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1.
J Cardiothorac Surg ; 16(1): 333, 2021 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-34794482

RESUMO

BACKGROUND: Thymic tumors usually present with adjacent organ invasion or pleural dissemination, but very few studies have reported on occult pleural dissemination detected intraoperatively. This study aimed to investigate the risk factors that can predict pleural dissemination preoperatively. METHODS: Consecutive patients with thymic tumors who underwent surgery from January 2010 to January 2017 were reviewed. Only patients without pleural dissemination detected preoperatively were included in this study. Demographic, clinical, pathological, and survival data were collected for statistical analysis. Further analyses were performed to find the risk factors of occult pleural dissemination. RESULTS: A total of 352 patients with thymic tumors were included in this study. Seven patients had pleural dissemination detected intraoperatively. All pleural dissemination cases were in clinical Masaoka-Koga stage III, and most underwent the video-assisted thoracoscopic surgery (VATS) approach (or VATS exploration). Univariate analysis showed that positive squamous cell carcinoma (SCC) antigen was the only predictor of pleural dissemination (p = 0.009). Tiny nodules close to the diaphragm were detected in the computed tomography scans of 1 case after reviewing the imaging data. Tumor recurrence occurred in 5 patients during follow-up. The disease-free survival rates were better in patients with a solitary nodule than those with multiple nodules (p = 0.019). No significant difference was detected in terms of disease-free survival rates between SCC antigen positive and SCC antigen negative patients. CONCLUSIONS: Positive SCC antigen was the only detected risk factor for predicting pleural dissemination in thymic tumors preoperatively in this study. The VATS approach (including VATS exploration) is suggested for patients with clinical Masaoka-Koga stage III and SCC antigen positive thymic tumors, according to our experience.


Assuntos
Recidiva Local de Neoplasia , Neoplasias do Timo , Humanos , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Pleura/patologia , Pleura/cirurgia , Estudos Retrospectivos , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia
2.
BMC Infect Dis ; 21(1): 1142, 2021 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-34749670

RESUMO

BACKGROUND: Ureaplasma urealyticum (UU) is found among the normal vaginal flora in a considerable proportion of asymptomatic women; however, adult central nervous system (CNS) infection of UU is extremely rare. Good's syndrome (GS) is an adult-onset immunodeficiency characterized by thymoma, hypogammaglobulinaemia, low or absent B­cells, and an inverted CD4+/CD8+ T­cell ratio. Patients with GS usually have severe or recurrent infections. CASE PRESENTATION: We describe the case report of a 49-year-old woman who developed UU meningitis. Initial routine anti-viral and anti-bacterial therapy showed no improvement in the patient's condition. Next-generation sequencing (NGS) of cerebrospinal fluid (CSF) identified the UU DNA sequence. Accordingly, a diagnosis of UU meningitis was made, and minocycline therapy was initiated. The patient responded favourably, with no signs of disease at subsequent follow-up. According to the severity and rarity of the case, secondary immunodeficiency was suspected. Flow cytometry found hypogammaglobulinaemia. Combined with the previous history of thymoma, the patient was diagnosed with immune deficiency disease of GS. CONCLUSIONS: This case may be the first adult case report in the literature describing UU meningitis in a patient with GS. The diagnosis of GS should be considered in patients presenting with unexplained antibody deficiency and thymoma.


Assuntos
Agamaglobulinemia , Meningite , Timoma , Neoplasias do Timo , Agamaglobulinemia/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Timoma/complicações , Ureaplasma urealyticum
3.
Scand J Immunol ; 94(4): e13094, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34780092

RESUMO

The thymus produces self-limiting and self-tolerant T cells through the interaction between thymocytes and thymus epithelial cells (TECs), thereby generating central immune tolerance. The TECs are composed of cortical and medullary thymic epithelial cells, which regulate the positive and negative selection of T cells, respectively. During the process of negative selection, thymocytes with self-reactive ability are deleted or differentiated into regulatory T cells (Tregs). Tregs are a subset of suppressor T cells that are important for maintaining immune homeostasis. The differentiation and development of Tregs depend on the development of TECs and other underlying molecular mechanisms. Tregs regulated by thymic epithelial cells are closely related to human health and are significant in autoimmune diseases, thymoma and pregnancy. In this review, we summarize the current molecular and transcriptional regulatory mechanisms by which TECs affect the development and function of thymic Tregs. We also review the pathophysiological models of thymic epithelial cells regulating thymic Tregs in human diseases and specific physiological conditions.


