New onset of myasthenia gravis 10 years after proton beam therapy for thymoma.
New onset of myasthenia gravis 10 years after proton beam therapy for thymoma.
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胸腺瘤质子束治疗 10 年后新发重症肌无力。
DOI：
10.1007/s11748-014-0484-9
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Nakajima J.
中科院分区：
文献类型：
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作者：
Karasaki T;Murakawa T;Nagayama K;Nitadori JI;Anraku M;Kikuchi Y;Shinozaki-Ushiku A;Igaki H;Nakajima J.
一名36岁女性在66 GyE时接受质子束治疗包裹型B1胸腺瘤以达到治愈目的。影像学部分缓解。虽然肿瘤大小自那时起一直稳定，但她在质子治疗后10年发展为全身性重症肌无力。行胸腺扩大切除术。肿瘤与心包之间无粘连，肿瘤与胸骨之间也无粘连，可能是由于布拉格峰效应。在切除的肿瘤中观察到广泛的玻璃样变，伴小病灶的活肿瘤细胞，显示退化的A型样形态。尚不能确定活细胞是否代表退行性变化的复发或新生肿瘤形成，也不清楚活细胞是否是重症肌无力发作的原因。
A 36-year-old woman underwent proton beam therapy for encapsulated type B1 thymoma for curative intent at 66 GyE. Radiographically partial response was achieved. Although the tumor size had been stable since that time, she developed systemic myasthenia gravis 10 years after the proton therapy. Extended thymectomy was performed. There were no adhesions between the tumor and the pericardium, and there were no adhesions also between the tumor and the sternum, probably due to the favor of Bragg peak effect. Extensive hyalinization with small foci of viable tumor cells showing degenerated type A-like morphology was observed in the resected tumor. Whether the viable cells represented recurrence with degenerative changes or de novo tumor formation was unable to be determined, and whether the viable cells were responsible for the onset of myasthenia gravis remained unclear.