Abstract
A thymectomy is now generally accepted as a major option of treatment for myasthenia gravis (MG) patients, both with and without thymomas. In recent years, developments in endoscopic surgical procedures have achieved the benefit of less invasiveness, though that has led to discussion regarding the most suitable surgical approach. The rationale for choosing a thymectomy for nonthymomatous MG is based on its function to remove the germinal centers (GCs) in the thymi, where acetylcholine receptor (AChR)-specific B cells clonally proliferate, and differentiate into antibody producing cells with a high affinity, as demonstrated by the author when working with Willcox [1, 2]. In addition, we found that a decrease in antibody titer 1 year after a thymectomy had a significant inverted correlation with the number of GC B cells in thymic lymphocytes in those patients [3]. Further, the author and Willcox reported that lymphocytes in remnant thymi adjacent to tumors spontaneously produce anti-AChR an tibodies in MG patients with a thymoma [4].
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Sims GP, Shiono H, Willcox N et al (2001) Somatic hypermutation and selection of B cells in thymic germinal centers responding to acetylcholine receptor in myasthenia gravis. J Immunol 167:1935–1944
Shiono H, Roxanis I, Zhang W et al (2003) Scenarios for autoimmunization of T and B cells in myasthenia gravis. Ann N Y Acad Sci 998:237–256
Okumura M, Ohta M, Takeuchi Y et al (2003) The immunologic role of thymectomy in the treatment of myasthenia gravis: implication of thymus-associated Blymphocyte subset in reduction of the anti-acetylcholine receptor antibody titer. J Thorac Cardiovasc Surg 126:1922–1928
Shiono H, Wong YL, Matthews I et al (2003) Spontaneous production of anti-IFN-alpha and anti-IL-12 autoantibodies by thymoma cells from myasthenia gravis patients suggests autoimmunization in the tumor. Int Immunol 15:903–913
Fukai I, Funato Y, Mizuno T et al (1991) Distribution of thymic tissue in the mediastinal adipose tissue. J Thorac Cardiovasc Surg 101:1099–1102
Scelsi R, Ferro MT, Scelsi L et al (1996) Detection and morphology of thymic remnants after video-assisted thoracoscopic extended thymectomy (VATET) in patients with myasthenia gravis. Int Surg 81:14–17
Masaoka A, Monden Y (1981) Comparison of the results of transsternal simple, transcervical simple, and extended thymectomy. Ann N Y Acad Sci 377:755–765
Ohta M, Hirabayasi H, Okumura M et al (2003) Thoracoscopic thymectomy using anterior chest wall lifting method. Ann Thorac Surg 76:1310–1311
Shigemura N, Shiono H, Inoue M et al (2006) Inclusion of the transcervical approach in video-assisted thoracoscopic extended thymectomy (VATET) for myasthenia gravis: a prospective trial. Surg Endosc 20:1614–1618
Shiono H, Inoue A, Tomiyama N et al (2006) Safer video-assisted thoracoscopic thymectomy after location of thymic veins with multidetector computed tomography. Surg Endosc 20:1419–1422
Masaoka A, Yamakawa Y, Niwa H et al (1996) Extended thymectomy for myasthenia gravis patients: A 20-year review. Ann Thorac Surg 62:853–859
Jaretzki A 3rd, Barohn RJ, Ernstoff RM et al (2000) Myasthenia gravis: Recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology 55:16–23
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© 2008 Springer-Verlag Italia
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Shiono, H., Ohta, M., Okumura, M. (2008). Open Videoassisted Techniques: Thoracoscopic Extended Thymectomy with Bilateral Approach and Anterior Chest Wall Lifting. In: Lavini, C., Moran, C.A., Morandi, U., Schoenhuber, R. (eds) Thymus Gland Pathology. Springer, Milano. https://doi.org/10.1007/978-88-470-0828-1_20
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