Yoshida T, Suzuki T, Suzuki S, Masuda M, Usuda R, Tanaka H, Inoue Y, Yoshimura A
Department of Thoracic and Cardiovascular Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
Kyobu Geka. 2006 Mar;59(3):247-50.
A 35-year-old man visited our hospital complaining of blepharoptosis and fatigability of the left arm. Under a diagnosis of myasthenia gravis (Osserman Ila), ambenonium was administered and improvements were noted. At 40-year-old, the patient underwent extended thymectomy due to the development of thymoma, which invaded the lung and pericardium (Masaoka stage Ill). Then ADOC therapy (doxorubicin hydrochloride+cisplatin+vincristine sulfate+cyclophosphamide) was initiated. At 47-year-old, we found recurrence of disseminated thymoma in thoracic cavity. Because of multiple metastatic lesions, radiotherapy in combination with chemotherapy was chosen and these lesions were reduced in size. Facial and foot edema developed at 50-year-old. Chest X-ray revealed bilateral pleural effusion. He was diagnosed as minimal change nephrotic syndrome and steroid therapy was started. The changes in cellular immunity due to thymoma is considered to be causative in the development of nephrotic syndrome. We report the clinical course of our case and discuss with reference to the literature.
一名35岁男性因左侧上睑下垂和左臂乏力前来我院就诊。诊断为重症肌无力（Osserman Ila型），给予安贝氯铵治疗后症状有所改善。40岁时，患者因胸腺瘤进展侵犯肺和心包（Masaoka III期）接受了扩大胸腺切除术。随后开始ADOC治疗（盐酸多柔比星+顺铂+硫酸长春新碱+环磷酰胺）。47岁时，我们发现胸腔内弥漫性胸腺瘤复发。由于存在多处转移灶，选择了放疗联合化疗，这些病灶体积缩小。50岁时出现面部和足部水肿。胸部X线检查显示双侧胸腔积液。他被诊断为微小病变型肾病综合征并开始使用类固醇治疗。胸腺瘤导致的细胞免疫变化被认为是肾病综合征发生的原因。我们报告该病例的临床过程并结合文献进行讨论。
