Clinical comparative analysis of thymectomy between subxiphoid and subcostal arch thoracoscopic resection and open resection for the treatment of thymoma with myasthenia gravis / 中华胸心血管外科杂志

Objective To compare and analyze clinical effects of extended thymectomy for the treatment of thymoma with myasthenia gravis(MG) between subxiphoid and subcostal arch thoracoscopic resection(SR) and the median sternotomy(MS) with a propensity-matched analysis.Methods We retrospectively analyzed 528 patients presented with MG and admitted in Tangdu Hospital of Air Force Military Medical University from December 2011 to December 2016,among whom 402 underwent subxiphoid and subcostal arch thoracoscopic extended thymectomy(SR group) and 126 median sternotomy(MS group).Another 126 patients were produced by a propensity-matched analysis in these 402 patients,to match with MS group.Perioperative outcomes were compared between SR group and MS group.Results All operations were accomplished successfully,without conversion to thoracotomy in SR group.Most postoperative outcomes were equal in remission of MG and postoperative complication between the two groups(P ＞ 0.05).There were statistical differences between MS group and SR group in operation time [(106.3 ±32.7)min vs.(533.2 ±37.3) min],intraoperative blood loss[(138.2 ±26.7)ml vs.(38.2 ± 10.3) ml],chest drainage duration[(3.3 ± 1.6) days vs.0 day],hospital length of stay [(5.0 ± 2.5) days vs.(2.5 ± 1.8) days],patients'satisfaction level(6.1 ±2.3 vs.8.9 ± 1.2),the incidence of postoperative wound infections(4.8％ vs.0.8％),the incidence of myasthenic crisis(7.1％ vs.1.6％)and pain scores,all P ＜0.05.Conclusion Subxiphoid and subcostal arch thoracoscopic extended thymectomy is a safe and feasible minimally invasive procedure for tmanagement of MG with thymoma.

Bilateral thoracoscopic surgery for invasive thymoma complicated with myasthenia gravis: A case report and literature review / 吉林大学学报(医学版)

Objective:To observe the effect of bilateral thoracoscopic surgery for invasive thymoma complicated with myasthenia gravis,and to explore feasibility of surgical procedure.Methods:Bilateral thoracoscopic extended thymectomy was performed in one patient with invasive thymoma complicated with myasthenia gravis,with complete resection of thymus and anterior mediastinal adipose tissue through bilateral approach,and the curative effect was observed.Results:Bilateral thoracoscopic thymectomy for invasive thymoma had radical effects with rapid recovery after surgery,avoiding large surgical trauma and more complications in open surgery and flawed in removing contralateral fat and ectopic thymus with unilateral thoracoscope.Conclusion:Bilateral thoracoscopic extended thymectomy has radical effects for invasive thymoma complicated with myasthenia gravis,confirming its feasible surgical procedure.

Bilateral thoracoscopic surgery for invasive thymoma complicated with myasthenia gravis: A case report and literature review / 吉林大学学报(医学版)

Objective: To observe the effect of bilateral thoracoscopic surgery for invasive thymoma complicated with myasthenia gravis, and to explore feasibility of surgical procedure. Methods: Bilateral thoracoscopic extended thymectomy was performed in one patient with invasive thymoma complicated with myasthenia gravis, with complete resection of thymus and anterior mediastinal adipose tissue through bilateral approach, and the curative effect was observed. Results: Bilateral thoracoscopic thymectomy for invasive thymoma had radical effects with rapid recovery after surgery, avoiding large surgical trauma and more complications in open surgery and flawed in removing contralateral fat and ectopic thymus with unilateral thoracoscope. Conclusion: Bilateral thoracoscopic extended thymectomy has radical effects for invasive thymoma complicated with myasthenia gravis, confirming its feasible surgical procedure.

