Ishibashi Hironori, Takasaki Chihiro, Okubo Kenichi
Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan,
Gen Thorac Cardiovasc Surg. 2015 Jun;63(6):365-8. doi: 10.1007/s11748-013-0308-3. Epub 2013 Aug 15.
A 34-year-old woman underwent thymo-thymectomy for myasthenia gravis (MG) and was diagnosed with type B3 Masaoka stage I thymoma. Phrenic nerve paralysis developed 8 years after surgery, and a left-sided mediastinal mass was seen on a chest radiograph 10 years after surgery. Chest computed tomography revealed a tumor measuring 57 × 21 × 28 mm beside the aortic arch. Surgical resection of the tumor with partial resection of phrenic and recurrent nerve, the left upper lobe, and the pericardium was performed through a left thoracotomy. Histological examination confirmed recurrent thymoma invading the resected surrounding organs. The patient received radiation therapy postoperatively and was alive with stable symptoms of MG at the 2-year follow-up. Symptomatic relapse of thymoma is very rare and an occult recurrent thymoma should be considered in patients with unilateral phrenic nerve paralysis even after complete resection of thymoma. Detailed examination with careful follow-up should be considered.
一名34岁女性因重症肌无力（MG）接受了胸腺切除术，被诊断为B3型Masaoka I期胸腺瘤。术后8年出现膈神经麻痹，术后10年胸部X线片显示左侧纵隔肿块。胸部计算机断层扫描显示主动脉弓旁有一个大小为57×21×28mm的肿瘤。通过左胸切口对肿瘤进行手术切除，并部分切除膈神经和喉返神经、左上叶及心包。组织学检查证实为复发性胸腺瘤侵犯周围切除的器官。患者术后接受了放射治疗，在2年随访时存活，MG症状稳定。胸腺瘤症状性复发非常罕见，即使在胸腺瘤完全切除后，单侧膈神经麻痹患者也应考虑隐匿性复发性胸腺瘤。应考虑进行详细检查并仔细随访。
