Rare thymus mass found in man, 70, with myasthenia gravis
Thymomas more common in younger patients; tumor removed to treat disease
A 70-year-old man was diagnosed with myasthenia gravis (MG) and with a mass in his thymus, a small, immune cell-producing gland in the upper chest, that is not usually found in elderly adults with MG, a case study from India reports.
The man began exhibiting disease symptoms, including eyelid droopiness and breathlessness, months before coming to a hospital’s outpatient office. Doctors discovered and then surgically removed the mass as a likely way of treating the disease. The mass later was confirmed to be a thymoma, or a rare tumor that forms in the thymus.
“It is uncommon for an elderly patient to present with thymic mass and myasthenia gravis concurrently,” the scientists wrote.
The report, “Thymic mass in an elderly male patient with myasthenia gravis: A rare presentation,” was published in Radiology Case Reports.
Thymomas are found in about 15% of MG patients, but usually at younger ages
An autoimmune disease, MG is caused by self-reactive antibodies that target and attack proteins at neuromuscular junctions — the sites of communication between nerve and muscle cells. Common symptoms include muscle weakness and fatigue, with the earliest ones often being weakness in the muscles that control eye and eyelid movement.
Abnormalities in the thymus are common in MG patients, with thymomas being present in about 10% to 15% of cases.
As people age, however, the thymus shrinks and the cells that make up the gland are replaced by fat cells. This process, known as involution of the thymus, is normally complete by the time a person turns 60. Because of involution, it is unusual for people older than age 60 to have an enlarged thymus or to develop thymic masses.
Here, a 70-year-old man went for medical treatment after experiencing droopiness in both of eyelids, double vision, and eye watering.
The man reported that, six months earlier, watering in both of his eyes and double vision in his right eye had started. After eight days, his right eyelid began drooping, with complete sagging within 10 days.
For more than a month, he was only able to see out of his left eye, until vision in that eye also began to blur, followed by the eyelid beginning to droop. A week later, the left eyelid completely drooped and there was swelling around the eye.
Simultaneously, the man reported becoming breathless after walking a few steps.
An eye examination confirmed his drooping eyelids, double vision, and restricted movements in both eyes. Doctors then performed the ice pack test, a common approach for diagnosing MG. During the test, they applied ice to his eyelids and saw the droopiness lessen within five minutes.
A chest X-ray to determine the reason for the man’s breathlessness revealed a well-defined round mass on the right side of his thymus. After it was removed in a surgery, analysis found the mass to be a thymoma.
“Surgical management [of thymomas with MG] is the treatment of choice and involves thymectomy, which plays a tremendous role in the reduction of the symptoms of myasthenia gravis,” the scientists wrote.
The man was determined to be stable, and he was discharged from the hospital with the advice to visit with doctors in two weeks.
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