[A case of post-thymomectomy myasthenia gravis after extrapleural pneumonectomy for invasive thymoma which necessistated long-term mechanical ventilation].
The patient was a 58-year-old male with invasive thymoma which had disseminated in the left thorax and was histologically a polygonal cell type lesion. While the serum value of anti-acetylcholine receptor antibody was high before surgery, there were signs of myasthenia gravis. After preoperative chemotherapy, a thymectomy and left panpleuropneumonectomy were conducted. Forty days after surgery, the patients suffered post-thymomectomy myasthenia gravis, which necessitated mechanical ventilation for 6 months. Despite steroid therapy and 17 plasmapheresis procedures the tidal volume increased by little more than 200-250 ml during that time. The causes of ventilatory failure, therefore, were probably decreased pulmonary function due to extrapleural pneumonectomy and the myasthenia gravis. According to the literature, polygonal cell type thymomas with high serum levels of anti-acethycholine receptor antibody have higher incidences of post-thymomectomy myasthenia gragvis than other ones. Therefore, the risk of post-thymomectomy myasthenia gravis should be kept in mind when extrapleural pneumonectomy for invasive thymoma is being considered, especially in the cases of this type.
Nomori
H
H
Department of Thoracic Surgery, Saiseikai Central Hospital.
Horio
H
H
D001323:Autoantibodies / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000628:therapy*; D009361:Neoplasm Invasiveness; D011013:Pneumonectomy / Q000379:methods; D011183:Postoperative Complications / Q000628:therapy*; D011950:Receptors, Cholinergic / Q000276:immunology; D012121:Respiration, Artificial; D012306:Risk; D013934:Thymectomy; D013945:Thymoma / Q000473:pathology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors
D001323:Autoantibodies; D011950:Receptors, Cholinergic