Analysis of dosimetric results of postoperative intensity modulated radiation therapy using single-energy or mixed-energy photons in invasive thymoma patients / 中华放射医学与防护杂志

Objective To compare the dosimetric results of postoperative intensity modulated radiation therapy (IMRT) using single-energy or mixed-energy photons in invasive thymoma patients.Methods Simulation CT images were acquired and clinical target volume (CTV),planning target volume (PTV) and organs at risk (OARs) were defined.Three sets of fixed-field IMRT planning were generated using 6 MV,10 MV and mixed 6/10 MV photons for each case.Monitor Units (MUs) for each plan were recorded after optimization,and parameters of PTV such as conformity index (CI),homogeneity index (HI) and dose to OARs were evaluated on dose-volume histograms.Results Near-Maximal dose (D2％) received by PTV was better in mixed-energy IMRT as compared with 6 MV(t =3.107,P ＜0.05).HI was better in mixed-energy than in 6 MV(t =2.924,P ＜0.05).There were statistically significant differences in CI among three IMRT plans.MU was higher in 6 MV than in both 10 MV and mixed-energy IMRT.The percentages of lung volumes receiving 5 Gy (V5),10 Gy(V10),20 Gy (V20),30 Gy (V30) and the mean lung dose (D) were also significantly different in most plans.V30 and V40 of the heart were comparable between 6 MV and mixed energy plans but better than in 10 MV plan.Conclusions If the reasonable choice of beam angles and number,and capability of energy selection according to beam directions,with combined advantages of low and high energy photons,mixed IMRT plans can improve the quality of IMRT plans in general and has clinical potential for postoperative radiotherapy of invasive thymomas.

Resection and reconstruction of mediastinal great vessels in invasive thymoma.

Objective : To evaluate the safety, feasibility, and outcome following radical excision of thymoma with resection and reconstruction of invaded mediastinal vessels. Study Design : A retrospective study. Patients and Methods : Six patients with thymoma invading the superior vena cava (SVC) and/or the brachiocephalic veins (BCVs) were reviewed in this study. All the patients underwent radical excision of the tumor along with invaded mediastinal vessels followed by vessel reconstruction or repair. The clinical presentation, operative details, postoperative course, and follow-up were reviewed and analyzed. Results : Three patients presented with features suggestive of SVC syndrome. Contrast-enhanced computed tomography of the chest was the primary imaging modality, which detected a tumor with invasion of major mediastinal veins. WHO type B2 was the commonest histologic type, which was seen in 4 cases. Intraoperatively, SVC invasion, SVC and BCV invasion, and BCV invasions alone were seen in 1, 2, and 3 cases, respectively. The vessels were reconstructed with a prosthetic graft in 3 patients, and autologous pericardial tube graft was used in 1 patient. Two patients had primary repair of the wall of the involved vessel. Postoperative course was complicated by ventilator support requirement in 2, graft thrombosis in 2, acute renal failure in 1 and pneumonia in 1 patient. All patients are alive at the end of follow-up period ranging between 18 and 24 months. Conclusion: Thymoma excision with the reconstruction of SVC or BCV is safe and feasible in experienced hands.

A Case of Distal Seeding of Invasive Thymoma

We report a case of a distal seeding of invasive thymoma at descending abdominal aortic wall. It is relatively common that direct extension of invasive thymoma into the adjacent great arteries and veins. But distal seeding of invasive thymoma is extremely rare. We found abnormal mass at abdominal aortic wall incidentally during routine transthoracic echocardiography. Operation of aortic segment replacement and mass removal was carried out. Histological evaluation of mass found invasive thymoma.

A Case of Pernicious Anemia and Myasthenia Gravis after Thymectomy and Irradiation of an Invasive Thymoma / 대한내과학회지

Herein we wish to report a case of pernicious anemia and myasthenia gravis occurred after treatment with removal of an invasive thymoma and irradiation. Nine years ago, the male patient was visited due to chest pain, and was found a mediastinal mass at his age of 55. He received open thoracotomy and was found stage III invasive thymoma which infiltrated phrenic nerve and pericardium. After removal of thymoma, he received 4,500cGy of radiation. Two years later, he complained of left eyelid drooping and diagnosed as myasthenia gravis with tensilon test. His myasthenic eye symptom was controled with Mestinon. After 9 years from thymectomy, he complained of dizziness and dyspnea on exertion. Bone marrow smear revealed megaloblastic anemia and serum vitamin B12 level was 42.24pg/ml. Gastric juice analysis revealed achlorhydria with positive anti-intrinsic factor antibody. 6 weeks after treatment with parenteral vitamin B12, hematologic findings were normalized.