Assuntos
Linfócitos T Reguladores/citologia , Linfócitos T Reguladores/imunologia , Imunidade Adaptativa , Animais , Doenças Autoimunes/genética , Doenças Autoimunes/imunologia , Diferenciação Celular/imunologia , Células Dendríticas/citologia , Células Dendríticas/imunologia , Células Epiteliais/classificação , Células Epiteliais/citologia , Células Epiteliais/imunologia , Feminino , Homeostase , Humanos , Masculino , Modelos Imunológicos , Poliendocrinopatias Autoimunes/genética , Poliendocrinopatias Autoimunes/imunologia , Gravidez , Transdução de Sinais/imunologia , Linfócitos T Reguladores/classificação , Timócitos/classificação , Timócitos/citologia , Timócitos/imunologia , Timoma/imunologia , Timo/citologia , Timo/imunologia , Neoplasias do Timo/imunologia
4.
BMC Med ; 19(1): 300, 2021 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-34781947

RESUMO

BACKGROUND: Multi-omics studies have shown a high and lack of common driver mutations in most thymomas (TH) and thymic carcinomas (TC) that hamper the development of novel treatment approaches. However, deregulation of apoptosis has been proposed as a common hallmark of TH and TC. BH3 profiling can be utilized to study the readiness of living cancer cells to undergo apoptosis and their dependency on pro-survival BCL-2 family proteins. METHODS: We screened a cohort of 62 TH and TC patient samples for expression of BCL-2 family proteins and used the TC cell line 1889c and native TH for dynamic BH3 profiling and treatment with BH3 mimetics. RESULTS: Immunohistochemical overexpression of MCL-1 and BCL-xL was a strong prognostic marker of TH and TC, and BH3 profiling indicated a strong dependency on MCL-1 and BCL-xL in TH. Single inhibition of MCL-1 resulted in increased binding of BIM to BCL-xL as an escape mechanism that the combined inhibition of both factors could overcome. Indeed, the inhibition of MCL-1 and BCL-xL in combination induced apoptosis in a caspase-dependent manner in untreated and MCL-1-resistant 1889c cells. CONCLUSION: TH and TC are exquisitely dependent on the pro-survival factors MCL-1 and BCL-xL, making them ideal candidates for co-inhibition by BH3 mimetics. Since TH show a heterogeneous dependency on BCL-2 family proteins, upfront BH3 profiling could select patients and tailor the optimal therapy with the least possible toxicity.


Assuntos
Timoma , Neoplasias do Timo , Apoptose , Linhagem Celular Tumoral , Humanos , Proteína de Sequência 1 de Leucemia de Células Mieloides/genética , Prognóstico , Proteínas Proto-Oncogênicas c-bcl-2/genética , Neoplasias do Timo/tratamento farmacológico , Neoplasias do Timo/genética , Proteína bcl-X/genética
7.
J Med Invest ; 68(3.4): 396-399, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34759168

RESUMO

A 76-year-old woman with a history of angina pectoris, hypertension and dyslipidemia was pointed out an abnormal opacity in the right hilar region on routine chest X-ray. Chest computed tomography showed masses in the anterior mediastinum with the invasion of the adjacent ascending aorta, right brachiocephalic vein and right pleura. Histologic examination led to a diagnosis of Masaoka stage IVa thymoma. Three courses of chemotherapy were given, but further tumor progression was seen. Thereafter, the patient was followed without aggressive treatments. One year after the initial diagnosis, she presented with dyspnea and right chest pain. Chest CT revealed right massive pleural effusion with pleural dissemination and much further progression of existing tumors. For the purpose of symptom palliation, a low dose (5 mg / day) of prednisolone was commenced, which unexpectedly led to marked alleviation of patient's symptoms and dramatic decrease of pleural effusion. To the best of our knowledge, this is the first report of an invasive thymoma responded to low-dose corticosteroid. The present case suggests that corticosteroids, even at low doses, might be potentially effective for invasive thymoma after failure of surgery, chemotherapy and radiotherapy. J. Med. Invest. 68 : 396-399, August, 2021.


