Abstract
AB017. Robotic thymectomy for Morvan’s syndrome associated with thymoma: a case report
Daichi Kakibuchi1, Shunta Ishihara1,2, Masanori Shimomura1, Satoru Okada1, Tatsuo Furuya1, Masayoshi Inoue1
1Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan;
2Division of Thoracic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
Correspondence to: Daichi Kakibuchi, MD. Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-Ku, Kyoto 602-8566, Japan. Email: kakib91@koto.kpu-m.ac.jp.
Background: The Morvan’s syndrome is a rare disorder in which autoantibodies against the voltage-gated potassium channel (VGKC) complex protein in neurons causes central neuropathy. Forty percent of patients with Morvan’s syndrome have concomitant thymoma. We present a case, in which the neurological symptoms improved and a good course was achieved by perioperative drug therapy and extended thymectomy.
Case Description: A 67-year-old man presented with low back pain, numbness in the lower limbs, and general malaise. He developed insomnia, abnormal behavior, muscle weakness, dysarthria, weight loss, orthostatic hypotension, vesico-rectal disturbance, and various other central nervous system symptoms and autonomic disorders. He was seropositive for anti-VGKC complex antibodies, and was diagnosed as Morvan’s syndrome. Chest computed tomography (CT) revealed a 4.5 cm mass in the anterior mediastinum, suspected to be thymoma. He was neurologically unable to communicate with us when he came to our hospital. However, after steroid pulse therapy and therapeutic plasma exchange, the nervous system symptoms improved and he was able to express his willingness to be treated. The prednisolone dosage was reduced from 45 to 20 mg/day. Robotic subxiphoid-optical thymectomy was performed for mediastinum mass. The tumor was of thymic origin and protruded into the right thoracic cavity. An extended thymectomy was performed to remove the tumor and the thymus up to the inferior pole of the thyroid gland. Postoperative course was uneventful, and the neurological symptoms were stable. He was transferred to the previous hospital on the 7th day after surgery. The pathological findings were type A thymoma, classified as p-T1aN0M0 stage I in the tumor-node-metastasis (TNM) classification and stage II according to the Masaoka staging. The neurological symptoms improved further, and he was discharged home three months after surgery. The dose of steroid was reduced to 5 mg/day, and one year and 10 months after the surgery, the neurological symptoms remained only orthostatic hypotension, poor memory, and poor swallowing function, and there was no recurrence of thymoma.
Conclusions: The neurological symptoms in Morvan’s syndrome with concomitant thymoma could improve by the combined management with the extended thymectomy and immunosuppressive drug therapy.
Keywords: Thymoma; Morvan’s syndrome; robotic thymectomy; case report
Acknowledgments
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-24-ab017/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient for the publication of this case report. A copy of the written consent is available for review by the editorial office of this journal.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/med-24-ab017
Cite this abstract as: Kakibuchi D, Ishihara S, Shimomura M, Okada S, Furuya T, Inoue M. AB017. Robotic thymectomy for Morvan’s syndrome associated with thymoma: a case report. Mediastinum 2024;8:AB017.
