The actual incidence of multiple thymoma is unknown and rarely reported because it remains controversial whether the cases represent a disease of multicentric origin or a disease resulting from intrathymic metastasis. In this case, a patient underwent total thymectomy for multiple thymoma with myasthenia gravis via bilateral video-assisted thoracic surgery. A well-encapsulated multinodular cystic mass, measuring 57 mm×50 mm×22 mm in the right lobe of the thymus, and a well-encapsulated mass, measuring 32 mm×15 mm×14 mm in the left lobe, were found. Both tumors were type B2 thymoma. Few cases of multiple thymoma with myasthenia gravis have ever been reported in the literature. We report a case of synchronous multiple thymoma associated with myasthenia gravis.
Humans ; Incidence ; Myasthenia Gravis* ; Neoplasm Metastasis ; Thoracic Surgery, Video-Assisted ; Thymectomy ; Thymoma* ; Thymus Gland

Thymic hyperplasia is frequently observed in Graves' disease. However, detectable massive enlargement of the thymus is rare, and the mechanism of its formation has remained elusive. This case showed dynamic changes in thymic hyperplasia on serial computed tomography images consistent with changes in serum thyrotropin receptor (TSH-R) antibodies and thyroid hormone levels. Furthermore, the patient's thymic tissues underwent immunohistochemical staining for TSH-R, which demonstrated the presence of thymic TSH-R. The correlation between serum TSH-R antibody levels and thymic hyperplasia sizes and the presence of TSH-R in her thymus suggest that TSH-R antibodies could have a pathogenic role in thymic hyperplasia.
Adult ; Female ; Graves Disease/*complications/surgery/therapy ; Humans ; Male ; Receptors, Thyrotropin/blood ; Thymus Gland/diagnostic imaging ; Thymus Hyperplasia/*diagnostic imaging/etiology/immunology ; Thyroid Hormones ; Thyroidectomy ; Thyrotropin/blood ; Tomography, X-Ray Computed ; Young Adult

DiGeorge syndrome is an immunodeficient disease associated with abnormal development of 3rd and 4th pharyngeal pouches. As a hemizygous deletion of chromosome 22q11.2 occurs, various clinical phenotypes are shown with a broad spectrum. Conotruncal cardiac anomalies, hypoplastic thymus, and hypocalcemia are the classic triad of DiGeorge syndrome. As this syndrome is characterized by hypoplastic or aplastic thymus, there are missing thymic shadow on their plain chest x-ray. Immunodeficient patients are traditionally known to be at an increased risk for malignancy, especially lymphoma. We experienced a 7-year-old DiGeorge syndrome patient with mediastinal mass shadow on her plain chest x-ray. She visited Severance Children's Hospital hospital with recurrent pneumonia, and throughout her repeated chest x-ray, there was a mass like shadow on anterior mediastinal area. We did full evaluation including chest computed tomography, chest ultrasonography, and chest magnetic resonance imaging. To rule out malignancy, video assisted thoracoscopic surgery was done. Final diagnosis of the mass which was thought to be malignancy, was lymphoproliferative lesion.
Child ; Diagnosis ; DiGeorge Syndrome* ; Humans ; Hypocalcemia ; Lymphoma ; Lymphoproliferative Disorders ; Magnetic Resonance Imaging ; Mediastinal Neoplasms ; Phenotype ; Pneumonia ; Thoracic Surgery, Video-Assisted ; Thorax ; Thymus Gland ; Ultrasonography

Ectopic mediastinal parathyroid adenomas or hyperplasias account for up to 25% of primary hyperparathyroidism cases. Most abnormal parathyroid glands are found in the superior mediastinum within the thymus and can be removed through a cervical incision; however, a few of these glands are not accessible using standard cervical surgical approaches. Surgical resection has traditionally been performed via median sternotomy or thoracotomy. However, recent advancement in video-assisted thoracic surgery techniques has decreased the need for sternotomy or thoracotomy to remove these ectopic parathyroid glands. Here, we report a successful case of video-assisted thoracoscopic removal of a mediastinal parathyroid adenoma.
Hyperparathyroidism, Primary ; Hyperplasia ; Mediastinum ; Parathyroid Glands ; Parathyroid Neoplasms* ; Sternotomy ; Thoracic Surgery, Video-Assisted ; Thoracotomy ; Thymus Gland

The peritoneum is the most frequent site of recurrence for gastric cancer after gastrectomy, followed by the liver and lymph nodes. In contrast, metastasis to the thymus is rare. Annual surveillance with computed tomography was performed on a 67-year-old man who previously underwent a distal gastrectomy and D2 lymph node dissection for gastric cancer at Tottori University. Five years after the initial operation, an anterior mediastinal tumor was detected by computed tomography. The patient underwent video-assisted thoracic surgery to remove the tumor. Histopathology revealed adenocarcinoma cells similar to those of the gastric cancer resected 5 years previously. Thymic metastasis was considered likely based on the location of the tumor. The recognition that gastric cancer can metastasize to unusual anatomic locations, such as the thymus, can facilitate an accurate, prompt diagnosis and appropriate treatment.
Adenocarcinoma* ; Aged ; Diagnosis ; Gastrectomy ; Humans ; Liver ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis* ; Peritoneum ; Recurrence ; Stomach Neoplasms ; Thoracic Surgery, Video-Assisted ; Thymus Gland

