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无重症肌无力的胸腺瘤所致自身免疫性斑秃:一例报告

Autoimmune alopecia areata due to thymoma without myasthenia gravis: a case report.

作者信息

Saito Yukino, Yazawa Tomohiro, Nagashima Toshiteru, Ohtaki Yoichi, Kawatani Natsuko, Narusawa Eiji, Yoshikawa Ryohei, Matsumura Nozomi, Maehara Tatsuro, Shirabe Ken

机构信息

Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-Machi, 371-8511, Maebashi, Gunma, Japan.

Department of Pathology, Gunma University Hospital, Gunma, Japan.

出版信息

Surg Case Rep. 2023 May 3;9(1):68. doi: 10.1186/s40792-023-01655-2.

Abstract

BACKGROUND

Thymoma is associated with autoimmune diseases. Myasthenia gravis is frequently associated with thymoma, but cases of thymoma complicated by alopecia areata are very rare. In this report, we present a case of thymoma associated with alopecia areata, but without Myasthenia gravis.

CASE PRESENTATION

A 60-year-old woman had a complaint of rapid progression of alopecia areata. A hair follicular biopsy was performed, which showed the infiltration of CD8-positive lymphocytes. She was prescribed topical steroids for 2 months prior to surgery, but her hair loss was not improved. Screening computed tomography showed a mass in the anterior mediastinum, which was suspected to be a thymoma. Myasthenia gravis was ruled out because she had no relevant symptoms or physical findings, and no anti-acetylcholine receptor antibodies were detected in serum. We performed a transsternal extended thymectomy based on a diagnosis of thymoma Masaoka stage I, without myasthenia gravis. Pathological examination showed Type AB thymoma, Masaoka stage II. The chest drainage tube was removed on postoperative day 1, and the patient was discharged on postoperative day 6. The patient has continued topical steroids and showed improvement 2 months postoperatively.

CONCLUSIONS

Although alopecia areata is a rare complication in thymoma cases without myasthenia gravis, thoracic surgeons need to keep this condition in mind because alopecia reduces the patient's quality of life.

摘要

背景

胸腺瘤与自身免疫性疾病相关。重症肌无力常与胸腺瘤相关,但胸腺瘤合并斑秃的病例非常罕见。在本报告中,我们介绍了一例无重症肌无力的胸腺瘤合并斑秃病例。

病例介绍

一名60岁女性主诉斑秃迅速进展。进行了毛囊活检,结果显示CD8阳性淋巴细胞浸润。术前2个月她接受了外用类固醇治疗,但脱发情况并未改善。胸部CT筛查显示前纵隔有一个肿块,怀疑是胸腺瘤。由于她没有相关症状或体征,血清中也未检测到抗乙酰胆碱受体抗体,故排除了重症肌无力。基于胸腺瘤Masaoka I期且无重症肌无力的诊断,我们实施了经胸骨扩大胸腺切除术。病理检查显示为AB型胸腺瘤,Masaoka II期。术后第1天拔除胸腔引流管,患者于术后第6天出院。患者继续使用外用类固醇,术后2个月情况有所改善。

结论

尽管斑秃在无重症肌无力的胸腺瘤病例中是一种罕见的并发症,但胸外科医生需要牢记这一情况,因为斑秃会降低患者的生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e48c/10156902/b374b6d4547b/40792_2023_1655_Fig1_HTML.jpg

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