Thymic epithelial tumors represent the most common neoplasms of the anterior mediastinum, while atypical type A thymoma is a rare subtype of thymoma. On the morphological basis of type A thymoma, this tumor exhibits some atypical histological features, such as abundant cells, increased mitotic counts, tumor necrosis, and increased Ki67 index. At present, the clinical and pathological data of this tumor is still available. Since it was formally named, 16 cases have been reported around the world. In order to improve the understanding of the disease, this article reviews the related literature and tries to elaborate the atypical type A thymoma from the aspects of pathological features, clinical manifestations, epidemiology and differential diagnosis.
Objective To assess the long-term results and relevant influencing factors of extended thymectomy and medicine-alone treatment of non-thymomatous myasthenia gravis (MG) patients. Methods We retrospectively analyzed the clinical data of 174 patients with non-thymomatous MG diagnosed and treated in our department from December 2009 to April 2017, including 81 males and 93 females, aged 13-88 (47.1±17.8) years. According to the different treatment methods, the patients were divided into two groups: an operation group (91 patients receiving extended thymectomy) and a medicine-alone group (83 patients receiving medical therapy alone). The efficacy was evaluated according to the Myasthenia Gravis Foundation of America (MGFA). Survival curves of the patients were plotted using the Kaplan-Meier method to evaluate the remission rate and survival rate. Cox regression analysis was used to assess the influencing factors of the outcomes. Results The patients were followed up for 3 to 94 (39.1±26.9) months. As a result, 29 patients (31.9%) achieved complete remission in the surgery group and 13 patients (15.7%) were completely relieved in the medicine-alone group (P=0.014). Further analysis showed that treatment pattern (P=0.018) and MG type (P=0.021) were the main factors related to the efficacy. Conclusion For patients with non-thymomatous MG, extended thymectomy is superior to the medicine-alone in terms of complete remission rate and the postoperative immunosuppression ratio.
Thymectomy is a major surgical procedure for patients with non-thymomatous myasthenia gravis，and can enhance their symptomatic remission rate and cure rate. There is still much controversy about appropriate surgical approach and extent of resection of thymectomy. The majority of thoracic surgeons believe that the completeness of thymectomy is closely associated with clinical symptom improvement，and perform complete resection of encapsulated thymus and surroun-ding fat tissues via mid-sternotomy. But minimally invasive thymectomies are often more acceptable by patients. On the contrary，in view of common existence of ectopic thymus tissue，some thoracic surgeons advocate a combination of cervical incision and sternotomy in order to further completely remove all thymus tissue.
ObjectiveTo compare the perioperative outcomes of subxiphoid robot-assisted extended thymectomy (SRAET) and video-assisted thoracoscopic extended thymectomy (VATET) for myasthenia gravis complicated with thymoma.MethodsRetrospective analysis of 61 patients with myasthenia gravis combined with thymoma who were admitted to the Department of Thoracic Surgery, West China Hospital, Sichuan University from January 2017 to June 2019 was performed. All patients underwent extended thymectomy, and the patients were divided into a SRAET group and a VATET group. There were 26 patients in the SRAET group, including 11 males and 15 females, with an average age of 42.20±13.20 years. There were 35 patients in the VATET group, including 14 males and 21 females, with an average age of 45.00±13.00 years. The perioperative outcomes of the two groups including gender, age, operation time, intraoperative blood loss, conversion rate, postoperative drainage, tube removal time, drainage volume, visual analogue scale, hospital stay and postoperative complications were compared.ResultsThere was no conversion to thoracotomy, death or myasthenia crisis in both groups. The operation time (111.42±28.60 min vs. 103.71±26.20 min, P=0.845), intraoperative blood loss (32.31±23.84 mL vs. 63.57±132.22 mL, P=0.239), visual analogue scale at postoperative 24 h (2.46±0.76 vs. 2.40±0.74, P=0.751) and postoperative 48 h (2.12±0.77 vs. 2.26±0.56, P=0.407), complication rate (3.8% vs. 2.9%, P=0.675), drainage volume (206.85±130.09 mL vs. 276.86±173.46 mL, P=0.089) and hospital stay (5.81±2.52 d vs. 5.29±2.17 d, P=0.642) were not significantly different between the two groups. The visual analogue scale of the SRAET group at postoperative 72 h (1.12±0.65 vs. 1.86±0.91, P=0.001) was significantly lower than that of the VATET group.ConclusionSRAET is a safe and feasible method with less postoperative short-term pain, which is an alternative surgical treatment for myasthenia gravis complicated with thymoma.
