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|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 4 | Page : 1094-1095
Association of Multilocular Thymic Cyst with Myasthenia Gravis
Shaman Gill, Pawan Dhull
Department of Neurology, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
|Date of Submission||08-Jul-2020|
|Date of Decision||15-Jul-2020|
|Date of Acceptance||23-Sep-2020|
|Date of Web Publication||2-Sep-2021|
Department of Neurology, Command Hospital (Central Command), Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gill S, Dhull P. Association of Multilocular Thymic Cyst with Myasthenia Gravis. Neurol India 2021;69:1094-5
Thymic cysts are uncommon lesions of the anterior mediastinum and may be unilocular or multilocular. They account for 1%–5% of anterior mediastinal masses and may be congenital or acquired. Association of multilocular thymic cysts with Myasthenia Gravis (MG) is rare.
We present a case of myasthenia gravis who was found to have a multilocular thymic cyst on evaluation, underwent thoracoscopic thymectomy and excision of the cyst and had improvement in symptoms after surgery.
54 years old male with no known comorbidities presented with complaints of fluctuating ptosis, intermittent fatigable diplopia of two months duration and history of fatigable proximal limb weakness of one month duration. Clinically, patient had partial ptosis left eye with enhanced ptosis in right eye. He had grade 4 power proximally in upper and lower limbs. He was diagnosed as a case of Myasthenia gravis and diagnosis was confirmed by acetyl choline receptor antibody (40.8 nmol/L), positive ocular cooling test and a decremental response on repetitive nerve stimulation test. CECT chest revealed 8 cm × 6 cm loculated cystic space occupying lesion in anterior mediastinum predominantly on right side with peripheral rim of calcification along with internal septa and calcification suggestive of anterior mediastinal cystic mass likely thymic cyst [Figure 1].
He was planned for thymectomy as thymectomy has been a proven therapy for patients with MG. Also, since thymic cyst has an association with thymoma, patient was subjected to thymectomy after one month of initial treatment and initial stabilization. He underwent video assisted thoracoscopic thymectomy and excision of thymic cyst. Histopathological examination of the excised cyst revealed multilocular cystic area filled with cheesy yellow color material. Microscopic exam revealed thymic cyst focally lined by flattened cuboidal epithelium with underlying fibro collagenous tissue with mild lymphoplasmacytic infiltrate, cholesterol granuloma and clefts and speckles of calcification. Margins were free of any tumor. Findings were suggestive of multilocular thymic cyst [Figure 2].
Patient was managed initially with tablet pyridostigmine 60 mg TDS along with oral steroids (Prednisolone 20 mg daily). He had gradual symptomatic improvement over next one month. He was given Intravenous Immunoglobin preoperatively and underwent thoracoscopic thymectomy with excision of the cyst. Postoperative period was uneventful. On subsequent follow up, patient had persistent symptomatic improvement after surgery. The steroids were gradually tapered and steroid sparing agent (Azathioprine) was added. Over next 6 months of follow up, patient had sustained response to therapy.
MG association with multilocular thymic cyst is extremely rare. There have been very few cases reported in literature [Table 1] and most of these have association with unilocular cysts.>/sup>
|Table 1: Previous case reports on association of thymic cysts with Myasthenia Gravis|
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Multilocular thymic cyst, though extremely rare, should be included in the spectrum of MG-associated thymic conditions. Also, its association with thymoma and thymic carcinoma merits thymectomy and cyst excision. The response of patient to surgery confirms its involvement in the pathophysiology of myasthenia gravis.
Department of Oncosurgery, Command Hospital (CC).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]