A mediastinal mass was incidentally found on chest radiography in a 46-yr-old woman who had had myasthenia gravis (MG) for 2 months. Computed tomography revealed a 4-cm in size, well-defined, and lobulating mass with nodular calcification that was located in the thymus. Microscopically, the mass consisted of diffuse amorphous eosinophilic materials. These deposits exhibited apple-green birefringence under polarized light microscopy after Congo red staining. Immunohistochemical analysis revealed that they were positive for both kappa and lambda light chains and negative for amyloid A. A diagnosis of localized primary thymic amyloidosis was finally made. After thymectomy, the symptoms of MG were controlled with reduced corticosteroid requirements. Localized thymic amyloidosis associated with MG has not been reported to date.
Amyloidosis/complications/*radiography/*surgery ; Calcinosis/*radiography/*surgery ; Female ; Humans ; Immunoglobulin kappa-Chains/immunology ; Immunoglobulin lambda-Chains/immunology ; Mediastinum/radiography/surgery ; Middle Aged ; Myasthenia Gravis/*complications ; Radiography, Thoracic ; Thymectomy ; Thymus Gland/radiography/surgery ; Tomography, X-Ray Computed

BACKGROUNDMany researches demonstrate that the secondary brain injury which is caused by autoimmune attack toward brain antigens plays an important role in surgical brain injury (SBI). Although traditional immunosuppression can reduce autoimmune attack, it will lower the body immunity. Immune tolerance, by contrast, not only does not lower the body immunity, but also could lighten autoimmunity. This study used thymus tolerance to develop an immune system that is tolerant to autologous cerebrospinal fluid (CSF) and autologous brain tissue so that autoimmune injury can be suppressed following the disruption of the blood-brain barrier, thereby reducing brain damage.

METHODSEighty experimental rabbits were divided into five groups by random number table method: 16 in SBI group (group A), 16 in SBI+CSF drainage group (group B), 16 in SBI+CSF drainage+PBS injection group (group C), 16 in SBI+CSF drainage+CSF intrathymic injection group (group D), and 16 in SBI+brain homogenate intrathymic injection group (group E). Rabbits' CSF was drained in group B; was drained and injected PBS into thymus in group C; was drained and injected CSF into thymus in group D; and was injected brain homogenate in group E. Half of the rabbits in each group were phlebotomized on 1st, 3rd, 7th, and 14th days to observe the changes in IL-l, TGF-β by ELISA test, and CD4CD25 regulatory T cells ratio by flow cytometry, and in other animals brain tissues were taken on 7th day for exploring FasL expression by RT-PCR. The least significant difference (LSD) test was used to make paired comparisons; P < 0.05 was considered statistically significant.

RESULTSThe levels of FasL, TGF-β, and the ratios of CD4CD25 regulatory T cells in groups D and E were apparently higher than those in other three groups (P < 0.05). Likewise, the levels of IL-1 in these two groups were lower than the other three groups (P < 0.05). Moreover, the ratios of CD4CD25 regulatory T cells and the levels of TGF-β in groups B and C were higher than those in group A, but the level of IL-1 was lower than that in group A (P < 0.05). There was no significant difference between groups B and C, and groups D and E.

CONCLUSIONThymic injection of CSF and brain homogenate may be able to reduce inflammation after SBI, so thymus immune tolerance may be a useful therapy to treat SBI.

Animals ; Autoantigens ; administration & dosage ; Brain ; surgery ; Brain Injuries ; etiology ; therapy ; Immune Tolerance ; physiology ; Rabbits ; Thymus Gland ; immunology

Isolated chylopericardium as a complication of cardiac surgery is very rare. Two cases of chylopericardium have been previously reported in Korea; both patients suffered from chylopericardium after a corrective cardiac surgery for a congenital heart disease such as atrial or ventricular septal defect. We report a case of chylopericardium in a 55-year-old mitral valve replacement patient. The reason for chylopericardium was unclear, but it might have been related with the damaged lymph nodes and blunt dissection of the thymus. While most chylopericardium cases require surgical intervention, we managed this chylopericardium case with a low-fat diet for 3 days.
Adult* ; Chylothorax ; Diet, Fat-Restricted ; Heart Defects, Congenital ; Heart Diseases* ; Heart Septal Defects, Ventricular ; Humans ; Korea ; Lymph Nodes ; Middle Aged ; Mitral Valve* ; Pericardial Effusion* ; Thoracic Surgery ; Thymus Gland

Adult ; CD5 Antigens ; metabolism ; Carcinoma, Papillary ; metabolism ; pathology ; Carcinoma, Squamous Cell ; metabolism ; pathology ; surgery ; Choristoma ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Hamartoma ; metabolism ; pathology ; Humans ; Proto-Oncogene Proteins c-kit ; metabolism ; Thymoma ; metabolism ; pathology ; Thymus Gland ; pathology ; Thymus Neoplasms ; metabolism ; pathology ; Thyroid Neoplasms ; metabolism ; pathology ; surgery ; Thyroidectomy ; methods

Child ; Female ; Head and Neck Neoplasms ; diagnosis ; pathology ; surgery ; Humans ; Parathyroid Neoplasms ; diagnosis ; pathology ; surgery ; Thymus Gland ; pathology ; surgery ; Thymus Neoplasms ; diagnosis ; pathology ; surgery