Ishikawa Keidai, Kato Tatsuya, Aragaki Masato, Ohbuchi Toshiro, Kimura Sachiko, Matsui Yoshiro, Kaji Mitsuhito
Department of Thoracic Surgery, Sapporo Minami-Sanjo Hospital, Sapporo, Hokkaido, Japan; Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Ann Thorac Cardiovasc Surg. 2014;20 Suppl:585-8. doi: 10.5761/atcs.cr.12.02165. Epub 2013 Apr 5.
A rare case of Castleman's disease with myasthenia gravis is reported. A 55-year-old woman with bilateral ptosis, speech impairment, and severe dyspnea had been previously diagnosed with myasthenia gravis. Computed tomography showed a 5 cm × 3 cm paratracheal mass in the mediastinum, thought to be an ectopic thymoma. Two days after surgical resection, the patient suddenly developed dyspnea. Postoperative myasthenic crisis was diagnosed, and plasmapheresis was performed. Her general condition improved, and her subsequent course was uneventful. The final pathological diagnosis was mediastinal solitary Castleman's disease, hyaline vascular type. Castleman's disease with myasthenia gravis is especially rare. One of the serious complications is postoperative myasthenic crisis. For patients with myasthenia gravis, the rate of postoperative myasthenic crisis seems significantly higher in Castleman's disease patients than in patients with thymic epithelial tumors. Castleman's disease with myasthenia gravis is discussed along with a review of the literature.
报告了一例罕见的卡斯特leman病合并重症肌无力病例。一名55岁女性，有双侧上睑下垂、言语障碍和严重呼吸困难，此前被诊断为重症肌无力。计算机断层扫描显示纵隔内气管旁有一个5 cm×3 cm的肿块，考虑为异位胸腺瘤。手术切除两天后，患者突然出现呼吸困难。诊断为术后重症肌无力危象，并进行了血浆置换。她的一般状况有所改善，随后病程平稳。最终病理诊断为纵隔孤立性卡斯特leman病，透明血管型。卡斯特leman病合并重症肌无力尤其罕见。严重并发症之一是术后重症肌无力危象。对于重症肌无力患者，卡斯特leman病患者术后重症肌无力危象的发生率似乎明显高于胸腺上皮肿瘤患者。结合文献复习对卡斯特leman病合并重症肌无力进行了讨论。
