Management of Thymic Carcinoma Patient with Myasthenia Gravis

· Case Report, Thoracic Oncology

Ariani Permatasari, Laksmi Wulandari

Background : Thymoma and thymic carcinoma are a tumor of anterior mediastinum originating from thymus gland. Approximately
30-50% of patients with thymoma have myastenia gravis, only 10-15% of patients with myasthenia gravis have thymoma. The data
on patients with myasthenia gravis having thymic carcinoma is rare. Such as thymoma, initial treatment of thymic carcinoma is
surgical resection, but multimodal treatment with surgery, radiotherapy and chemotherapy are often used.

Case report : A 46 years old female came with chief complaints of shortness of breath. Cough without sputum. She also had
dropping eyelids. A fatiguable and weakness of muscles upper and lower extremities especially after exertion. The patients had
history myasthenia gravis since 5 years. Neurological examination showed the presence of ptosis sinistra, diplopia, weakness in the
upper and lower extremities. The chest X-Ray showed a solid mass in the anterior mediastinum. The FNAB result is stage II
thymoma. The patients subsequently underwent thymectomy after being started on pyridostigmine and methylprednisolon. The
histopathology report after surgery was suggestive of an anaplastic type thymic carcinoma. She was staged as high grade thymic
carcinoma. The patient subsequently planned to be implemented chemotherapy.

Discussion : Thymic carcinoma is relatively rare malignant epithelial tumor of thymus, represents about 5-10% of tumors originating
from the thymus. Thymic abnormalities occur in three-quarters of patients with myasthenia gravis. Thymic carcinoma is a
heterogeneous group of aggressive, invasive epithelial malignant tumor. Classified histologically by Levina and Rosai and updated
by Sustar and Rosai into low grade and high grade. Treatment and prognosis depend on the stage and grade. Masaoka stage for
thymoma is not useful as a prognostic tool in thymic carcinoma. Multimodal treatment, especially complete resection, radiotherapy
and chemotherapy is a standard treatment for thymic carcinoma.

Summary : It has been reported of a female, 46 years old and thymic carcinoma. She also has myasthenia gravis. The patient
underwent thymectomy and subsequently planned to be implemented chemotherapy. (J Respir Indo. 2013; 33:57-65)

Keywords : Thymoma, thymic carcinoma, myasthenia gravis, surgery, chemotherapy.

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