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Germinal centers are associated with postthymectomy myasthenia gravis in patients with thymoma

 Hye Yoon Chung  ;  Ha Young Shin  ;  Young-Chul Choi  ;  Hyung Jun Park  ;  Jin Gu Lee  ;  Chang Young Lee  ;  Byung Jo Park  ;  Gi Jeong Kim  ;  Seung Woo Kim 
 EUROPEAN JOURNAL OF NEUROLOGY, Vol.31(2) : e16119, 2024-02 
Journal Title
Issue Date
Humans ; Myasthenia Gravis* / complications ; Retrospective Studies ; Thymectomy / adverse effects ; Thymoma* / complications ; Thymoma* / surgery ; Thymus Neoplasms* / complications ; Thymus Neoplasms* / surgery
germinal centers ; myasthenia gravis ; risk factors ; thymectomy ; thymoma
Background and purpose: Germinal centers (GCs) can be observed in the thymic tissues of patients with thymoma-associated myasthenia gravis (MG). Although an association between thymic GCs and MG has been suggested, it is unknown whether the presence of GCs could predict the development of MG after the resection of thymoma, known as postthymectomy MG.

Methods: We conducted a retrospective analysis of previously nonmyasthenic patients who underwent surgical removal of the thymoma. All available thymic tissue slides were rereviewed by a pathologist to assess for GCs. Patients were classified into GC-positive and GC-negative groups based on the presence of GCs. The incidence of postthymectomy MG was compared between the two groups, and the risk factors for postthymectomy MG were assessed.

Results: Of the 196 previously nonmyasthenic patients who underwent thymoma resection, 21 were GC-positive, whereas 175 were GC-negative. Postthymectomy MG developed in 11 (5.6%) patients and showed a higher incidence in the GC-positive group than in the GC-negative group (33.3% vs. 2.3%, p < 0.001). No postoperative radiotherapy and the presence of GCs were risk factors for postthymectomy MG in the univariate analysis. In multivariate analysis, invasive thymoma (hazard ratio [HR] = 9.835, 95% confidence interval [CI] = 1.358-105.372), postoperative radiotherapy (HR = 0.160, 95% CI = 0.029-0.893), and presence of GCs (HR = 15.834, 95% CI = 3.742-67.000) were significantly associated with postthymectomy MG.

Conclusions: Thymic GCs may be a significant risk factor for postthymectomy MG. Even in patients with thymoma who do not show clinical symptoms of MG, postthymectomy MG should be considered, especially if thymic GCs are observed.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Gi Jeong(김기정)
Kim, Seung Woo(김승우) ORCID logo https://orcid.org/0000-0002-5621-0811
Park, Byung Jo(박병조)
Park, Hyung Jun(박형준)
Shin, Ha Young(신하영) ORCID logo https://orcid.org/0000-0002-4408-8265
Lee, Jin Gu(이진구)
Lee, Chang Young(이창영)
Chung, Hye Yoon(정혜윤)
Choi, Young Chul(최영철) ORCID logo https://orcid.org/0000-0001-5525-6861
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