دورية أكاديمية
Thymus pathology in myasthenia gravis with anti-acetylcholine receptor antibodies and concomitant Hashimoto's thyroiditis. A four-case series and literature review.
| العنوان: | Thymus pathology in myasthenia gravis with anti-acetylcholine receptor antibodies and concomitant Hashimoto's thyroiditis. A four-case series and literature review. |
|---|---|
| المؤلفون: | Ionescu L; Department of Ophthalmology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania; costea10@yahoo.com, camelia.bogdanici@umfiasi.ro., Costea CF, Dănilă R, Bogdănici CM, Scripcariu DV, Livădariu RM, Dumitrescu GF, Gavrilescu CM, Dragomir RA, Sava A, Cucu AI, Tănase DM, Turliuc MD, Ciobanu Apostol DG |
| المصدر: | Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie [Rom J Morphol Embryol] 2021 Jan-Mar; Vol. 62 (1), pp. 73-83. |
| نوع المنشور: | Case Reports; Journal Article; Review |
| اللغة: | English |
| بيانات الدورية: | Publisher: Editura Academiei Române Country of Publication: Romania NLM ID: 9112454 Publication Model: Print Cited Medium: Internet ISSN: 2066-8279 (Electronic) Linking ISSN: 12200522 NLM ISO Abbreviation: Rom J Morphol Embryol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Bucuresti, România : Editura Academiei Române, [1990- |
| مواضيع طبية MeSH: | Hashimoto Disease* , Myasthenia Gravis*/complications , Thymus Neoplasms*, Adult ; Female ; Humans ; Male ; Receptors, Cholinergic ; Retrospective Studies |
| مستخلص: | Objective: Identifying the morphological features of thymus in patients with myasthenia gravis (MG) with anti-acetylcholine receptor (AChR) antibodies and concomitant Hashimoto's thyroiditis (HT), which were recruited from a single surgical unit of a tertiary referral hospital located in the North-Eastern region of Romania, over a period of 11 years. Patients, Materials and Methods: We retrospectively reviewed clinical, imaging, laboratory, thymic pathology, and outcome data that were obtained from medical records of patients with MG and concomitant HT, to whom a thymectomy was performed for a suspected thymic lesion. All the surgical interventions were done in the Third Clinic of Surgery, St. Spiridon Emergency County Hospital, Iaşi, Romania, for an 11 years' period, i.e., from January 1, 2000 and December 31, 2010. Results: Four patients (three females and one male) were included. The mean age of the patients at the time of their thymectomy was 40.25 years. Of all patients, 75% had moderate or severe MG, 100% had anti-AChR antibodies, and an electromyographic decrement greater than 25%. All patients have been diagnosed with HT in their past medical history by a full thyroid panel [high thyroid-stimulating hormone (TSH) values, low free thyroxine (fT4) values, and the presence of the anti-thyroid antibodies] and all of them have been treated with Euthyrox. Our four patients expressed different MG subtypes, each of them being associated with different thymus pathology. Thoracic computed tomography (CT) scan revealed heterogeneous mediastinal masses and established the correct diagnosis only in 25% of cases. The pathological exams also revealed a heterogeneous pattern of thymic lesions. In contrast with other studies, our patients with MG with anti-AChR antibodies and concomitant HT presented atrophic thymus more frequently (50%), but with particular morphological changes of Hassall's corpuscles. Also, 25% of cases were diagnosed with thymic lympho-follicular hyperplasia (TLFH) associated with thymic epithelial hyperplasia. In B2 thymoma, neoplastic epithelial cells expressed cytokeratin 19 (CK19) immunoreactivity, high Ki67 labeling index and strong p63 immunopositivity. Conclusions: In our series, MG and HT occurred simultaneously, or one of them was diagnosed before the other, raising some new questions regarding the immune mechanism of these two autoimmune diseases. Due to the heterogeneous morphological changes of the thymus that we found in this study, we can hypothesize that thymus is involved in the pathogenic mechanism of MG with anti-AChR-antibodies and concomitant HT development. |
| References: | Ann Anat. 2017 May;211:140-148. (PMID: 28279759) Orphanet J Rare Dis. 2018 Jun 25;13(1):99. (PMID: 29940999) Nihon Kyobu Geka Gakkai Zasshi. 1991 Feb;39(2):228-31. (PMID: 2033341) Br Med J. 1966 Apr 9;1(5492):904. (PMID: 20722214) Front Endocrinol (Lausanne). 2017 Jul 13;8:169. (PMID: 28751878) Front Immunol. 2018 May 07;9:964. (PMID: 29867946) Rom J Morphol Embryol. 2012;53(3):639-43. (PMID: 22990560) Front Immunol. 2012 Mar;3(March):19. (PMID: 22448160) Brain Behav. 2016 Aug 04;6(10):e00537. (PMID: 27781146) Medicine (Baltimore). 2015 May;94(21):e835. (PMID: 26020387) Rom J Morphol Embryol. 2017;58(1):201-206. (PMID: 28523319) Autoimmunity. 2015;48(6):362-8. (PMID: 25915571) Expert Rev Clin Immunol. 2012 Jul;8(5):427-38. (PMID: 22882218) Rom J Morphol Embryol. 2013;54(1):195-200. (PMID: 23529330) Neurology. 2000 Jul 12;55(1):16-23. (PMID: 10891897) Eur J Cardiothorac Surg. 2010 May;37(5):1137-43. (PMID: 20117014) Acta Neurol Scand. 2013 Mar;127(3):170-4. (PMID: 22725712) Rom J Morphol Embryol. 2009;50(4):729-31. (PMID: 19942974) Nature. 2005 Aug 25;436(7054):1181-5. (PMID: 16121185) Rev Pneumol Clin. 2003 Sep;59(4):213-5. (PMID: 14699299) Neurol Sci. 2003 Apr;24(1):34-6. (PMID: 12754655) Rom J Morphol Embryol. 2018;59(1):323-328. (PMID: 29940645) Br Med J. 1964 Mar 21;1(5385):748. (PMID: 14102022) Brain Nerve. 2011 Jul;63(7):685-94. (PMID: 21747138) Transl Neurosci. 2017 Apr 30;8:27-30. (PMID: 28729915) Clin Neurol Neurosurg. 2013 Apr;115(4):432-7. (PMID: 22770539) Aust N Z J Med. 1972 Nov;2(4):412-5. (PMID: 4512377) Malays Fam Physician. 2017 Aug 31;12(2):29-31. (PMID: 29423128) Rom J Morphol Embryol. 2017;58(3):731-738. (PMID: 29250648) Open Access Maced J Med Sci. 2018 Mar 05;6(3):472-478. (PMID: 29610603) Indian J Nephrol. 2019 Jan-Feb;29(1):62-64. (PMID: 30814797) Eur J Neurol. 2007 Dec;14(12):1403-4. (PMID: 17941854) Cells. 2019 Jul 02;8(7):. (PMID: 31269763) |
| المشرفين على المادة: | 0 (Receptors, Cholinergic) |
| تواريخ الأحداث: | Date Created: 20211005 Date Completed: 20211028 Latest Revision: 20220531 |
| رمز التحديث: | 20221213 |
| مُعرف محوري في PubMed: | PMC8597376 |
| DOI: | 10.47162/RJME.62.1.07 |
| PMID: | 34609410 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2066-8279 |
|---|---|
| DOI: | 10.47162/RJME.62.1.07 |