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Late recurrent thymoma in myasthenia gravis: a case series
  1. Jennifer Spillane1,
  2. Martin Hayward2,
  3. Nicholas P Hirsch3,
  4. Chris Taylor3,
  5. Dimitri M Kullmann1,3,
  6. Robin S Howard3
  1. 1Institute of Neurology, UCL, London, UK
  2. 2Cardiothoracic Unit, The Heart Hospital, University College Hospital, London, UK
  3. 3National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
  1. Correspondence to Dr Robin S Howard, Batten/Harris Neurological Intensive Care Unit, National Hospital for Neurology and Neurosurgery, London, WC1N3BG, UK; robin.howard{at}uclh.nhs.uk

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Background

Between 10% and 20% of patients with myasthenia gravis (MG) have a thymoma. Complete surgical removal forms the cornerstone of treatment regimes with adjuvant radiotherapy recommended in cases of incomplete resection. Thymomas are characterised by an indolent growth with good prognosis. However, recurrence is seen in 7–30% of patients.1

Myasthenic symptoms often remain after removal of a thymoma, with over 80% of the patients requiring continued immunosuppression.2 These patients continue to attend general neurology clinics and, therefore, it is necessary that neurologists are alert to the possibility of a thymoma recurrence.

We describe five patients with MG who had undergone a thymectomy but developed late recurrence of thymoma.

Methods

We undertook a review of the patient records from a dedicated MG clinic at the National Hospital for Neurology and Neurosurgery and identified cases of late recurrent thymoma. ‘Late’ was defined as a recurrence appearing at least 6 years after the initial resection. This interval was chosen based on a study showing that thymoma recurrence was usually observed within 6.25 years after the initial resection.3 Over many years, all of the patients were reviewed regularly by one of …

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