Note publique d'information : To describe autoimmune diseases in patients with thymoma; and 2) to perform a literature
review concerning this issue. Hospices Civils de Lyon Pathological records from 2005
to 2011 were reviewed to identify patients with thymoma, either benign or malignant.
All the patients who had thymoma and autoimmune phenomena were analyzed. The diagnosis
of autoimmune diseases was based on both clinical and serological findings. 46 of
the 85 (54.1%) cases of thymoma had an AD including: myasthenia gravis (MG) (n=33),
Hashimoto's thyroiditis (n=4), Isaac’s syndrome (n=3), Morvan syndrome (n=2), pure
red cell aplasia (n=2), systemic lupus (n=2), lichen planus (n=2), and one case of
each following conditions: aplastic anemia, autoimmune hemolytic anemia, Good’s syndrome,
pemphigus, autoimmune hepatitis, Graves’ disease, limbic encephalitis and inflammatory
myopathy. Six patients (7%) presented at least 2 ADs. The median age at the diagnosis
of thymoma was 58 years (21-82 years) and 53 years (21-81 years) at the diagnosis
of AD. The median duration of follow-up after surgery was 60 months (3-241 months).
According to the WHO classification, there were 12 cases class A thymoma, 44 class
B, 27 class AB, one carcinoma and one carcinoid tumor. In 33 patients the diagnosis
of AD preceded the diagnosis of thymoma, in 7 patients thymoma was diagnosed at the
same time as the AD and 7 patients had been operated when they developed an AD. There
were two cases of exacerbation of AD immediately after surgery. MG patients and another
AD patients were statistically similar in terms of age, gender and duration of follow-up.
Thymectomy was ineffective in 14 MG patients (41.2 %) who presented a relapse after
surgery and in 6 patients with another AD (64.7%). The first occurrence of an AD was
observed despite thymectomy especially in the youngest patients (median age of 35
years) (p<0.05). One single patient with MG developed another AD after thymectomy.
The presence of MG or another AD before or concomitantly with thymoma was not a predisposition
of the development of an AD after thymectomy. We describe here the outcome of a large
series of AD related to thymoma. Our results confirm previous data concerning an AD
occurrence in patients with thymoma and suggest individualized subgroups at risk to
develop autoimmune manifestations after thymectomy
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