Abstract
Between 10 and 15 per cent of patients with myasthenia gravis (MG) have a thymoma. We have evaluated the possibility of detecting such tumours on the basis of clinical features, radiological findings and immunological tests in a group of 70 MG patients. The mean age at onset of myasthenic symptoms was 67.6 years in the thymoma group and 33.8 years in the non-thymoma group. Otherwise, the clinical picture was similar.
Radiological examination revealed a mediastinal mass in 2 patients. Six of the 70 MG sera contained antibodies to a citric acid (CA) extract of striated muscle. At thymectomy, a thymoma was found in these 6 patients. None of the remaining 64 patients had evidence of a thymoma. Antibodies to AChR were detected in 52 of the 70 MG sera.
There was no relation between titres of AChR and CA antibodies. Three out of 5 sera from non-MG patients with a thymoma contained CA antibodies.
Apparently, this assay is a valuable technique for the identification of a thymoma at an early stage.
Sommario
Una percentuale variabile fino al 10 e al 15% dei miastenici è portatrice di timona. Vengono valutate le possibilità di diagnosticare i timomi sulla base dei dati clinici, radiologici e immunologici di un gruppo di 70 pazienti affetti da miastenia. L'età media di inizio dei sintomi miastenici risulta di 67.6 anni nel gruppo con timoma e di 33.8 anni nel gruppo senza timoma, mentre le caratteristiche cliniche sono del tutto sovrapponibili. Gli esami radiologici hanno rilevato una massa mediastinica in due pazienti. In 6 casi nel siero si sono posti in evidenza anticorpi nei confronti di un estratto in acido citrico di muscolo striato (CA) e alla timectomia in tutti questi 6 pazienti è stato riscontrato il timoma.
Anticorpi nei confronti AChR sono stati messi in evidenza in 52 dei 70 sieri.
Non si è vista una correlazione fra i titoli di anticorpi di AChR e di CA. 3 dei 5 sieri ricavati da pazienti non miastenici portatori di timoma contenevano anticorpi CA. Sembra quindi che questa tecnica sia valida per l'identificazione di un timoma allo stadio iniziale.
This is a preview of subscription content, log in via an institution to check access.
References
Aarli, J.A.:Myasthenia gravis. Antibodies to an acidsoluble antigen in striated muscle. Clin Exp Immunol 10: 453–461, 1972.
Aarli, J.A. andCloss, O.:Myasthenia gravis: Cross-striational fluorescence of muscle fibres mediated by Fc fragments. J Immunol 109: 271–274, 1972.
Aarli J.A., Lefvert, A.-.K., andTönder, O.:Thymomaspecific antibodies in sera from patients with myasthenia gravis demonstrated by indirect haemagglutination J Neuroimmunol 1 421–427, 1981.
Aarli, J.A. andThunold, S.:Serological detection of thymoma in myasthenia gravis. Eur Neurol 20: 380–387, 1981.
Aarli, J.A. andTönder, O.:Antiglobulin consumption test with sera from patients with myasthenia gravis. Clin Exp Immunol 7: 11–21, 1970.
Blalock, A., Mason, M.F., Morgan, H.J., andRiven, S.S.:Myasthenia gravis and tumors of the thymic region. Report of a case in which the tumor was removed. Ann Surg X 110: 544–561, 1939.
Castleman, B.:The pathology of the thymus gland in myasthenia gravis. Ann NY Acad Sci 135: 496–505, 1966.
Djanian, A.Y., Beutner, E.H., Witebsky, E.:Tanned-cell hemagglutination test for detection of antibodies in sera of patients with myasthenia gravis. J Lab Clin Med 63: 60–70, 1964.
Hale, J.F. andScowen, E.F.: In:Thymic Tumours, 1–93, Lloyd-Luke (Medical Books) Ltd, London 1967.
Keesey, J., Bein, M., Mink, J., Sample, F., Sarti, D., Mulder, D., Herrmann, C., andPeter, J.B.:Detection of thymoma in myasthenia gravis. Neurology 30: 233–239, 1980.
Lefvert, A.K., Bergström, K., Matell, G., Osterman, P.O., andPirskanen, R.:Determination of acetylcholine receptor antibody in myasthenia gravis: Clinical usefulness and pathogenetic implications. J. Neurol Neurosurg Psychiatry 41: 394–403, 1978.
Legolvan, D.P. andAbell, M.R.:Thymomas. Cancer 39:2142–2157, 1977.
Levine, G.D.:Pathology of the thymus in myasthenia gravis: Current concepts. In: Dau, P.C. (ed): Plasmapheresis and the Immunobiology of Myasthenia Gravis, 113–123, Houghton Mifflin, Boston 1978.
Lisak, R.P. andBarchi, R.L.: Myasthenia Gravis, Volume 11 in the Series: Major Problems in Neurology, W.B. Saunders Company, Philadelphia 1982.
Namba, T. Himei, H., andGrob, D.:Complement fixing and tissue binding serum globulins in patients with myasthenia gravis, and their relation to muscle ribonucleoprotein. J Lab Clin Med 70: 258–272, 1967.
Oosterhuis, H.J.G.H., Bethlem J., andFeltkamp, T.E.W.:Muscle pathology, thymoma, and immunological abnormalities in patients with myasthenia gravis. J Neurol Neurosurg Psychiatry 31: 460–463, 1968.
Osserman, K.E.: In:Myasthenia gravis, 1–286, Grune & Stratton, New York and London, 1958.
Peers, J., McDonald, B.L., andDakwins, R.L.:The reactivity of the antistriational antibodies associated with thymoma and myasthenia gravis. Clin Exp Immunol 27: 66–73, 1977.
Shulman, S., Lang, R.W., Beutner, E.H., andWitebsky, E.:Precipitation of autoantibody in serum from patients with myasthenia gravis. Immunology 10: 289–303, 1966.
Strauss, A.J.L., Seegal, B.C., Hsu, J.C., Burkholder, P.M., Nastuk, W.L., andOsserman, K.E.:Immunofluorescence demonstration of muscle binding, complement fixing serum globulin fraction in myasthenia gravis. Proc Soc Expo Biol Med 105: 184–191, 1960.
Van der Geld, H. andOosterhuis, H.J.G.H.:Muscle and thymus antibodies in myasthenia gravis. Vox Sang 8: 196–204, 1963.
Author information
Authors and Affiliations
Additional information
This investigation was supported by a grant from the Norwegian Research Council for Science and the Humanities
Rights and permissions
About this article
Cite this article
Aarli, J.A. The diagnosis of thymoma in myasthenia gravis. Ital J Neuro Sci 4, 393–397 (1983). https://doi.org/10.1007/BF02125617
Issue Date:
DOI: https://doi.org/10.1007/BF02125617