Clinical Analysis of Ectopic Kidney in Children

The diagnosis of carcinoma in situ of urinary bladder is difficult in that the symptoms and cystoscopic findings are nonspecific. The cytology of urine could be helpful for diagnosis of carcinoma in situ of urinary bladder. We present a case of bladder washing cytology of carcinoma in situ. A 54-year-old man presented with dysuria for 1 year. Cystoscopic findings revealed multifocal reddish trabeculated lesions. The bladder washing cytology revealed rather uniform tumor cells which were singly scattered or forming syncytium in the clean background. The nuclei were round to oval with inconspicious nucleoli. The cystoscopic biopsy revealed typical histologic features of carcinoma in situ of urinary bladder.

A Follow-up Study of DMSA Renal Scan in Chidren with Acute Pyelonephritis and Vesicoureteral Reflux

Angiosarcomas are rare tumors, seen most commonly in the skin and soft tissue of head and neck region. But it has been described in numerous body sites including thyroid, breast, liver, spleen, bone, etc.. Their biological behaviors depend on the microscopic grade, site of origin, and multifocality. We report the unique cytological features of an angiosarcoma in pleural fluid. A 61-year-old woman presented with a 6 month history of dyspnea on exertion and chest pain. Chest computerized tomography(CT) revealed multiple subpleural small nodules in the right lung and widespread air space consolidation and pleural effusion in the left lung. CT of liver revealed multiple small low attenuated lesion. The smears obtained from pleural fluid showed hypocellularity with a hemorrhagic background. The tumor cells were highly pleomorphic oval or spindle in shape and presented singly, in loose groups, in knitted syncytial aggregates, and in acinar pattern. Their nuclei had vesicular chromatin with delineated, thick nuclear membranes and occasionally a large eosinophilic, prominent nucleolus. The cytoplasm was plump, thin or projected in spindly fashion. Almost all tumor cells showed variable sized intracytoplasmic vacuoles and their nuclei were sometimes crescentic by a huge vacuole. Occasional binucleated tumor cells and mitotic figures were present. Cellular debris and streaky materials were identified. Needle biopsy specimen from the pleura revealed anastomosing slit-like spaces lined by pleomorphic tumor cells. The tumor cells showed a strong reactivity for CD31 and vimentin and focal weak reactivity for factor VIII-related antigen.

A Case of Pure Red Cell Aplasia Associated with Invasive Thymoma / 대한혈액학회지

Thymoma has been associated with a variety of diseases, including myasthenia gravis, pure red cell aplasia (PRCA), hypogammaglobulinemia, and other abnormal immune and endocrine disorders. Herein we report a case of PRCA associated with invasive thymoma in a 65-year-old man. In spite of total thymectomy and irradiation to the mediastinum, no significant response was observed. The mechanisms and management of PRCA associated with invasive thymoma are reviewed.

Thymoma: A clinicopathologic analysis of 66 cases

A total of 66 cases of thymoma(57 surgically resected cases and 9 incisional biopsy cases) were reviewed with an attempt to correlate pathomorphologic features and clinical presentations. Criteria of benign or invasive thymoma were primarily determined by operative clinical and pathologic findings. Of them, 21 cases were invasive thymomas. The mean age of patients at the time of surgery was 47 years and it occurred largely in the sixth decade. Myasthenia gravis was accompanied in 29 cases(43%). One patient died during folow-up period, and five of the remainder suffered from recurrence. Microscopically, mixed type was the most common one(33 cases), being followed by predominantly epithelial type(17 cases) and predominantly lymphocytic type(16 cases). Thirty four cases of thymomas were cortical type, 29 mixed type, and the remaining 3 medullary type. None of the histologic type were significantly correlated with tumor invasiveness, Myasthenia gravis was more frequently associated with mixed and cortical type, respectively.

Fine needle aspiration cytology of malignant thymoma: two cases of invasive thymoma and thymic carcinoma / 대한세포병리학회지

We report 4 cases of malignant thymoma which were composed of 2 cases of invasive thymoma and 2 cases of thymic carcinoma. The cytologic findings of invasive thymoma were similar to those of benign thymoma. The distinctive cytologic features of thymic carcinoma were necrotic background, irregular clusters and individually scattered arrangement of anaplastic epithelial cells, and some scattered mature small lymphocytes. These findings may be found in the Hodgkin'slymphoma, seminoma, and metastatic squamous cell carcinoma, undifferentiated carcinoma, and large cell carcinoma of the. lung. But, the feature of irregular clustering of anaplastic epithelial cell having scanty cytoplasm was different from Hodgkin'slymphoma and seminoma. Clinical and radiologic findings as well as cytologic finding were helpful in differential diagnosis of thymic carcinoma from metastatic carcinoma.