[Thymic Hyperplasia with Carcinoembryonic Antigen Elevation;Report of a Case].

A 64-year-old man was found to have serum carcinoembryonic antigen(CEA) elevation while undergoing an examination for recurrent gastroenteritis. His past medical history included gastroenteritis, rheumatoid arthritis, and diabetes. Blood testing revealed an increased CEA level of 153.00 ng/ml( normal ≤ 5.00 ng/ml). Chest computed tomography scan revealed an abnormal soft tissue shadow measuring 5.7 × 1.2 × 7 cm in the anterior mediastinum. The soft tissue shadow in the anterior mediastinum was the only abnormality found by whole-body examination. The possibility of a malignant tumor could not be ruled out, and the surgery was performed. Histopathological examination of the specimen confirmed thymic hyperplasia, and immunohistochemical staining detected CEA-positive cells. Serum CEA level normalized at three months after surgery and also 2 years postoperatively.

Bone loss in surgically ovariectomized premenopausal women is associated with T lymphocyte activation and thymic hypertrophy.

Postmenopausal osteoporosis is associated with estrogen deficiency and rapid bone loss. The mechanism by which estrogen deficiency results in bone loss has not been fully explained. Studies in mice rendered acutely estrogen deficient by ovariectomy have suggested that estrogen deficiency results in an activated T-lymphocyte phenotype and increased production of pro-osteoclastic cytokines. The aim of this study was to translate these findings from mouse models that suggest that the T lymphocyte plays an important role in the etiology of postmenopausal osteoporosis. We recruited premenopausal women who underwent ovariectomy for benign gynecologic conditions or for prophylaxis against ovarian cancer and a group of matched control women without ovariectomy (OVX). Subjects provided blood samples to characterize T-lymphocyte phenotype by flow cytometry and for T-lymphocyte culture and collection of conditioned media. Bone mineral density at the lumbar spine and left femoral neck was performed annually for 2 years, and volumetric measurements by computed tomography (CT) of the thymus were obtained during the first 6 months. We enrolled 6 patients who underwent OVX and 13 control women. The OVX subjects had a significant loss of bone mineral density at the lumbar spine and left femoral neck. The volumetric thymus measurements suggested an increase in thymus size in the OVX subjects but did not reach statistical significance owing to the small sample size. The T-lymphocyte phenotype in the OVX subjects demonstrated increased T-lymphocyte activation by flow cytometry compared to the control subjects. Our findings support the hypothesis that estrogen deficiency leads to an activated T-lymphocyte phenotype, which may contribute to the bone loss seen in estrogen deficiency. Larger clinical studies are necessary to confirm these findings.

Microarrays reveal distinct gene signatures in the thymus of seropositive and seronegative myasthenia gravis patients and the role of CC chemokine ligand 21 in thymic hyperplasia.

Myasthenia gravis (MG) is an autoimmune disease mainly caused by antiacetylcholine receptor autoantibodies (seropositive (SP) disease) or by Abs against unknown autoantigenic target(s) (seronegative (SN) disease). Thymectomy is usually beneficial although thymic hyperplasia with ectopic germinal centers is mainly observed in SP MG. To understand the role of thymus in the disease process, we compared the thymic transcriptome of non-MG adults to those of SP patients with a low or high degree of hyperplasia or SN patients. Surprisingly, an overexpression of MHC class II, Ig, and B cell marker genes is observed in SP but also SN MG patients. Moreover, we demonstrate an overexpression of CXCL13 in all MG thymuses leading probably to the generalized B cell infiltration. However, we find different chemotactic properties for MG subgroups and, especially, a specific overexpression of CCL21 in hyperplastic thymuses triggering most likely ectopic germinal center development. Besides, SN patients present a peculiar signature with an abnormal expression of genes involved in muscle development and synaptic transmission, but also genes implicated in host response, suggesting that viral infection might be related to SN MG. Altogether, these results underline differential pathogenic mechanisms in the thymus of SP and SN MG and propose new research areas.

[Activity of the thyroid and sex hormones in patients with myasthenia after surgical intervention].

In 1995-2003 yrs there were operated on 55 women for various forms of myasthenia. In 20 of them myasthenia coexisted with thymoma, in 35--have been combined with the thymus hyperplasia. In all the patients the hormonal misbalance was revealed, depending on changes in the thymus structure present.

Pseudo-myasthenia gravis and thymic hyperplasia in Graves' disease.

