been found to be involved in the tumorigenesis of NETTs. Histologically, NETTs are classified according to number of mitoses, the presence of necrosis, and the presence or absence of small cell features. NETTs display a wide spectrum of behavior, and they can be incidentally found on chest imaging, on screening in MEN-1, or present with symptoms of local compression. Advanced disease and paraneoplastic syndromes are common. CT-, PET/CT-, MRI-scans, and somatostatin receptor scintigraphy are the imaging modalities of choice both for the initial assessment as well as for monitoring after treatment. For patients with localized disease, complete surgical resection with lymphadenectomy provides the best chance of long-term, disease-free survival, and can be achieved through either an open or thoracoscopic approach. While chemotherapy-regimens based on platinum, taxane, and temozolomide are used most often, the optimum chemotherapy regimen in the adjuvant and palliative settings remains unclear, as does the role of radiotherapy. Ongoing research on the most effective use of somatostatin analogues, peptide receptor radionuclide therapy (PPRT), kinase inhibitors and immunotherapy in patients with other types of advanced neuroendocrine tumours may lead to further treatment options for NETTs in the future.
Collapse
Affiliation(s)
- Joel Lau
- Division of Endocrine Surgery, National University Health System, 119074, Singapore
| | - Titus Ioan Cvasciuc
- Division of Endocrine Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, 274 Grosvenor Rd, Belfast, BT12 6BA, UK
| | - Duncan Simpson
- Division of Endocrine Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, 274 Grosvenor Rd, Belfast, BT12 6BA, UK
| | - Mechteld C de Jong
- Division of Endocrine Surgery, National University Health System, 119074, Singapore
| | - Rajeev Parameswaran
- Division of Endocrine Surgery, National University Health System, 119074, Singapore; Yong Loo Lin School of Medicine, 10 Medical Dr, 117597, Singapore.
| |
Collapse
|
48
|
Ito Y, Miyauchi A, Hirokawa M, Kihara M, Onoda N, Miya A. Clinicopathological features and outcomes of intrathyroidal thymic carcinoma: a single institution study. Endocr J 2022; 69:1351-1356. [PMID: 35768280 DOI: 10.1507/endocrj.ej22-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Intrathyroidal thymic carcinoma (ITTC) is a rare malignancy of the thyroid. It is thought to originate from ectopic thymic tissue or embryonic thymic rest, in, or adjacent to, the thyroid. We analyzed the backgrounds, clinicopathological features, and prognosis of 20 patients with ITTC, treated at our hospital. Thirteen of the 15 patients (86%) who underwent ultrasonography were diagnosed as malignant, based on imaging findings. 16 of the 17 patients (93%) who underwent cytology, were diagnosed or suspected to be malignant. Locally curative surgery (thyroidectomy and lymph node dissection) was performed for 19 patients. Large tumor size (>4 cm) was positively related to pathological node metastasis (p = 0.0389). Fourteen patients, including nine Ex-positive patients, underwent adjuvant external beam radiotherapy (EBRT) of the neck after surgery. Two patients showed recurrence of thyroid bed after and neither of them underwent adjuvant EBRT after surgery. Two patients who underwent EBRT showed recurrences of the lateral nodes (level V and level II), but they were easily dissected by re-operation. Ten- and 20-year local recurrence-free survival rates were 84.9% and 60.6%, respectively. To date, four patients showed distant recurrence, and 10- and 20-year distant recurrence-free survival rates were 75.0% and 75.0%, respectively. Our findings indicate that 1) the prognosis of ITTC is generally favorable, and 2) large tumor size is significantly related to lymph node metastasis. Two patients showing recurrence of the central region did not undergo EBRT; thus, further comparative studies are desirable to elucidate whether EBRT can prevent significant local recurrence.
Collapse
Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | | | - Minoru Kihara
- Department of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Naoyoshi Onoda
- Department of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akihiro Miya
- Department of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| |
Collapse
|
49
|
Fu J, Cai XW, Hu SY, Lu T, Li XL. Thymic lipofibroadenoma of the anterior mediastinum: A rare case report. Medicine (Baltimore) 2022; 101:e31732. [PMID: 36401401 PMCID: PMC9678584 DOI: 10.1097/md.0000000000031732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Lipofibroadenoma is an extremely rare thymic tumor, and the anterior mediastinum is the most common site. CASE SUMMARY A 21-year-old male was admitted with fever without obvious cause for 2 months. After admission, the patient's highest temperature was 38.3°C, accompanied by diarrhea. Physical examination showed coarse breath sounds in both lungs. Chest enhanced computed tomography (CT) showed a mass of mixed density shadow on the left side of the anterior mediastinum with a size of approximately 9.2 cm × 5 cm × 2.1 cm and a clear boundary mixed with a low fat density shadow. Mediastinal tumors were removed under general anesthesia by video-assisted thoracoscopic surgery. Macroscopically, a clear boundary was shown between the tumor and the remaining thymus. Microscopically, the tumor contained a large amount of mature adipose and fibrous tissue with scattered cord-like epithelial tissue and a small number of lymphocytes scattered in the stroma. The tumor lacked thymic bodies. The neoplastic epithelial cells were oval or polygonal and arranged in fissures, the nuclei were uniform in size and mild in shape, and mitosis was rare. Epithelial cells were positive for AE1/AE3 and CK19, lymphocytes were positive for CD3 and CD20, and fat and fibrous tissue were positive for S-100 and vimentin, respectively. The Ki67 labeling index was less than 5%. Based on histological features and immunophenotype, thymic lipofibroadenoma was diagnosed. The patient was followed up 1 year after the operation, and no recurrence or residual lesions were found on the X-ray re-examination. CONCLUSION Lipofibroadenoma is a benign thymic tumor, and thymectomy is regarded as the best treatment. The biological behavior of thymic lipofibroadenoma is good, and the recurrence rate is low.
