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From the Institutes of Neurology (Drs. Evoli, Minisci, Di Schino, Marsili, Punzi, Batocchi, and Tonali), Surgery (Drs. Doglietto and Granone), Radiology (Dr. Trodella), Internal Medicine (Dr. Cassano), and Pathology (Dr. Lauriola), Catholic University, Rome, Italy.
Address correspondence and reprint requests to Dr. Amelia Evoli, Institute of Neurology, Catholic University, L.go F. Vito, 1-00168 Rome, Italy; e-mail: a.evoli{at}rm.unicatt.it
Objective: To examine the characteristics of thymoma when associated with MG and to evaluate those conditions that can complicate management and affect survival.
Methods: The study includes 207 myasthenic patients who were operated on for thymoma, with at least 1-year follow-up from surgery. MG severity and response to treatment, the occurrence of paraneoplastic diseases and extrathymic malignancies, thymoma histologic types and stages, adjuvant therapy, tumor recurrences, and causes of death were recorded.
Results: MG-associated thymoma was predominantly of B type and was invasive in the majority of patients. MG was generally severe, and most patients remained dependent on immunosuppressive therapy. Other paraneoplastic disorders and extrathymic malignancies were found in 9.66 and 11.11% of patients. Thymoma recurrences occurred in 18 of 115 patients with invasive tumors (15.65%) and were often associated with the onset/aggravation of autoimmune diseases. On completion of the study, MG and thymoma accounted for a similar mortality rate.
Conclusions: Thymoma should be considered as a potentially malignant tumor requiring prolonged follow-up. The presence of myasthenic weakness can still complicate its management. Thymoma-related deaths are bound to outnumber those due to MG in the future.
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