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Table of Contents    
LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 1  |  Page : 103-105

Association of unilocular thymic cyst and myasthenia gravis


1 Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, India
2 Department of Cardiovascular Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, India
3 Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, India

Date of Submission23-Oct-2011
Date of Decision14-Nov-2011
Date of Acceptance05-Jan-2012
Date of Web Publication7-Mar-2012

Correspondence Address:
Amit Agarwal
Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.93599

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How to cite this article:
Mishra AK, Agarwal S K, Pradhan S, Agarwal A. Association of unilocular thymic cyst and myasthenia gravis. Neurol India 2012;60:103-5

How to cite this URL:
Mishra AK, Agarwal S K, Pradhan S, Agarwal A. Association of unilocular thymic cyst and myasthenia gravis. Neurol India [serial online] 2012 [cited 2019 Jun 18];60:103-5. Available from: http://www.neurologyindia.com/text.asp?2012/60/1/103/93599


Sir,

The association of thymic cyst (TC) and myasthenia gravis (MG) is very rarely reported. We report three male patients with unilocular TC and MG. All three had symptoms of weakness, fatigability and diagnosis of MG was made on clinical, electrophysiological and immunological evidence. MG symptoms were controlled with pyridostigmine, prednisolone, or azathioprine. Trans-sternal thymectomy was done under general anesthesia. Extubation was done in the operation room and they were observed in the surgical intensive care unit (ICU) for 24 h. Pyridostigmine was started early in the postoperative period. Patient I and Patient II had an uneventful recovery and were discharged on postoperative Day 12 and Day 8 on 120, 180 mg of pyridostigmine respectively. The third patient developed worsening of symptoms and required a higher dose of pyridostigmine (240 mg/24 h) from the preoperative dose of 180 mg and was discharged on postoperative Day 10 [Table 1], [Figure 1], [Figure 2] and [Figure 3].
Table 1: Patient details

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Figure 1: CT scan showing unilocular thymic cyst

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Figure 2: Per-op thymic cyst arising from left lower limb

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Figure 3: Gross photograph of thymectomy specimen with cyst

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TCs are relatively uncommon, [1],[2],[3],[4],[5] however, these cysts are being increasingly detected with advances in imaging. They can be congenital or acquired. [6],[7] Congenital are uni- or multi-locular, derived from remnants of the fetal thymo-pharyngeal duct, and contain clear to straw or chocolate-colored fluid after an intracystic hemorrhage. [8] Acquired cysts are multi-locular, have thickened walls with severe inflammation lined partially by epithelium seen with mediastinal Hodgkin's disease or previous thoracic surgery. TCs on CT are homogenous masses of low attenuation value, low Hounsfield units and an indistinct surrounding capsule consistent with thymoma. [6],[7],[8] CT can show precise anatomic localization and local invasion of thymoma. However, the density of cyst contents may or may not differ from the adjacent thymic parenchyma, [4] so recognition of cyst by CT may not be possible as happened in our patients. Thymoma is associated with MG in about 15-20% of cases. Cystic changes have been reported in 40% of thymomas. Surgery has a definitive role to differentiate thymomas accompanied by large cystic degeneration from TC. Complete surgical excision and histopathological examination is recommended in patients with suspected TC and MG.

 
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1.Okumura S, Ohata T, Fujioka M, Nakabayashi H. A case of multilocular thymic cyst with myasthenia gravis. Nippon Kyobu Geka Gakkai Zasshi 1995;43:917-21.  Back to cited text no. 1
    
2.Yamamura H, Mase T, Shioi K, Aoyama T, Nogaki H, Nagata Y, et al. A case of thymic cyst and thymoma with myasthenia gravis. Kyobu Geka 1997;50:975-7.  Back to cited text no. 2
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3.Yamamura M, Shimizu Y, Suehiro S, Miyamoto T, Nakamura K. A case of thymic cyst and thymolipoma with ocular myasthenia gravis. Nihon Kyobu Geka Gakkai Zasshi 1993;41:461-6.  Back to cited text no. 3
[PUBMED]    
4.Yamashita S, Yamazaki H, Kato T, Yokota T, Matsumoto N, Matsukura S. Thymic carcinoma which developed in a thymic cyst. Intern Med 1996;35:215-8.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Silverman JF, Olson pr0 , Dabbs DJ, Landreneau R. Fine -needle aspiration cytology of a mediastinal seminoma associated with multi loculaer thymic cyst. Diagn Cytopathol 1999;20:224-8.  Back to cited text no. 5
    
6.Nishino M, Ashiku SK, Kocher ON, Thurer RL, Boiselle PM, Hatabu H. The Thymus: A Comprehensive Review. Radiographics 2006;26:335-48.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Bogot NR, Quint LE. Imaging of thymic disorders. Cancer Imaging 2005;5:139-49.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Nasseri F, Eftekhari F. Clinical and Radiologic Review of the Normal and Abnormal Thymus: Pearls and Pitfalls. Radiographics 2010;30:413-28.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

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