[Abstract]This study reports a case of an 83-year-old female patient with systemic severe myasthenia gravis (American Myasthenia Foundation class Ⅳb) and multiple comorbidities who achieved minimal clinical status through preoperative alemtuzumab treatment (10 mg/kg, once per week for 4 consecutive weeks). After undergoing robotic thymectomy, the patient remained clinically stable in the early postoperative period until the 5th day after surgery when she developed dysphagia. Despite intravenous immunoglobulin and other therapeutic interventions, the patient’s myasthenic symptoms continued to worsen, coughing was impaired, respiratory insufficiency intensified, non-invasive ventilation support was required, and pulmonary infection occurred. Clinical symptoms further deteriorated, with diarrhea, urinary tract infection, and progressive respiratory tract infection. She was subsequently transferred to the intensive care unit for invasive mechanical ventilation and therapeutic plasmapheresis. These interventions failed to halt the disease progression, which eventually led to multiple organ dysfunction syndrome, and the patient died. Notably, among the other 12 patients receiving alemtuzumab treatment during the same period, none experienced such severe complications. This case is exceptional, and a direct causal relationship between alemtuzumab and mortality risk cannot be established at this time. Further research is needed to clarify perioperative immune management strategies.
ObjectiveTo investigate the safety and feasibility of laryngeal mask general anesthesia as a replacement of tracheal intubation general anesthesia in the "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch for thymoma patients without myasthenia.MethodsFrom January 2018 to June 2019, clinical data of patients with thymoma who underwent the novel "three-port" operation in our institution were analyzed retrospectively. The patients were divided into two groups according to the anesthesia methods, including a tracheal intubation general anesthesia group and a laryngeal mask general anesthesia group. There were 70 patients in the tracheal intubation general anesthesia group, including 42 males and 28 females, with an average age of 45.83±15.89 years. There were 39 patients in the laryngeal mask general anesthesia group, including 26 males and 13 females, with an average age of 43.31±15.64 years. The clinical data of the two groups were compared.ResultsThe baseline characteristics of the patients in the two groups were well balanced (P>0.05). No massive bleeding, conversion to thoracotomy, postoperative myasthenia or death occurred in those patients. No patient with laryngeal mask anesthesia had a conversion to tracheal intubation anesthesia during the operation. There was no significant difference in the operation time, intraoperative bleeding, intraoperative maximum partial pressure of CO2, lowest partial pressure of oxygen and anesthesia effect score between the two groups (P>0.05). There was also no statistical difference in postoperative aspiration, gastrointestinal discomfort, length of hospital stay, pain score and patient satisfaction degree between the two groups (P>0.05). However, the anesthesia time before operation and the time of awake after anesthesia in the laryngeal mask anesthesia group were significantly shorter than those in the tracheal intubation general anesthesia group (P<0.05), and the incidence of transient arrhythmia, laryngeal discomfort and hoarseness in the laryngeal mask general anesthesia group was significantly lower than that in the tracheal intubation general anesthesia group (P<0.05).ConclusionThe "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch under laryngeal mask general anesthesia is safe and feasible in the treatment of thymoma without myasthenia, and can be recommended routinely.
ObjectiveTo analyze the research hotspots and progress of surgical treatment of myasthenia gravis. MethodsThe top 100 most cited articles on surgical treatment of myasthenia gravis were identified by searching the Web of Science database, and a bibliometric analysis was conducted. ResultsThe publication year of the top 100 most cited articles ranged from 1939 to 2021, and the number of citations ranged from 55 to 850 per article. Most of the included articles were original research articles (75/100), which were mainly retrospective studies (64/75). The United States was the country with the most published articles and most citations, and Annals of Thoracic Surgery was the most sourced journal (n=20). Through VOSviewer analysis, high-density keywords were thymectomy, maximal thymectomy, extended thymectomy, transcervical thymectomy, thymoma, and autoantibodies. ConclusionThe scope of surgical resection, surgical approach and pathogenesis are the current hotspots in the field of surgical treatment of myasthenia gravis. It is hoped that this paper can provide references for future researches in this field.
