Thymus Hyperplasia and Thymoma Type B in Patients with Myasthenia Gravis: Two case reports and Literature Review
AJTES Vol 9, No 1, January 2025
Dumani S., et al. - Thymus Hyperplasia and Thymoma Type B in Patients with Myasthenia Gravis...

Keywords

Thymoma
Thymic Hyperplasia
Myasthenia Gravis
Surgical Resection
Minimally Invasive Surgery

How to Cite

Dumani, S., Kuqo, A., Likaj, E., Kuci, S., Ikonomi, M., Dibra, L., Mehmeti, A., Celiku, E., & Veshti, A. (2025). Thymus Hyperplasia and Thymoma Type B in Patients with Myasthenia Gravis: Two case reports and Literature Review. Albanian Journal of Trauma and Emergency Surgery, 9(1), 1730-1735. https://doi.org/10.32391/ajtes.v9i1.428

Abstract

Introduction: The thymus gland plays a pivotal role in immune system regulation, but conditions such as thymic hyperplasia (TH) and thymoma pose distinct clinical challenges due to their rarity and complex presentation in surgical practice. Both conditions can mimic similar symptoms, particularly in patients with Myasthenia Gravis (MG), where surgery serves as both a diagnostic and therapeutic intervention. This report presents the surgical management and outcomes of two MG patients with distinct thymic pathologies: TH and Type B thymoma, alongside a review of the relevant literature.

Two MG patients were referred to our clinic for surgical intervention. The first patient underwent a standard sternotomy for the resection of TH, while the second patient underwent a mini-sternotomy for thymectomy targeting a Type B thymoma. Both procedures were completed successfully with uneventful postoperative courses. Surgical resection remains the gold standard for the treatment and definitive diagnosis of thymic gland abnormalities. Advances in surgical techniques, including minimally invasive approaches, offer excellent outcomes with reduced morbidity, providing a viable alternative to traditional methods.

Conclusion: The cases underscore the critical role of surgical intervention in managing thymic pathologies in MG patients. Both traditional and minimally invasive techniques yield excellent clinical outcomes, reinforcing their importance in the treatment paradigm for thymic hyperplasia and thymoma. Further studies are needed to refine surgical approaches and optimize patient outcomes.

https://doi.org/10.32391/ajtes.v9i1.428
Dumani S., et al. - Thymus Hyperplasia and Thymoma Type B in Patients with Myasthenia Gravis...

References

Detterbeck, F. C., & Parsons, A. M. (2004). Thymic tumors. The Annals of Thoracic Surgery, 77(5), 1860–1869. https://doi.org/10.1016/j.athoracsur.2003.10.001

Toker A, Sonett JR. Minimally Invasive Thymectomy for Thymic Disorders: Current Perspectives. Ann Thorac Surg. 2022;113(1):150-157. http://dx.doi.org/10.21037/med.2018.04.02

Carter, B. W., Lichtenberger, J. P., 3rd, & Benveniste, M. F. (2018). MR Imaging of Thymic Epithelial Neoplasms. Topics in magnetic resonance imaging: TMRI, 27(2), 65–71. https://doi.org/10.1097/RMR.0000000000000160

Ströbel, P., Hartmann, E., Rosenwald, A., Kalla, J., Ott, G., Friedel, G., Schalke, B., Kasahara, M., Tomaru, U., & Marx, A. (2014). Corticomedullary differentiation and maturational arrest in thymomas. Histopathology, 64(4), 557–566. https://doi.org/10.1111/his.12279

Kondo K, Yoshizawa K. Surgical Treatment for Thymoma and Thymic Carcinoma. Gen Thorac Cardiovasc Surg. 2019;67(12):742-749.

Falkson, C. B., Bezjak, A., Darling, G., Gregg, R., Malthaner, R., Maziak, D. E., Yu, E., Smith, C. A., McNair, S., Ung, Y. C., Evans, W. K., & Lung Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-Based Care (2009). The management of thymoma: a systematic review and practice guideline. Journal of Thoracic Oncology: official publication of the International Association for the Study of Lung Cancer, 4(7), 911–919. https://doi.org/10.1097/jto.0b013e3181a4b8e0

Wright C. D. (2008). Management of thymomas. Critical reviews in oncology/hematology, 65(2), 109–120. https://doi.org/10.1016/j.critrevonc.2007.04.005

Khan MA, Anjum F. Thymic Hyperplasia. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560558/

Wei, B., & Cerfolio, R. (2016). Robotic thymectomy. Journal of visualized surgery, 2, 136. https://doi.org/10.21037/jovs.2016.07.17

