The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 20 , Issue 5
Showing 1-20 articles out of 20 articles from the selected issue
  • Masashi Muraoka, Shinji Akamine, Tomoshi Tsuchiya, Ryotaro Kamohara, S ...
    2006 Volume 20 Issue 5 Pages 700-705
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    We evaluated the efficacy and safety of the intraoperative needle aspiration biopsy (NAB) for the diagnosis of indeterminate pulmonary nodule. We performed intraoperative NAB for 197 patients who had not obtained a definitive diagnosis preoperatively. We evaluated procedural complications, the accuracy and sensitivity of diagnosis. The recurrence and prognosis of 182 patients who were diagnosed as lung cancer by NAB (NAB group) were compared with 469 patients who had obtained a definitive diagnosis preoperatively (POD group). A ninety-four percent diagnostic sensitivity and 93.9% accuracy for lung cancer were obtained. In 11 patients who diagnosed as carcinoma after a partial resection of the lung for definitive diagnosis, 9 patients had adenocarcinoma; 6 of 9 had bronchioloalveolar carcinomas. The mean diameter of the tumors in 11 patients was 21mm. No patients in the NAB group suffered from severe complications after the procedure. Five patients (2.7%) in the NAB group had carcinomatous pleuritis at the time of recurrence, however the incidence was not significant (2.3% in the POD group). No patients in the NAB group had pleural dissemination in the early stage after surgery. There was no significant difference in the 5-year survival rate between the two groups (91.2% in the NAB group vs. 81.5% in the POD group). Intraoperative NAB showed a good efficacy, with a high accuracy for the diagnosis of lung cancer and was a safe procedure, without severe complications. The risk of disseminating the carcinoma cells was very small and NAB did not lead to a poor prognosis for the patients.
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  • Yu Shomura, Yutaka Takahashi, Yukihiro Imai
    2006 Volume 20 Issue 5 Pages 706-714
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) has been established as an important diagnostic imaging method in the preoperative workup of suspicious pulmonary focal lesions. A standard uptake value (SUV), which is a quantity index of FDG-PET findings, is used to diagnose of malignancy. We have based diagnose of malignancy on FDG-PET qualitative analysis using visual assessment along with the results of chest radiography and CT. Preoperative FDG-PET was performed in 26 patients with clinical suspected T1 lung cancer. FDG-PET qualitative diagnosis (PET visual diagnosis) was compared with the quantitative analysis using SUV (PET SUV diagnosis) in those 26 patients. There were 22 malignant cases and 4 benign cases in which SUVs were 3.62±3.88 and 2.33±1.49, respectively. Both sensitivity and accuracy were significantly higher for PET visual diagnosis than for PET SUV diagnosis (86% vs 45%, p=0.005, 77% vs 50%, p=0.046, respectively). FDG-PET qualitative analysis including the results of chest radiography and CT should be used for the diagnosis of malignancy in clinical suspected T1 lung cancer.
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  • Fumio Maitani, Kana Oiwa, Tomoki Nakagawa, Ryota Masuda, Yoshimasa Ino ...
    2006 Volume 20 Issue 5 Pages 715-718
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    We have been performing thoracoscopic surgery to treat chest trauma since 1994. By June 2005 we had performed thoracoscopic operations to treat 34 cases of chest trauma. The patients ranged in age from 6 to 90 years old (mean: 40.7 years). The origin of trauma was from different sources: 21 sharp injuries, 11 traffic accidents, and 2 accidental falls. Owing to poor control of bleeding in 2 of the 34 cases, a conversion was made to standard thoracotomy. In the remaining 32 cases it was possible to complete surgery by a thoracoscopic approach (14 partial resections, 7 coagulations, 5 exploratory thoracoscopies, 5 pulmonary sutures, and 1 suture and repair of the bronchus). We considered the following to be indications for surgery by this approach, in blunt trauma: (1) exploratory thoracoscopy for diaphragm rupture and vascular damage; (2) persistent pulmonary fistula; (3) hemothorax 500ml or more per 6 hours; and in sharp trauma: (1) stabbing wounds; (2) intrathoracic foreign bodies and pleural lavage. We consider that thoracoscopic surgery may be first treatment of choice for treating chest trauma patiants without severe bleeding causing hypovolemic shock.