ObjectiveTo investigate the safety and efficacy of totally no tube three-port thoracoscopic surgery (TNTT) for thymic tumor via lateral thoracic approach. MethodsThe clinical data of patients with thymoma admitted to the Department of Thoracic Surgery of the General Hospital of Northern Theater Command from November 2021 to May 2022 were retrospectively analyzed. The patients were divided into a TNTT group and a single utility port video-assisted thoracic surgery (SVATS) group according to different surgical methods. The clinical data were compared between the two groups. ResultsA total of 111 patients were collected. There were 44 patients in the TNTT group, including 20 males and 24 females, with an average age of 60.11±8.64 years, and 67 patients in the SVATS group, including 30 males and 37 females, with an average age of 62.40±7.92 years. There was no significant difference between the two groups in the baseline data (P>0.05). The postoperative hospital stay and intraoperative blood loss were shorter or less in the TNTT group (P<0.05), and the visual analogue scale score 48 hours after the operation was smaller in the SVATS group (P<0.05). ConclusionTNTT has a good surgical safety, and can shorten postoperative hospital stay, reduce intraoperative blood loss, and has significant advantages in enhanced recovery after surgery, but SVATS can reduce postoperative pain in patients.
Thymectomy is the main treatment for thymoma and other thymic diseases. But the incidence of non-therapeutic thymectomy is high due to the difficulty in the differential diagnosis of anterior mediastinum lesions. Formerly, it was believed that the thymus gradually degraded and lost function with aging, and the preservation of the thymus was not valued. Recent studies have found that the removal of the thymus at all ages has adverse effects on overall health and leads to a significant increase in the risk of autoimmune diseases, malignancy, and all-cause mortality. Therefore, unnecessary thymectomy should be avoided. This article reviews the influence of thymectomy, including the changes of immunological indexes and clinical prognosis, and further discusses the current situation and avoidance methods of non-therapeutic thymectomy.
摘要:目的:研究胸腺瘤與前縱隔(血管前間隙)淋巴瘤的MSCT表現,提高對二者的診斷與鑒別診斷能力。方法:回顧性分析經手術病理證實的30例胸腺瘤與18例血管前間隙淋巴瘤MSCT表現,著重觀察腫瘤的密度、形態及其與周圍結構的關系。結果:30例胸腺瘤中,24例良性胸腺瘤與鄰近大血管分界清晰,腫塊表現 “D”字或反“D”字狀,平掃CT值16~59 Hu,增強CT值20~110 Hu;6例侵襲性胸腺瘤邊界不清,呈分葉狀、不規則形,密度不均,平掃CT值23~42 Hu,增強CT值23~60 Hu。18例淋巴瘤中,單發于前上縱隔者6例,其余12例呈多結節、腫塊狀,侵入血管間隙生長,致大血管受壓,增強掃描呈輕度強化,常伴有其它部位淋巴結增大。結論:MSCT能清晰顯示胸腺瘤與前縱隔淋巴瘤的影像學表現特征,并能有效提高對二者的鑒別診斷。Abstract: Objective: To diagnosis and differentiate thymoma and malignant lymphoma in the anterior mediastinum on the basis of multislice CT (MSCT) imaging features. Methods:We retrospectively reviewed 30 cases with thymoma and 18 cases with malignant lymphoma proven by surgery and pathology.More attention was put on the density, morphology and relation with the surrounding structures of the tumors. Results: The CT manifestations of 30 cases of thymoma were shown as: For 24 cases of benign thymoma, the boundaries were clear, the shapes were “D” signs or contra“D” signs, CT attenuation value were 1659Hu and 20110Hu on unenhanced and contrastenhanced scanning. For 6 cases of malignant thymoma, the boundaries were unclear, the shapes were lobulated or irregular, the density was heterogeneous, CT attenuation value were 2342Hu and 2360Hu on unenhanced and contrastenhanced scanning. For 18 cases of malignant lymphoma, 6 cases were located at anterior mediastinum, 12 cases were nodes or multiple mass, enveloped the neighboring vessel structures, mildly enhanced on contrastenhanced scanning, and associated with enlargement of lymph nodes in other place. Conclusion: MSCT can display the imaging features of thymoma and anterior mediastinal lymphoma, and effectively differentiate thymoma and mediastinal lymphoma.