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Case Report
Pleural drop-metastasis five years post-thymectomy manifesting with myasthenia gravis
1 Intern, Florida Lung Asthma and Sleep Specialists, Orlando, Florida, USA
2 Attending Physician, Florida Lung Asthma and Sleep Specialists, Orlando, Florida, USA
Address correspondence to:
Fortune O Alabi
(MD, FABSM, FCCP), Intern, Florida Lung Asthma and Sleep Specialists, Orlando, Florida,
USA
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Article ID: 101060Z01CA2019
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Alabi CO, Basso RG, Alabi FO. Pleural dropmetastasis five years post-thymectomy manifesting with myasthenia gravis. Int J Case Rep Images 2019;10:101060Z01CA2019.ABSTRACT
Introduction: Thymomas are the most common tumors in the anterior mediastinum. Intrathoracic recurrence of thymomas after initial resection is common and mostly seen in patients with advanced Masaoka stage. A number of paraneoplastic syndromes can be associated with thymoma, but myasthenia gravis (MG) is the most common. A total radical thymectomy often leads to a resolution of MG in a considerable number of patients. However, MG relapse post-thymectomy can occur whether there is a recurrence of the thymoma or not. In this case report, a patient presented with MG five years after radical removal of a thymoma which was not associated with MG before his surgery.
Case Report: A 47-year-old male while on admission for acute meningitis was incidentally found to have a mediastinal mass on a chest X-ray and then confirmed by computed tomography (CT) of the chest. The mass was about 5 × 3 cm in size and located in the left perivascular space of his mediastinum. A biopsy of the mass obtained by Chamberlain procedure confirmed the presence of invasive thymoma (WHO type B2). He had no features suggestive of associated paraneoplastic syndrome. The thymoma was subsequently resected and found to be Masaoka stage 3. Postoperative radiotherapy was suggested to the patient, but he declined it. Five years later, the patient presented with ptosis, intermittent generalized muscle weakness with occasional shortness of breath and was diagnosed with MG with positive acetylcholine receptor antibodies. He was treated with pyridostigmine and plasmapheresis. A minimally heterogenous 10.6 × 4.4 cm mass was found within the posteromedial aspect of the pleural reflection of his left lower lung lobe on chest CT scan with contrast. A CT-guided biopsy of the mass was performed which confirmed the recurrence of the invasive thymoma with pathology report histologically similar to the previously resected thymoma. The patient was diagnosed with recurrence of invasive thymoma by pleural drop-metastasis and was managed by radiation therapy.
Conclusion: Myasthenia gravis can manifest on recurrence of thymoma in a patient post-thymectomy even though there was no MG associated with the initial thymoma.
Keywords: Myasthenia gravis, Pleural metastasis, Post-thymectomy, Thymoma
SUPPORTING INFORMATION
Author Contributions
Christopher O Alabi - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Rafaela G Basso - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Fortune O Alabi - Analysis of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Christopher O Alabi et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