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  • Koichi Tanaka, Kuniaki Okada, Hideki Kawamura, Harubumi Kato
    2006 Volume 20 Issue 5 Pages 719-723
    Published: July 15, 2006
    Released: March 11, 2008
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    We studied 62 cases of primary lung cancer resected in our hospital from July 2003 to June 2005. The study focused on the existence of multiple primary cancers, clinical background, and pathological findings. There were 24 cases (38.7%) of multiple primary cancers and the average patient age was 66.6-years, including 16 cases of metachronous and 8 cases of synchronous cancers, of which 19 were double primary cancers, 3 triple primary cancers, and 2 quadruples. Ten foci of the multiple primary cancers existed in the stomach, 8 in the large intestine, 5 in the breast, 3 in the lung, and one each in the esophagus, kidney, liver, tongue, and prostate gland. The 22 lung cancer tumors (91.7%) were detected by radiographic examinations in multiple primary cancer cases, and 31 additional tumors (81.6%) were detected in non-multiple primary cancer cases. Nine cases (23.7%) of non-multiple primary cancer had lymph node metastasis; however, no multiple primary cancer cases had lymph node metastasis (p<0.05). The incidence of lung cancer from July 2003 to June 2005 in cases of gastric cancer resected from 1994 to 2003 in our hospital was nine. That is higher than the predicted incidence (6.53 cases in two years) from the Japanese official cancer incidence data. We suggested that the presence of gastric cancer increased the possibility of contracting primary lung cancer. Nationwide investigation and further consideration are necessary to confirm this suggestion.
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  • Ryutaro Sakabe, Hidenori Mukaida, Yoshinori Yamashita, Wataru Takiyama
    2006 Volume 20 Issue 5 Pages 724-728
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    We report a case of thymoma with pure red cell aplasia. A 75-year-old man was admitted to the hospital because of dyspnea on effort, and his blood examination showed severe anemia (Hb 5.5g/dl). Bone marrow aspiration showed erythroid aplasia and normal level of myelocyte. Chest CT scan revealed a solid tumor of 4cm in size in the anterior mediastinum. He was diagnosed with pure red cell aplasia associated with thymoma and underwent extended thymothymectomy following transfusion of concentrated red cells. Pathological findings of the resected specimen showed type B1 thymoma due to the World Health Organization (WHO) histological classification. Tumor invasion to the mediastinal pleura was confirmed, so Masaoka's staging classification was stage II. Because the anemia persisted one month after the operation, Cyclosporin A (100mg/day) was administered for postoperative adjuvant therapy. Three weeks later, increase of reticulocyte and improvement of anemia was successfully provided. Twelve months after the operation, he remains well without recurrence.
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  • Takuma Tsukioka, Kiyotoshi Inoue, Takashi Iwata, Nobuhiro Izumi, Shinj ...
    2006 Volume 20 Issue 5 Pages 729-734
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    A 52-year-old man with recurrent hemoptysis and a bronchopulmonary infectious disease was admitted to our hospital. He had severe hemoptysis and bronchial artery embolization was performed. At that time, abnormal vessels supplying the right middle lobe and lingula were detected. On another day, an angiography was performed, which revealed four abnormal vessels, from the right internal thoracic artery and the right inferior phrenic artery supplying the right middle lobe and from the left gastric artery and the left inferior phrenic artery supplying the lingula. A chest computed tomographic scan revealed dilatation of the bronchi in the right middle lobe and lingula. Bilateral intralobar pulmonary sequestration was diagnosed. A laboratory examination revealed that the serum carbohydrate antigen 19-9 (CA19-9) level was high. His respiratory function was normal and a synchronous resection was performed. Right middle lobectomy and resection of the lingula were performed through a bilateral axillary thoracotomy. The abnormal vessels could be detected in the bilateral pulmonary ligament and mediastinal pleura and were all ligated and resected. After the operation, the symptoms disappeared and he was discharged on POD 29. A bilateral intralobar pulmonary sequestration is rare. Only eight cases have been reported, but none have described a synchronous resection case. This is the first reported case of a synchronous resection for a bilateral intralobar pulmonary sequestration.
