de Macedo JE, Lopes S, Gouveia H, Oliveira S, Cunha J, Faria AL, Rego S, Oliveira A, Krug L, Bravo EM. Myasthenia gravis as a form of clinical presentation of thymic carcinoma. World J Respirol 2015; 5(2): 176-179 [DOI: 10.5320/wjr.v5.i2.176]
Corresponding Author of This Article
Joana Espiga de Macedo, MD, Department of Medical Oncology of Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido de Pinho, 4520-211 Santa Maria Da Feira, Portugal. joanamacedo@hotmail.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Respirol. Jul 28, 2015; 5(2): 176-179 Published online Jul 28, 2015. doi: 10.5320/wjr.v5.i2.176
Myasthenia gravis as a form of clinical presentation of thymic carcinoma
Joana Espiga de Macedo, Sílvia Lopes, Helena Gouveia, Sofia Oliveira, João Cunha, Ana Luísa Faria, Sónia Rego, Albino Oliveira, Luís Krug, Emílio Macias Bravo
Joana Espiga de Macedo, Sílvia Lopes, Helena Gouveia, Sofia Oliveira, João Cunha, Ana Luísa Faria, Sónia Rego, Emílio Macias Bravo, Department of Medical Oncology of Centro Hospitalar de Entre o Douro e Vouga, 4520-211 Santa Maria Da Feira, Portugal
Albino Oliveira, Department of Pathology of Centro Hospitalar de Entre o Douro e Vouga, 4520-211 Santa Maria Da Feira, Portugal
Luís Krug, Department of Radiology of Centro Hospitalar de Entre o Douro e Vouga, 4520-211 Santa Maria Da Feira, Portugal
Author contributions: All authors contributed to this manuscript.
Institutional review board statement: The study was reviewed and approved by the Oncology Department of Centro Hospitalar entre Douro e Vouga, Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Joana Espiga de Macedo has received fees for serving as a speaker, such as consultant and/or an advisory board member for Celgene, Merck and Roche. Emílio Macias Bravo has received fees for serving as a speaker, such as consultant and/or an advisory board member for Astellas, Merck and Roche. Ana Luísa Faria has received serving as a speaker for Celgene. Sónia Rego has received serving as a speaker for AstraZeneca, Grunenthal and Pharmamar.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Joana Espiga de Macedo, MD, Department of Medical Oncology of Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido de Pinho, 4520-211 Santa Maria Da Feira, Portugal. joanamacedo@hotmail.com
Telephone: +351-93-6050138 Fax: +351-25-6373867
Received: September 25, 2014 Peer-review started: September 26, 2014 First decision: December 17, 2014 Revised: April 18, 2015 Accepted: April 28, 2015 Article in press: April 30, 2015 Published online: July 28, 2015 Processing time: 313 Days and 7.5 Hours
Abstract
Thymic carcinomas are rare tumors of the thymus arising in the thymic epithelium. They represent less than 1% of thymic malignancies. They often present with an advanced disease and metastasize to regional lymph nodes and distant sites. They have a worse prognosis with a 5-year survival rate of 30%-50%, while thymomas are much less invasive and have a 5-year survival of approximately 78%. We report a rare form of clinical presentation of a thymic carcinoma in which the diagnosis of myasthenia gravis was the cornerstone of the diagnosis of cancer. Surgery is considered the salvage treatment when possible. Radiotherapy is a second choice of salvage treatment, when possible depending on its localization and relation to nearby structures such as vascular structures. Molecular target therapy is a more directed, more expensive but less toxic treatment. Further studies need to be carried out for its approval worldwide, outside clinical trials.
Core tip: We report a rare form of clinical presentation of a thymic carcinoma in which the diagnosis of myasthenia gravis was the cornerstone of the diagnosis of cancer. Surgery is considered the salvage treatment when possible. Radiotherapy is a second choice of salvage treatment, when possible depending on its localization and relation to nearby structures such as vascular structures. The prognosis is very reserved, when neither surgery nor radiotherapy can be accomplished. Having an unfavorable molecular signature, less than 10% of thymic carcinomas have c-kit mutations, and clinical outcome of these patients is detrimental.
