Open AccessThymectomy in non thymomatous myasthenia gravis: Impact of pathology on outcome and role of survivin in pathogenesis
Author(s) -
Mohamed Mahmoud Abo Elnasr,
Dina M. El-Guindy,
Ayman M. Al-Malt,
Abdel Hady M. Taha
Publication year - 2016
Publication title -
journal of the egyptian society of cardio-thoracic surgery
Language(s) - English
Resource type - Journals
eISSN - 2524-1745
pISSN - 1110-578X
DOI - 10.1016/j.jescts.2016.11.002
Subject(s) - myasthenia gravis , thymectomy , survivin , pathogenesis , medicine , ocular myasthenia , immunohistochemistry , pathology , gastroenterology , immunology , cancer
AbstractBackgroundMyasthenia gravis is an autoimmune disorder characterized by production of acetylcholine receptor antibodies. These antibodies are mainly produced by thymic B-lymphocytes.ObjectiveOur aim was to detect the correlation between thymic pathology and outcome of myasthenia gravis. Moreover, we tried to detect the involvement of survivin as an apoptosis inhibitor in pathogenesis of myasthenia.Patients and methodsThis study was a prospective study conducted on 36 non thymomatous myasthenic patients subjected to thymectomy. Patients were followed for 6 months after operation. Moreover, 36 control normal thymic specimens were obtained from patients operated for open heart surgery. Resected thymic tissue was sent for histopathological examination and immunohistochemical staining by survivin to examine its role in pathogenesis of myasthenia.ResultsPatients were divided into group A with hyperplastic thymus and group B with atrophic thymus. Nine patients had no improvement after surgery and the remaining had variable degrees of clinical improvement. Pathology of thymus did not affect clinical outcome with significant improvement in both groups.Decreased duration of symptoms before surgery and female sex are statistically associated with more improvement of patients' symptoms. Positive expression of survivin was detected in germinal centers of all hyperplastic and atrophic thymuses. All the control thymuses were negative for survivin expression.ConclusionThymectomy for myasthenia gravis is an effective and beneficial procedure even in patients with atrophic thymus. Survivin is expressed in all myasthenic thymuses confirming its role in pathogenesis of myasthenia gravis