BACKGROUND: Diagnostic confusion between thyroid disease and myasthenia gravis (MG) can arise because the two may have similar clinical features, and also because of the more frequent coexistence of these autoimmune disorders in the same individual. In MG, autoantibodies directed against the acetylcholine receptor result in muscle weakness. Thymic pathology is well recognized in MG, with thymic hyperplasia frequent in early onset MG and thymoma more common in later onset MG. In Graves' disease, autoantibodies against thyroid antigens result in hyperthyroidism. A seldom-recognized feature of Grave's disease is the occurrence of an enlarged thymus (thymic hyperplasia) on chest CT, or of thymic lymphoid hyperplasia pathologically. CASE STUDY: This report describes a case in which the discovery of a mediastinal mass during imaging of the thyroid, and the presence of myasthenic-like symptoms, in a patient with Graves' disease prompted investigations into whether the patient also had MG. RESULTS: Despite symptoms which strongly suggested MG, subsequent investigations did not confirm the diagnosis, and treatment of Grave's lead to a resolution of the symptoms and regression of the thymic enlargement seen on CT. CONCLUSIONS: The case study highlighted clinical similarities between Grave's disease and myasthenia gravis which might cause diagnostic confusion, and also the investigations which are useful in order to differentiate the two diseases. In addition to common clinical features, the autoimmune diseases Grave's disease and myasthenia gravis may both produce radiological thymic enlargement.

[Hypophyseal-adreno-gonadal system function in myasthenia patients with tumorous and nontumorous pathology of the thymus]. / Sostoianie gipofizarno-adrenogonadnoi sistemy u bol'nykh miasteniei pri opukholevoi i neopukholevoi patologii vilochkovoi zhelezy.

Overall twenty-five patients (all women) who ranged from 16 to 56 years old were examined. They were divided into two groups: group I was formed of subjects with hyperplasia of the thymus gland, group II--thymoma. Blood serum levels of prolactin, progesterone, estriol, estradiol, testosterone hydrocortisone. All patients showed a significant increase in average blood plasma levels of estrogens, testosterone and prolactin. Average levels of progesterone and hydrocortisone in patients with thymus hypertrophy were lower than in controls, while in thymoma patients these were much higher. The data submitted are indicative of substantial differences in the endocrine status of myasthenia patients depending on tumor or nontumor lesion of the thymus gland, which fact may suggest different pathogenetic mechanisms of development of the condition.

[Characteristics of hormonal homeostasis in children with thymus enlargement syndrome]. / Osobennosti gormonal'nogo gomeostaza u detei s sindromom uvelicheniia vilochkovoi zhelezy.

Hormonal homeostasis was examined in 104 children aged 1 to 14 years with thymus enlargement. There was a significant growth of somatotropic hormone in children of the first 3 years of life, characterized by thyroid dysfunction and hypofunction increase with age, by a tendency towards ACTH and hydrocortisone lowering under 6 years of age, and a significant decrease of those parameters in children over 6 years. The children with thymus enlargement also showed other disorders of hormonal homeostasis.

[Hormonal and immunological status of children with thymus hyperplasia]. / Gormonal'nyi i immunologicheskii status u detei s giperplaziei vilochkovoi zhelezy.

The state of the adrenocortical system, cellular and humoral immunity was studied in 152 infants, suffering from thymomegaly, associated with virus-bacterial pneumonia. The results obtained allow one of to consider the hormonal and immunological state of the patients with thymomegaly to be inhibited and the adrenocortical hypofunction to be secondary. Therefore, the infants with thymomegaly should be separated into a special "risk" group, according to their immunodeficient states, respiratory allergies, acute and chronic adrenocortical deficiency.

Leukocyte and lymphoid cell counts in myasthenia gravis.

Serial leukocyte counts and lymphoid cell counts were compared before and after thymectomy via sternal-splitting incision in 50 patients with myasthenia gravis. Leukocyte counts and lymphoid cell counts of the thymectomized patients also were compared to those of 30 non-thymectomized myasthenic patients and 150 non-myasthenic patient controls. While mean leukocyte counts did not change significantly before and 5.5 plus or minus 5 years after thymectomy, mean lymphoid cell counts were slightly lower during this observation period post-thymectomy (t equals 1.918, p equals 0.03). Lower lymphoid cell counts appeared to correlate with a favorable response of myasthenia gravis in patients with thymic hyperplasia and mainly involuted thymus.