Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Aug 2;12(8):e229163.
doi: 10.1136/bcr-2018-229163.

Thymoma-associated multiorgan autoimmunity

Chien-Tzu Hung  1 , Tsen-Fang Tsai  2 , Jin-Shing Chen  1 , Min-Shu Hsieh  3   4
Affiliations
Case Reports

Thymoma-associated multiorgan autoimmunity

Chien-Tzu Hung et al. BMJ Case Rep. .

Abstract

Thymoma-associated multiorgan autoimmunity is a relatively new term to describe the rare paraneoplastic syndrome that complicates thymoma, which can involve the thyroid, liver and intestine in addition to the skin. The pathology often indicates a graft-versus-host-like pattern commonly observed in recipients of an allogeneic haematopoietic cell transplant. We report a case of type B2 and B3 thymoma with invasion to the lung and pleura in a patient who presented with oral lichen planus and graft-versus-host-like erythroderma. The cutaneous lesions improved after complete resection of the thymoma in combination with systemic glucocorticoids, which was subsequently complicated by cytomegalovirus pneumonitis.

Keywords: cardiothoracic surgery; dermatology.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None to declare

Figures

Figure 1
Figure 1
(A) Chest radiography reveals a mediastinal tumour and multiple pleura-based masses with a pleural effusion of the right lung. (B) CT reveals a mediastinal tumour with invasion to the anterior chest wall and pleura-based masses with a pleural effusion.
Figure 2
Figure 2
Skin lesions of the trunk 7 days after the operation.
Figure 3
Figure 3
(A) H&E, 200×: interface dermatitis with dyskeratotic cells and confluent parakeratosis; dermis shows a perivascular infiltrate of lymphocytes with scattered eosinophils. (B) H&E, 400×: frequent dyskeratosis (arrows) and confluent parakeratosis. (C) Direct immunofluorescence staining: several cytoid bodies (under IgG, IgA, IgM and C1q staining) in the lower epidermis, dermal–epidermal junction and upper dermis. There was no intercellular or linear basement membrane pattern deposition.
Figure 4
Figure 4
(A) H&E, 40x type B2 thymoma with a bluish appearance at low magnification and lung invasion. (B) H&E, 200x, type B2 thymoma with small lymphocytes mixed with some aggregates of epithelial cells. (C) 40x, type B3 thymoma with a pink appearance at low magnification (D) type B3 thymoma with a predominance of polygonal epithelial cells.
Figure 5
Figure 5
Skin lesions of the trunk 24 days after operation.
See this image and copyright information in PMC

References

    1. Marx A, Willcox N, Leite MI, et al. . Thymoma and paraneoplastic myasthenia gravis. Autoimmunity 2010;43:413–27. 10.3109/08916930903555935 - DOI - PubMed
    1. Weksler B, Lu B. Alterations of the immune system in thymic malignancies. J Thorac Oncol 2014;9:S137–S142. 10.1097/JTO.0000000000000299 - DOI - PubMed
    1. Wadhera A, Maverakis E, Mitsiades N, et al. . Thymoma-associated multiorgan autoimmunity: a graft-versus-host-like disease. J Am Acad Dermatol 2007;57:683–9. 10.1016/j.jaad.2007.02.027 - DOI - PubMed
    1. Muramatsu K, Fujita Y, Inokuma D, et al. . Cutaneous manifestations of thymoma-associated multi-organ autoimmunity: a fatal sign. Acta Derm Venereol 2016;96:818–9. 10.2340/00015555-2367 - DOI - PubMed
    1. Nakayama M, Itoh M, Kikuchi S, et al. . Thymoma-associated cutaneous graft-versus-host-like disease possibly treated with Narrow-band UVB phototherapy. Eur J Dermatol 2016;26:208–9. 10.1684/ejd.2015.2716 - DOI - PubMed

Publication types

MeSH terms

Substances