Assuntos
Timoma , Neoplasias do Timo , Idoso , Feminino , Humanos , Prednisolona , Timoma/diagnóstico por imagem , Timoma/tratamento farmacológico , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/tratamento farmacológico , Tomografia Computadorizada por Raios X
8.
Eur Respir Rev ; 30(162)2021 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-34670805

RESUMO

Thymic tumours are rare thoracic malignancies, that may be aggressive and difficult to treat. The pillars of the management include pathological review, consideration of differential diagnoses, staging and multidisciplinary discussion. Assessment of resectability is key to drive the treatment sequencing. Association with autoimmune diseases, especially myasthenia gravis, is observed, which impacts the oncological management. Networks are being built at the national and international levels. This article provides an overview of the most recent findings in the diagnosis, staging, histology, and management strategies of thymic tumours.


Assuntos
Miastenia Gravis , Timoma , Neoplasias do Timo , Diagnóstico Diferencial , Humanos , Miastenia Gravis/diagnóstico , Miastenia Gravis/epidemiologia , Miastenia Gravis/terapia , Estudos Retrospectivos , Timoma/diagnóstico , Timoma/terapia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgia
9.
Rom J Morphol Embryol ; 62(1): 73-83, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34609410

RESUMO

OBJECTIVE: Identifying the morphological features of thymus in patients with myasthenia gravis (MG) with anti-acetylcholine receptor (AChR) antibodies and concomitant Hashimoto's thyroiditis (HT), which were recruited from a single surgical unit of a tertiary referral hospital located in the North-Eastern region of Romania, over a period of 11 years. PATIENTS, MATERIALS AND METHODS: We retrospectively reviewed clinical, imaging, laboratory, thymic pathology, and outcome data that were obtained from medical records of patients with MG and concomitant HT, to whom a thymectomy was performed for a suspected thymic lesion. All the surgical interventions were done in the Third Clinic of Surgery, St. Spiridon Emergency County Hospital, Iasi, Romania, for an 11 years' period, i.e., from January 1, 2000 and December 31, 2010. RESULTS: Four patients (three females and one male) were included. The mean age of the patients at the time of their thymectomy was 40.25 years. Of all patients, 75% had moderate or severe MG, 100% had anti-AChR antibodies, and an electromyographic decrement greater than 25%. All patients have been diagnosed with HT in their past medical history by a full thyroid panel [high thyroid-stimulating hormone (TSH) values, low free thyroxine (fT4) values, and the presence of the anti-thyroid antibodies] and all of them have been treated with Euthyrox. Our four patients expressed different MG subtypes, each of them being associated with different thymus pathology. Thoracic computed tomography (CT) scan revealed heterogeneous mediastinal masses and established the correct diagnosis only in 25% of cases. The pathological exams also revealed a heterogeneous pattern of thymic lesions. In contrast with other studies, our patients with MG with anti-AChR antibodies and concomitant HT presented atrophic thymus more frequently (50%), but with particular morphological changes of Hassall's corpuscles. Also, 25% of cases were diagnosed with thymic lympho-follicular hyperplasia (TLFH) associated with thymic epithelial hyperplasia. In B2 thymoma, neoplastic epithelial cells expressed cytokeratin 19 (CK19) immunoreactivity, high Ki67 labeling index and strong p63 immunopositivity. CONCLUSIONS: In our series, MG and HT occurred simultaneously, or one of them was diagnosed before the other, raising some new questions regarding the immune mechanism of these two autoimmune diseases. Due to the heterogeneous morphological changes of the thymus that we found in this study, we can hypothesize that thymus is involved in the pathogenic mechanism of MG with anti-AChR-antibodies and concomitant HT development.


Assuntos
Doença de Hashimoto , Miastenia Gravis , Neoplasias do Timo , Adulto , Feminino , Humanos , Masculino , Miastenia Gravis/complicações , Receptores Colinérgicos , Estudos Retrospectivos
10.
J Med Case Rep ; 15(1): 491, 2021 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-34610824

RESUMO

BACKGROUND: Cardiac myxoma is the most common type of primary cardiac tumor, and thymic carcinoid is a rare neuroendocrine tumor. No previous reports have described surgical management of concomitant occurrence of these neoplasms. We report a case of simultaneous surgical resection in a patient with coexisting cardiac myxoma and atypical thymic carcinoid. CASE PRESENTATION: A 44-year-old Japanese woman underwent chest roentgenography revealing an abnormality in the mediastinum. Computed tomography revealed a 100 mm mass in the anterior mediastinum and also a 30 mm mass in the left atrium. The mediastinal tumor was diagnosed as atypical carcinoid by biopsy. Having completed resection of atypical thymic carcinoid, cardiac mass was successfully resected with careful consideration of minimizing operation time and optimizing patient safety and oncological treatment. The histopathological diagnosis of the cardiac mass was myxoma. No adjuvant chemotherapy was administered, and no recurrence was seen as of the 45 month follow-up. CONCLUSIONS: The simultaneous surgery of cardiac myxoma and atypical thymic carcinoid was feasible and effective. To the best of our knowledge, this is the first case report to describe one-stage treatment of these neoplasms.


