title: Unusual clinical behaviour of thymoma with recurrent myasthenia gravis.
abstract: A 58-year old man with thymoma and myasthenia gravis (MG) had undergone thymectomy 8 years ago with histopathologically confirmed non-invasive WHO-type AB thymoma. After 5 years of complete remission, symptoms of MG resurfaced, and a recurrent anterior mediastinal mass was detected for which he received radiotherapy. He presented to us 3 years later with productive cough and exertional dyspnoea; the positron emission tomography-computed tomography scan revealed a metabolically active pulmonary nodule in the right lung as the only site of disease for which a right lower lobectomy was done. Microscopy established an intrapulmonary WHO-type B2 thymoma and the patient is currently asymptomatic on steroids, anticholinesterase and immunosuppressant therapy. We discuss the variable and unpredictable course of thymomas; the possibility of transformation into more aggressive types with each recurrence, association with recurrent MG post-thymectomy and presentation several years later with metastatic disease.
authors.affiliation: Department of Surgical Oncology, Division of Thoracic surgery,  Tata Memorial Hospital, Mumbai,  India.
authors.forename: Keduovinuo K
authors.initials: KK
authors.lastname: Keditsu
authors.forename: George
authors.initials: G
authors.lastname: Karimundackal
authors.forename: Nirmala A
authors.initials: NA
authors.lastname: Jambhekar
authors.forename: C S
authors.initials: CS
authors.lastname: Pramesh
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000737:chemistry / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009157:Myasthenia Gravis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D009364:Neoplasm Recurrence, Local; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D012008:Recurrence; D012086:Reoperation; D003074:Solitary Pulmonary Nodule / Q000737:chemistry / Q000556:secondary* / Q000601:surgery; D013934:Thymectomy; D013945:Thymoma / Q000737:chemistry / Q000556:secondary* / Q000601:surgery; D013953:Thymus Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor