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Pathological Findings in Myasthenia Gravis Patients with Thymic Hyperplasia and Thymoma

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Pathology & Oncology Research

Abstract

Thymectomy is routinely carried out in patients with myasthenia gravis (MG) and thymomas. However, there is still a dispute as to whether MG patients with thymic hyperplasia should undergo thymectomy. We aimed to investigate the pathological findings in the thymus in patients with co-existing MG and thymic hyperplasia or thymomas treated with thymectomy, as well as effects of immunosuppression. Thirty-three patients with MG were selected and grouped accordingly: patients with no thymic abnormalities, patients with thymic hyperplasia, and patients with thymomas. All patients were treated with methylprednisolone alongside immunosuppression. A separate cohort of 24 MG patients with thymic hyperplasia or thymomas and treated with thymectomy were selected. As controls, 5 patients with thymomas or thymic carcinoma without MG were selected. Expression of CD5, extracellular regulated protein kinases1/2 mitogen activated protein kinase (ERK1/2MAPKs) and CD95 ligand (FasL) in the thymus was examined. Methylprednisolone and immunosuppressive therapy are highly effective in MG patients with normal thymus tissue and MG patients with thymic hyperplasia compared to MG patients with thymomas alone. CD5 expression was highest in MG patients with thymic hyperplasia, correlating with expression of ERK1/2MAPKs. FasL expression was similar across all groups. Thymomas may be distinguished from thymic hyperplasia by expression of CD5 and ERK1/2MAPKs. Thymectomy is the preferred treatment for MG patients with thymomas but may not be necessary in MG patients with thymic hyperplasia who are treated with immunosuppressive therapy.

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Acknowledgements

We thank Dr. Lee-Ming Kow at Rockefeller University and Dr. Ding-Guo Shen at Xi’an Gaoxin Hospital for their valuable advice in manuscript preparation.

Author Contributions

Dr. Ping Chen, Ying-Peng Wang, Dan-lei Mou: study concept, analysis, literature review, and initial draft of paper; Dr. Zheng-Yi Li, Qiu-Min Qu, Ting Wang, Li-Hua Chen: acquisition of data for literature search, clinical scoring and analysis; Dr.Hong-Yan Wang, Yuan Deng, Xiao-Feng Li: tissue processing, immunohistochemistry experiments and analysis; Dr. Xian-hao Xu, Gang Zhao: critical revision of manuscript for intellectual content and clarity.

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Authors and Affiliations

  1. Department of Neurology, Xijing Hospital, Fourth Military Medical University, No. 169, Changle West Road, Xi’an, 710032, China

    Ping Chen, Ting Wang & Gang Zhao

  2. Department of Neurology, Beijing Aerospace General Hospital, Beijing, 100076, China

    Ying-Peng Wang

  3. Department of Infectious disease, Beijing You’an Hospital, Capital Medical University, Beijing, 100075, China

    Dan-lei Mou

  4. Department of Neurology, First Affiliated Hospital of Medical College, Xi’an Jiao Tong University, Xi’an, 710061, China

    Zheng-Yi Li & Qiu-Min Qu

  5. Department of Pathology, First Affiliated Hospital of Medical College, Xi’an Jiao Tong University, Xi’an, 710061, China

    Hong-Yan Wang, Yuan Deng & Xiao-Feng Li

  6. Department of Neurology, Federal Ministry of Health Beijing Hospital, No. 1, Dahua Road, Beijing, 100730, China

    Xian-Hao Xu

Authors
  1. Ping Chen
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  2. Ying-Peng Wang
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Corresponding authors

Correspondence to Xian-Hao Xu or Gang Zhao.

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Study Funding

National Natural Science Foundation of China 81201294.

47th Scientific Research Foundation for the Returned Overseas Chinese Scholars, State Education Ministry, 2nd degree.

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This article has no disclosures relevant to the manuscript.

Additional information

Ping Chen, Ying-Peng Wang, Dan-lei Mou, Xian-Hao Xu and Gang Zhao contributed equally to this work.

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Chen, P., Wang, YP., Mou, Dl. et al. Pathological Findings in Myasthenia Gravis Patients with Thymic Hyperplasia and Thymoma. Pathol. Oncol. Res. 24, 67–74 (2018). https://doi.org/10.1007/s12253-017-0213-7

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  • DOI: https://doi.org/10.1007/s12253-017-0213-7

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