Document Detail


Malignant thymoma associated with myasthenia gravis, Graves' disease, and SIADH.
MedLine Citation:
PMID:  18520111     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with thymoma are likely to present with associated autoimmunologic disorders. The occurrence of syndrome of inappropriate antidiuretic hormone (SIADH) attributable to thymoma is extremely rare. We herein present an extremely rare case of a 59-year-old man patient who was discovered to have malignant thymoma associated with myasthenia gravis, Graves' disease, and SIADH. He was admitted for evaluation and treatment of hyponatremia (Na 125 mEq/l). SIADH was diagnosed, and thymoma was identified as its cause. The patient was also found to have both Graves' disease and myasthenia gravis. The hyponatremia was normalized with water restriction and 3% saline therapy before thymectomy. The thymic tumor was a Masaoka stage III thymoma that resulted in direct invasion to the wall of the innominate vein, but there was no finding of invasion to other mediastinal organs. Complete thymectomy with innominate vein graft was performed. Microscopic histopathology findings corresponded to those of a mixed-type thymoma and type B2. However, immunohistochemical stain for antidiuretic hormone was negative in the tumor cells. Adjuvant radiation therapy was employed postoperatively, and the patient's postoperative recovery was uneventful. He subsequently reached a euthyroid state. And the reversal to normal sodium and osmolality levels was continued after the tumor removal without any further management for hyponatremia. The observation of this interesting case and a literature review provided us with the opportunity to explore the pathogenesis and clinical aspects of thymoma-related autoimmune and/or endocrine disorders which must be suspected in patients with thymoma.
Authors:
Byung-Wan Lee; Sung-Hee Ihm; Ho-Seung Shin; Hyung-Joon Yoo
Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2008-06-02
Journal Detail:
Title:  Internal medicine (Tokyo, Japan)     Volume:  47     ISSN:  1349-7235     ISO Abbreviation:  Intern. Med.     Publication Date:  2008  
Date Detail:
Created Date:  2008-06-03     Completed Date:  2008-07-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9204241     Medline TA:  Intern Med     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  1009-12     Citation Subset:  IM    
Affiliation:
Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Hallym University, Seoul, Korea.
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MeSH Terms
Descriptor/Qualifier:
Graves Disease / complications*
Humans
Immunohistochemistry
Inappropriate ADH Syndrome / etiology*,  metabolism
Male
Middle Aged
Myasthenia Gravis / complications*
Thymectomy
Thymoma / complications*,  diagnosis,  surgery
Thymus Neoplasms / complications*,  diagnosis,  surgery
Vasopressins / metabolism
Chemical
Reg. No./Substance:
11000-17-2/Vasopressins

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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