COMPARISON OF CT AND PATHOLOGIC FINDINGS & CLINICAL OUTCOME AFTER THYMECTOMY WITH OR WITHOUT PLASMAPHERESIS IN PATIENTS WITH MYASTHENIA GRAVIS
Keywords:
CT, Thymectomy, Plasmapheresis, Myasthenia GravisAbstract
Objective: To compare computed tomographic (CT) appearance of the thymus with results from histologic
examination of thymic tissue and clinical outcome in patients with myasthenia gravis who underwent thymectomy
with or without plasmapheresis.
Method and Materials: This study comprised of 47 patients, who were operated on in the period from January 2002
to December 2009 for myasthenia gravis. Computed tomography was done in all cases .Of these 47 patients,
preoperative plasmapheresis was performed in 20 patients (group B) and the remaining 27 patients (group A) had no
preoperative plasmapheresis based on non availability of plasmapheresis kit. Outcome in the form of requirement of
ventilation, symptomatic improvement, hospital stay and requirement of drugs were assessed at the end of one year
and compared between the two groups. Specimens sent for histopathology were analyzed. Follow up was done in all
cases.
Results: Eighteen out of twenty seven patients (66%) in group A required ventilatory support in the immediate
postoperative period, whereas four out of twenty patients (20%) in group B required it. Significant and sustained
symptomatic improvement was noted in group B as compared with group A (P-0.01). Twenty-eight patients had
normal CT findings, seven had a diffusely enlarged thymus, and 12 had a focal mass. The results of histologic
examination showed that 16 of 28 patients with normal CT findings had normal thymic tissue and 12 had lymphoid
follicular hyperplasia; all seven patients with an enlarged thymus had lymphoid hyperplasia. Five of 12 patients with
a focal mass at CT had lymphoid hyperplasia, and seven had thymoma.
Conclusion: CT is of limited value in distinguishing lymphoid follicular hyperplasia from a normal thymus or
thymoma and in predicting clinical outcome. Preoperative plasmapheresis in the patients of myasthenia gravis is
beneficial and can cause a significant difference in the postoperative outcome.
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