Metastasizing thymoma and myasthenia gravis: favorable response to glucocorticoids after failed chemotherapy and radiation therapy

Article Abstract:

Myasthenia gravis, an autoimmune disease of the neuromuscular junction, occurs as a complication in up to 44 percent of patients with tumors of the thymus, sometimes as long as 22 years after the initial tumor diagnosis. In the case of a 47-year-old woman, the initial thymoma was discovered 8 years earlier, at age 39. The tumor was excised, and she received radiation in the area of the tumor. Two years later, new nodules were resected, and within a year another recurrence necessitated the use of chemotherapy. At age 43 she had surgery again, and at age 46 masses in the chest were treated by implanting radium. At age 47, after complaining of muscle weakness, CT scan showed masses in the liver. Surgery revealed many irregular rubbery masses in the abdomen that were confirmed by histology to be metastatic thymoma. Deterioration of her muscular condition continued, and she required ventilation. A diagnosis of myasthenia gravis was made, and measurement of her autoantibodies against the acetylcholine receptor revealed 7.76 nanomoles per liter (normal is less than 0.1). The patient was placed on prednisone. She returned to work after 10 months, and continues in remission on prednisone and pyridostigmine. Metastases to the abdomen are not common in cases of thymoma, but this patient experienced them despite aggressive multinodal therapy over a period of 8 years. Nonetheless, daily glucocorticoid treatment, initiated upon diagnosis of myasthenia gravis, produced regression of the tumor and a rapid reduction of tumor burden. Glucocorticoids should be considered in cases of thymoma, even when radiotherapy, chemotherapy, and surgery have failed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Risk factors, Corticosteroids, Adrenocortical hormones, Myasthenia gravis, Thymoma

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Myelodysplastic syndromes presenting in pregnancy: a report of five cases and the clinical outcome

Article Abstract:

The myelodysplastic syndromes (MDS), a group of blood disorders, are characterized by impaired hematopoiesis, the production and development of blood cells, and by hypercellular bone marrow, or increased numbers of cells in the bone marrow. Impaired hematopoiesis results in blood-related failures, and 20 to 70 percent of MDS cases evolve to acute nonlymphocytic leukemia, a type of blood cancer. MDS affects all age groups, but most commonly occurs in persons aged 70 years and older. MDS may arise from unknown causes or result from certain conditions, such as radiation treatment or chemotherapy. In 1982 this syndrome was classified into five subsets. Cases are described of five patients, aged 22 to 36 years, who developed MDS during pregnancy between June 1982 and March 1987. Three of the women developed acute leukemia, and a fourth underwent bone marrow transplantation, which was unsuccessful. Complete remission from MDS was achieved by only one patient, but all five patients eventually died. Only one woman experienced a normal vaginal delivery and gave birth to a full-term, healthy infant. The association between MDS and pregnancy appears to be more than coincidental; in most of these cases MDS progresses to acute leukemia. Pregnant women who have refractory macrocytic anemias (which are characterized by decreased oxygen-carrying capacity of the blood) should be carefully assessed for the presence of MDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Physiological aspects, Leukemia, Pregnancy, Complications of, Pregnancy complications, Myelodysplastic syndromes

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