Yoshimatsu H, Ishikura Y, Odagiri S, Mizoguchi Y. [Clinical examinations of thymic abnormalities and significance of thymectomy in the patients with autoimmune disease]. Rinsho Kyobu Geka = Japanese Annals of Thoracic Surgery. 1989 Jun;9(3):267-272

Nazarbaghi, S., Amiri-Nikpour, M. R., Mahmodlou, R., Arjmand, N., & Rezaei, Y. (2015). Clinical Outcomes of Myasthenia Gravis with Thymoma and Thymic Hyperplasia Undergoing Extended Transsternal Thymectomy: A Single-Center Experience. North American journal of medical sciences, 7(11), 503–508. https://doi.org/10.4103/1947-2714.170608|

Diaz, A., Black, E., & Dunning, J. (2014). Is thymectomy in non-thymomatous myasthenia gravis of any benefit?. Interactive cardiovascular and thoracic surgery, 18(3), 381–389. https://doi.org/10.1093/icvts/ivt510

Cooper J. D. (2019). History of Thymectomy for Myasthenia Gravis. Thoracic surgery clinics, 29(2), 151–158. https://doi.org/10.1016/j.thorsurg.2018.12.011

Regnard, J. F., Magdeleinat, P., Dromer, C., Dulmet, E., de Montpreville, V., Levi, J. F., & Levasseur, P. (1996). Prognostic factors and long-term results after thymoma resection: a series of 307 patients. The Journal of thoracic and cardiovascular surgery, 112(2), 376–384. https://doi.org/10.1016/S0022-5223(96)70265-9

Masaoka, A., Monden, Y., Nakahara, K., & Tanioka, T. (1981). Follow-up study of thymomas with special reference to their clinical stages. Cancer, 48(11), 2485–2492. https://doi.org/10.1002/1097-0142(19811201)48:11<2485::aid-cncr2820481123>3.0.co;2-r

Ruffini, E., Filosso, P. L., Guerrera, F., Lausi, P., Lyberis, P., & Oliaro, A. (2018). Optimal surgical approach to thymic malignancies: New trends challenging old dogmas. Lung cancer (Amsterdam, Netherlands), 118, 161–170. https://doi.org/10.1016/j.lungcan.2018.01.025

Zhang, Y., Lin, D., Aramini, B., Yang, F., Chen, X., Wang, X., Wu, L., Huang, W., & Fan, J. (2023). Thymoma and Thymic Carcinoma: Surgical Resection and Multidisciplinary Treatment. Cancers, 15(7), 1953. https://doi.org/10.3390/cancers15071953

Funaki, S., Shintani, Y., Fukui, E., Kanzaki, R., Kanou, T., Ose, N., Minami, M., & Okumura, M. (2020). Surgical treatment strategies for invasive thymoma. Journal of thoracic disease, 12(12), 7619–7625. https://doi.org/10.21037/jtd-19-3045

Detterbeck, F. C., Parson, A. M., & Rocco, G. (2018). The Role of Surgery in the Management of Thymoma: A Comprehensive Review. Journal of Thoracic Oncology, 13(4), 489-502.

Kanzaki, R., Kanou, T., Ose, N., Funaki, S., Shintani, Y., Minami, M., Kida, H., Ogawa, K., Kumanogoh, A., & Okumura, M. (2019). Long-term outcomes of advanced thymoma in patients undergoing preoperative chemotherapy or chemoradiotherapy followed by surgery: a 20-year experience. Interactive cardiovascular and thoracic surgery, 28(3), 360–367. https://doi.org/10.1093/icvts/ivy276

Ströbel P, Bauer A, Puppe B, et al. Molecular Diagnostics in Thymoma: Future Prospects. Front Oncol. 2022; 12:874565.

Carter BW, Benveniste MF, Madan R, et al. Imaging of the Thymus. Semin Thorac Cardiovasc Surg. 2020;32(4):1008-1021.

Khawaja I. (2023). Effect of Thymectomy on Outcomes of Myasthenia Gravis Patients: A Case-Control Study at a Tertiary Care Hospital. Cureus, 15(4), e37584. https://doi.org/10.7759/cureus.37584

Roden, A. C., Ahmad, U., Cardillo, G., Girard, N., Jain, D., Marom, E. M., Marx, A., Moreira, A. L., Nicholson, A. G., Rajan, A., Shepherd, A. F., Simone, C. B., 2nd, Strange, C. D., Szolkowska, M., Truong, M. T., & Rimner, A. (2022). Thymic Carcinomas - A Concise Multidisciplinary Update on Recent Developments From the Thymic Carcinoma Working Group of the International Thymic Malignancy Interest Group. Journal of Thoracic Oncology: official publication of the International Association for the Study of Lung Cancer, 17(5), 637–650. https://doi.org/10.1016/j.jtho.2022.01.021

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.