Assuntos
Tumor Carcinoide , Neoplasias Cardíacas , Mixoma , Neoplasias do Timo , Adulto , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/cirurgia , Feminino , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Humanos , Mixoma/diagnóstico por imagem , Mixoma/cirurgia , Recidiva Local de Neoplasia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/cirurgia
11.
Gen Dent ; 69(6): 25-28, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34678738

RESUMO

Thymomas are neoplasms associated with paraneoplastic disorders. Severe hypersensitivity reactions involving the oral cavity may be the first sign of an undiagnosed thymoma. Oral manifestations of an underlying thymoma may present as recurrent severe painful lesions with associated significant morbidity, often not responding to standard therapeutic measures. This case report describes the treatment of a 75-year-old woman who presented with severe oral lichenoid hypersensitivity reactions secondary to an undiagnosed underlying thymoma. No substantial improvement of the oral conditions was achieved with conventional therapies (topical and systemic steroids); however, almost complete resolution of the lesions was achieved following completion of radiation therapy for the thymic neoplasm. This article is intended to serve as a resource for clinicians to understand early, rare manifestations of an undiagnosed thymoma.


Assuntos
Erupções Liquenoides , Síndromes Paraneoplásicas , Timoma , Neoplasias do Timo , Idoso , Feminino , Humanos , Erupções Liquenoides/diagnóstico , Erupções Liquenoides/etiologia , Mucosa Bucal , Timoma/complicações , Timoma/terapia , Neoplasias do Timo/complicações , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/terapia
12.
Artigo em Inglês | MEDLINE | ID: mdl-34672144

RESUMO

Robotic thymectomy is the most innovative surgical approach for treating disease of the anterior mediastinum. Robotic surgery offers low postoperative morbidity, faster recovery, shorter hospital stay, and better cosmetic results, without compromising surgical radicality. During the operation, the patient is placed in a supine position at the left edge of the operating table with the left hemithorax upward; the position is maintained with sandbags. The target area for the autodocking should be toward the jugulum. The first surgical step is to isolate the inferior thymic horns via the dissection that starts from the inferior portion of the mediastinal tissue and proceeds toward the right side, following the contralateral pleural reflection. Afterward, it is necessary to move toward the superior horns, following the phrenic nerve, the first landmark, to the innominate vein, our second landmark. Finally, we dissect the superior horns while searching for the thymic veins, which could appear atrophic, and clip the vessels to safely isolate the innominate vein. During this step, it is useful to use a retraction movement to progressively dissect the horns from the jugulum. The thymus gland is removed en bloc with the perithymus fat using an endoscopic bag inserted through the right port incision.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Neoplasias do Timo , Humanos , Tempo de Internação , Timectomia
13.
In Vivo ; 35(6): 3623-3626, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34697204

RESUMO

BACKGROUND/AIM: Thymic lipofibroadenoma is a benign growth of unknown etiology extremely rarely described in the literature, morphologically resembling lipofibroadenoma of the breast. The diagnosis is usually a postoperative surprise and is made by the anatomopathologist. Surgical resection is curative. CASE REPORT: The presented case is the first reported in a woman, to date. The patient was successfully submitted to surgery and complete resection of the giant intrathoracic tumor was performed. The histopathological and immunohistochemical studies came to demonstrated the presence of a thymic lipofibroadenoma while the postoperative outcomes were favorable. CONCLUSION: In cases presenting large intrathoracic tumors complete resection is able to provide a significant improvement of the general condition of the patient, as well as a chance for cure.


Assuntos
Neoplasias do Sistema Respiratório , Timoma , Neoplasias do Timo , Feminino , Humanos , Período Pós-Operatório , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgia
14.
Can Vet J ; 62(10): 1067-1070, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34602633

RESUMO

An 8-year-old cat was presented with pruritus, purulent paronychia, scaling, crusting, and spontaneous alopecia. Histopathology revealed intraepidermal neutrophilic pustular acantholytic dermatitis and hyperkeratotic cytotoxic interface dermatitis. No thoracic mass was seen on a lateral radiograph. Ectopic thymoma was discovered on necropsy. This case highlights the necessity for thorough investigation of any case of feline exfoliative dermatitis and pemphigus foliaceus for the presence of thymoma. Key clinical message: Comorbidity of exfoliative dermatitis and pemphigus foliaceus in a cat should prompt a thorough investigation for presence of a thymoma, possibly with advanced imaging techniques.