Collapse
Affiliation(s)
- Jing Fu
- Department of Pathology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan Province, China
| | - Xing-Wei Cai
- Department of Anesthesiology, Chengdu First People’s Hospital, Chengdu, Sichuan Province, China
| | - Shuang-Ye Hu
- Department of Pathology, Longquanyi District of Chengdu Maternal and Child Health Care Hospital, Chengdu, Sichuan Province, China
| | - Tao Lu
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan Province, China
- Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan Province, China
| | - Xing-Lan Li
- Department of Pathology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan Province, China
- * Correspondence: Xing-lan Li, Department of Pathology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No.32 West Second Section First Ring Road, Chengdu 610072, Sichuan Province, China (e-mail: )
| |
Collapse
|
50
|
Lagarde A, Le Collen L, Boulagnon C, Brixi H, Durlach A, Mougel G, Cuny T, Delemer B, Barlier A, Romanet P. Early Detection of Relapse by ctDNA Sequencing in a Patient with Metastatic Thymic Tumor and MEN1 Mosaicism. J Clin Endocrinol Metab 2022; 107:e4154-e4158. [PMID: 35904487 DOI: 10.1210/clinem/dgac454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disease caused by inactivating mutations in the MEN1 gene. In the literature, few cases of MEN1 have been reported because of mosaic MEN1 mutations. OBJECTIVE We performed an extensive molecular characterization in several lesions and blood samples, including plasmatic circulating cell-free DNA (ccfDNA) in an exceptional case of a patient with MEN1 mosaicism causing primary hyperparathyroidism, multiple pancreatic neuroendocrine tumors (NETs), and a metastatic thymic NET. METHODS Blood, ccfDNA and multiple tissue analysis were performed by next-generation sequencing. RESULTS MEN1 mosaicism was confirmed by multiple tissue analysis. Somatic analysis of the largest pancreatic NET revealed the same MEN1 second-hit mutation as found in the thymic lesion, demonstrating its metastatic origin from the thymic lesion. Moreover, in ccfDNA we found the mosaic MEN1 mutation but also the somatic second-hit mutation found in the thymic primary tumor, revealing the presence of circulating tumor DNA (ctDNA). After surgical removal of the pancreatic metastasis, the mutated fraction of both mutations decreased, before increasing again several weeks before a new clinical relapse, suggesting that thymic ctDNA may be used as an early tumor biomarker. CONCLUSION This exceptional MEN1 case highlighted (1) the importance of looking for MEN1 mosaicism, (2) that MEN1 mosaicism can cause very aggressive disease, and (3) the interest in analyzing ccfDNA for confirming MEN1 mosaicism but also as a potential tumor biomarker for NET.
Collapse
Affiliation(s)
- Arnaud Lagarde
- Aix Marseille Univ, APHM, INSERM, MMG, Hospital La Conception Laboratory of Molecular Biology, Marseille, France
| | - Lauriane Le Collen
- Department of Endocrinology Diabetology, University of Reims , Reims, France
- Inserm/CNRS UMR 1283/8199, Institut Pasteur de Lille , EGID, Lille, France
- Department of Clinical Genetics, University of Reims , Reims, France
| | - Camille Boulagnon
- Biopathology Laboratory, Pôle de Biologie Territorial, CHU de Reims, 51092 Reims, France
- Université de Reims Champagne Ardenne (URCA), CNRS, UMR 7369 MEDyC, Reims, France
| | - Hedia Brixi
- Department of Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
| | - Anne Durlach
- Biopathology Laboratory, Pôle de Biologie Territorial, CHU de Reims, 51092 Reims, France
- Inserm UMR-S 1250, 51092 Reims, France
| | - Grégory Mougel
- Aix Marseille Univ, APHM, INSERM, MMG, Hospital La Conception Laboratory of Molecular Biology, Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, APHM, INSERM, MMG, Hospital La Conception Department of endocrinology, Marseille, France
| | - Brigitte Delemer
- Department of Endocrinology Diabetology, University of Reims , Reims, France
| | - Anne Barlier
- Aix Marseille Univ, APHM, INSERM, MMG, Hospital La Conception Laboratory of Molecular Biology, Marseille, France
| | - Pauline Romanet
- Aix Marseille Univ, APHM, INSERM, MMG, Hospital La Conception Laboratory of Molecular Biology, Marseille, France
| |
Collapse
|