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178 Lucaciu OR. et al.Jurnalul de Chirurgie (Iaşi), 2013, Vol. 9, Nr. 28. Bagga S, Bloch EM. Imaging of an invasivemalignant thymoma on PET Scan: CT andhistopathologic correlation. Clin Nucl Med.2006; 31(10): 614-616.9. Wilkins EW, Grillo HC, Scannell JG,Moncure AC, Mathisen DJ. J. MaxwellChamberlain Memorial Paper. Role of stagingin prognosis and management of thymoma.Ann Thorac Surg. 1991; 51(6): 888-892.10. Wu KL, Mao JF, Chen GY, et al. Prognosticpredictors and long-term outcome ofpostoperative irradiation in thymoma: a studyof 241 patients. Cancer Invest. 2009; 27(10):1008-1015.11. Okumura M, Ohta M, Tateyama H, et al. TheWorld Health Organization histologicclassification system reflects the oncologicbehavior of thymoma: a clinical study of 273patients. Cancer. 2002; 94(3): 624-632.12. Barratt S, Puthucheary ZA, Plummeridge M.Complete regression of a thymoma toglucocorticoids, commenced for palliation ofsymptoms. Eur J Cardiothorac Surg. 2007;31(6): 1142-1143.13. Fujiwara T, Mizobuchi T, Shibuya K,Hiroshima K, Fujisawa T, Iwai N. Rapidregression of stage IVb invasive thymomaunder palliative corticosteroid administration.Gen Thorac Cardiovasc Surg. 2007; 55(4):180-183.14. Shin DM, Walsh GL, Komaki R, et al. Amultidisciplinary approach to therapy forunresectable malignant thymoma. Ann InternMed. 1998; 129(2): 100-104.15. Engels EA, Pfeiffer RM. Malignant thymomain the United States: demographic patterns inincidence and associations with subsequentmalignancies. Int J Cancer. 2003; 105(4): 546-551.16. Dango S, Passlick B, Thiemann U, et al. Therole of a pseudocapsula in thymic epithelialtumors: outcome and correlation withestablished prognostic parameters. Results of a20-year single center retrospective analysis. JCardiothorac Surg. 2009; 4(1): 33.17. Gonzalez M, Krueger T, Perentes JY,Matzinger O, Peters S, Ris HB. Extrapleuralpneumonectomy with venous confluenceresection for stage IVA thymic tumors. AnnThorac Surg. 2011; 91(3): 941-943.18. Arvind K, Roman D, Umashankkar K, PramodKJ, Shiv KC, Neeti M. Resection andreconstruction of mediastinal great vessels ininvasive thymoma. Indian J Cancer. 2010;47(4): 400-405.19. Venuta F, Anile M, Diso D, et al. Thymomaand thymic carcinoma. Eur J CardiothoracSurg. 2010; 37(1): 13-25.20. Wright CD. Pleuropneumonectomy for thetreatment of Masaoka stage IVA thymoma.Ann ThoracSurg. 2006; 82(4):1234-1239.
CAZURI CLINICE 179Jurnalul de Chirurgie (Iaşi), 2013, Vol. 9, Nr. 2MIASTENIA GRAVIS POST-TIMECTOMIEC. Motaş , Natalia Motaş, T. HorvatClinica de Chirurgie Toracică, Institutul Oncologic „Prof. Dr. Al. Trestioreanu” BucureştiUniversitatea de Medicină şi Farmacie „Carol Davila”, BucureştiMIASTENIA GRAVIS AFTER THYMECTOMY (Abstract): Although the relationship betweenmyasthenia gravis and thymomas it is well known, with some of myasthenias disappearing afterthymectomy, myasthenia may develop after thymoma resection. We present a case of 36 years oldman who developed generalized myasthenia 6 years after thymoma surgery; it had beenperformed tumorectomy, mediastinal fat resection, resection of the anterior wall of leftbrachiocefalic vein with PTFE patch reconstruction (Masaoka stage III thymoma). After 4 yearsof corticoid therapy (methylprednisolone) he was operated for steroid cataract. 11 years afterresection he is tumor-free and the brachiocefalic vein is functional on CT-scan. Myasthenia afterthymectomy is rare but possible after thymoma resection; it is not influenced by association ofmediastinal fat resection. The titer of specific auto antibodies and the grade of thymoma invasionare predictive factors for myasthenia development after thymectomy.KEY WORDS: MIASTENIA GRAVIS; THYMOMA; THYMECTOMYSHORT TITLE: Miastenia gravis post timectomieMyasthenia gravis after thymectomyHOW TO CITE: Motaş C, Motaş N, Horvat T. [Myasthenia gravis after thymectomy]. Jurnalul de chirurgie (Iaşi). 2013;9(2): 179-184. DOI: 10.7438/1584-9341-9-2-10.INTRODUCEREMiastenia gravis (MG) este o boalăautoimună a sinapsei neuromusculare, carese caracterizează printr-o oboseală excesivăa musculaturii striate, ce apare la efort şi serecuperează parţial sau total prin repaus sausub acţiunea unor substanţe anticolinesterazice.Timoamele sunt tumorimaligne care derivă din ţesutul epitelialtimic.Atât miastenia cât şi timoamele suntleziuni rar întâlnite în practica curentă:miastenia gravis apare cu o frecvenţă anualăde 0,25-2 cazuri/100.000 locuitori [1], întimp ce în cazul timoamelor frecvenţa anualăeste de 0,15 cazuri/100.000 locuitori [2],adică 0,2-1,5% din totalitatea tumorilormaligne.Este binecunoscută relaţia dintretimoame şi miastenia gravis: 10-15% dinmiastenii pot coexista cu un timom şi,invers, circa 30% din timoame pot prezentaca manifestare paraneoplazică miasteniagravis [3].Deşi mecanismul fiziopatologic almiasteniei nu este încă bine cunoscut, rolultimusului este însă unanim acceptat. Pe altăparte o manifestare paraneoplazică anunţă şiînsoţeşte o malignitate şi de multe ori seremite după exereza completă a leziuniitumorale. La prima vedere este paradoxal cao paraneoplazie, care apare în strânsălegătură cu un organ transformat malign, săapară la multă vreme după ce organulrespectiv şi implicit tumora au fost extirpate.Miastenia postoperatorie este definită caforma de miastenie gravis care apare dupărezecţia unui timom non-miastenic.PREZENTARE DE CAZPacientul D.S., la vârsta de 36 de ani,în 2001, în urma unui examen radiologic deReceived date: 11.01.2013Accepted date: 15.03.2013Adresa de corespondenţă: Dr. Cezar MotaşAleea Compozitorilor, nr.15, bloc 821, sc. A, ap. 39, sector 6, Bucureşti, RomaniaTel.: 0040 (0) 744 63 87 03E-mail: cezarmotas@gmail.com
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