Assuntos
Doenças do Gato , Dermatite Esfoliativa , Pênfigo , Timoma , Neoplasias do Timo , Animais , Gatos , Comorbidade , Dermatite Esfoliativa/veterinária , Pênfigo/veterinária , Timoma/complicações , Timoma/veterinária , Neoplasias do Timo/veterinária
15.
J Transl Med ; 19(1): 413, 2021 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-34600541

RESUMO

BACKGROUND: The length of time for clinical improvement of patients with thymomatous myasthenia gravis (MG) after extended thymectomy is not clear. The purpose of this study was to determine the length of time after thymectomy in patients with thymomatous MG to achieve a 3-point reduction of Quantitative Myasthenia Gravis Score (QMGS), and identify variables associated with a failure to achieve the reduction. METHODS: The records of patients with thymomatous MG who underwent extended thymectomy from January 2005 to December 2018 were retrospectively reviewed. The primary end point was a reduction of 3 points of QMGs and the secondary end point was another reduction of 3 points of QMGs. RESULTS: A total of 481 patients were included in the analysis, the mean age of the patients was 41.63 ± 8.55 years, and approximately 60% were male. The median time to achieve a 3 point decrease in QMGS was 6 months, and the median time to achieve another 3 point decrease was 30 months. Multivariable analysis indicated that age ≥ 42 years and Masaoka-Koga stage > I were associated with a lower probability of achieving a 3 point decrease in QMGS (HR = 0.55 and 0.65, respectively). Likewise, multivariable analysis indicated that age ≥ 42 years and Masaoka-Koga stage > I were associated with a lower probability of achieving a second 3 point decrease in QMGS (HR = 0.53 and 0.53, respectively). CONCLUSIONS: In patients with thymomatous MG who receive thymectomy, age ≥ 42 years and Masaoka-Koga stage > I are associated with a worse prognosis and failure to achieve a 3 point decrease in QMGS.


Assuntos
Miastenia Gravis , Timoma , Neoplasias do Timo , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/complicações , Miastenia Gravis/cirurgia , Estudos Retrospectivos , Timectomia , Resultado do Tratamento
17.
Medicina (Kaunas) ; 57(9)2021 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-34577855

RESUMO

Background and Objectives: Thymomas are associated with a high frequency of paraneoplastic manifestations. Paraneoplastic syndrome (PNS) with thymoma presents a challenge to clinicians because of the need to decipher the association between the presenting symptoms and the underlying tumor. The condition most commonly noted in patients with PNS with thymoma is myasthenia gravis. Other common autoimmune diseases that may present as PNS include systemic lupus erythematosus, pure red cell aplasia, and Good syndrome. Seventy-six percent of patients with PNS-associated thymoma experience resolution of PNS after curing thymoma. Materials and Methods: A 37-year-old man with a two-month fever accompanied by polyarthritis accidently found thymoma after contrast computed tomography scans of his chest. He accepted Video assisted thoracoscopic surgery with resection of thymoma. Results: Fever and polyarthritis resolved after operation but recurred in five days due to cytomegalovirus viremia, which might be predisposed by previous antibiotics treatment before the diagnosis of thymoma. Conclusion: Patients with a thymoma also have a high frequency of PNS, and the most frequent condition found in patients with PNS-associated thymoma is myasthenia gravis. Fever with polyarthritis has been rarely reported as a symptom of PNS-associated thymoma. Here we reported an unusual case of PNS mimicking reactive arthritis with thymoma, as diagnosed based on the patient's clinical progression, imaging examination, and laboratory tests. The patient died of his comorbidities, and his death may have been related to long-term antibiotic use and consequent intestinal dysbiosis. This challenging case may help to inform clinicians of the need for detailed work-up of fever with unknown origin in the presence of chronic polyarthritis to prevent the overdiagnosis of inflammatory arthritis or rheumatic disease and avoid further comorbidities. Detailed work-up should include the patient's history of infections, inflammation, and malignant or nonmalignant tumors.


Assuntos
Artrite Reativa , Miastenia Gravis , Síndromes Paraneoplásicas , Timoma , Neoplasias do Timo , Adulto , Humanos , Masculino , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico , Recidiva Local de Neoplasia , Síndromes Paraneoplásicas/diagnóstico , Timoma/complicações , Timoma/diagnóstico , Neoplasias do Timo/complicações , Neoplasias do Timo/diagnóstico
18.
Ann Palliat Med ; 10(9): 10083-10090, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34551569

RESUMO

With the growing use of immune checkpoint inhibitors (ICIs), recurrent immune-related adverse events (irAEs) have become more common after recovery from initial immune toxicity. Here we report one case of anti-PD-1-related pneumonitis in a patient with advanced thymoma, who experienced two episodes of pneumonitis during 10 months of treatment with a PD-1 inhibitor. By reviewing recent advances in ICI-related adverse events, we summarize the clinical characteristics of recurrent immune-related pneumonitis, illustrate potential predictive biomarkers for irAEs, and evaluate the value of resuming anti-PD-1 treatment in this patient. To date, evidence regarding retreatment following improvement from an irAE is scarce, and further clinical trials are needed to address this scenario.


Assuntos
Pneumonia , Timoma , Neoplasias do Timo , Humanos , Inibidores de Checkpoint Imunológico , Pneumonia/induzido quimicamente , Pneumonia/tratamento farmacológico , Retratamento , Timoma/tratamento farmacológico , Neoplasias do Timo/tratamento farmacológico
19.
J Cardiothorac Surg ; 16(1): 275, 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34579751

RESUMO

BACKGROUND: To explore the risk factors for prolonged ventilation after thymectomy in patients with thymoma associated with myasthenia gravis (TAMG). METHODS: We reviewed the records of 112 patients with TAMG after thymectomy between January 2010 and December 2019 in Peking University People's Hospital. Demographic, pathological, preoperative data and the Anesthesia, surgery details were assessed with multivariable logistic regression analysis to predict the risk of prolonged ventilation after thymectomy. A nomogram to predict the probability of post-thymectomy ventilation was constructed with R software. Discrimination and calibration were employed to evaluate the performance of the nomogram. RESULTS: By multivariate analysis, male, low vital capacity (VC), Osserman classification (IIb, III, IV), total intravenous anesthesia, and long operation time were identified as the risk factors and entered into the nomogram. The nomogram showed a robust discrimination, with an area under the receiver operating characteristic curve (AUC) of 0. 835 (95% confidence interval [CI], 0.757-0.913). The calibration plot indicated that the nomogram-predicted probabilities compared very well with the actual probabilities (Hosmer-Lemeshow test: P = 0.921). CONCLUSION: The nomogram is a valuable predictive tool for prolonged ventilation after thymectomy in patients with TAMG.


Assuntos
Miastenia Gravis , Timoma , Neoplasias do Timo , Anestesia Geral , Humanos , Masculino , Miastenia Gravis/complicações , Miastenia Gravis/cirurgia , Estudos Retrospectivos , Fatores de Risco , Timectomia/efeitos adversos , Timoma/complicações , Timoma/cirurgia
20.
Artigo em Inglês | MEDLINE | ID: mdl-34491637

RESUMO

We report the case of an intrathoracic giant thymoma with elongated thymic vessels, which was successfully resected under three-dimensional computed tomography guidance. A large, left-sided intrathoracic mass was incidentally found in a 41-year-old woman during a routine work-up for uterine cancer. Six vessels were noted arising from the tumor, five of which were connected to the anterosuperior mediastinum. The vasculature suggested that the tumor originated from the thymus and grew into the left pleural cavity, which pulled and elongated the associated vessels. Preoperative computed tomography imaging demonstrated that these vessels were located behind the tumor, which increased the risk for catastrophic intraoperative bleeding. We created a detailed surgical plan using our preoperative computed tomography data and successfully excised the tumor using intraoperative three-dimensional computed tomography guidance. Histopathological examination revealed a type AB thymoma without capsular invasion. This case highlighted the role of preoperative planning and intraoperative imaging in resecting an intrathoracic giant thymoma safely. In the video, we demonstrate how we performed the procedure under three-dimensional navigation.


Assuntos
Timoma , Neoplasias do Timo , Adulto , Feminino , Humanos , Mediastino , Timoma/diagnóstico por imagem , Timoma/cirurgia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/cirurgia , Tomografia Computadorizada por Raios X
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