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  • Jiro Abe, Toru Takahashi, Yasushi Matsuda, Toru Hasumi, Keiji Kanma, Y ...
    2006 Volume 20 Issue 5 Pages 735-740
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    We encountered a case of Lambert-Eaton myasthenic syndrome complicated to small cell lung cancer. He has survived for six years after intense therapy for small cell carcinoma including surgery. His serum anti-VGCC [voltage gated calcium channel] antibody titer level was 20 times higher than that of upper normal limit before he received multimodal treatment. Whereas the high titer level was maintained, his myasthenic symptoms gradually disappeared within three years of the treatment. It is suggested that not only the anti-VGCC antibody level but also other unknown molecules are involved in the etiology of Lambert-Eaton myasthenic syndrome.
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  • Toshiya Bessho, Junji Arimoto, Osamu Nishimura
    2006 Volume 20 Issue 5 Pages 741-744
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    Intrathoracic chest wall type lipoma is a rare tumor. We report a case of an intrathoracic chest wall type lipoma resected by VATS. A 29-year-old man was referred our hospital for an abnormality on chest X-ray. Chest X-ray showed a left lower mass shadow. CT revealed a homogenious low density intrathoracic mass arising from the chest wall. MRI demonstrated a high intensity mass like a fat tissue. The tumor was pedunculated from the chest wall and easily resected by VATS. The tumor size was 10×8×3cm and 60g. The histological diagnosis was mature lipoma. Postoperative course was uneventful. He is well without recurrence one year after surgery. Video-assisted thoracic surgery seems to be useful for the resection of the pedunculated intrathoracic chest wall type lipoma.
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  • Takahiro Sawada, Masami Sato, Satomi Takahashi, Kaoru Koike
    2006 Volume 20 Issue 5 Pages 745-750
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    We present a 79-year-old female patient. She underwent a chest X-ray mass examination. An abnormal shadow hidden in the cardiac shadow was pointed out. Later, we identified a calcified nodular shadow in chest CT and we noticed its mobility in the thoracic cavity. So we made a diagnosis of thoracolithiasis. At her request, we removed two smooth-surfaced white calculuses by thoracoscopic surgery at the same time. The core of the large calculus was necrotized fat tissue, and that of the small calculus was black particles like charcoal. Lamellar fibrous tissue enclosed the cores and had become hyalinized. The final pathological diagnosis was thoracolithiasis.
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  • Hiroe Aoshima, Kunihiro Oyama, Toyohide Ikeda, Toshihide Shimizu, Naok ...
    2006 Volume 20 Issue 5 Pages 751-755
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    An asymptomatic 53-year-old male was admitted with an abnormal shadow on his chest X-ray. Computed tomography (CT) revealed a mass lesion in the middle mediastinum that was 1.5×5.1cm in size. An angiography of the tumor revealed a hypervascular area that was fed by the left bronchial artery; therefore, left bronchial arterial embolization (BAE) was performed. Subsequently, the mediastinal tumor was completely resected by video-assisted thoracoscopic surgery (VATS) and was diagnosed as a hemangioma. Documentation indicates that hemangiomas are characterized by copious blood supply, are difficult to detach, and easily hemorrhage. However, by VATS, we were able to resect the tumor without blood loss or any other problems. Preoperative embolization of the tumor artery was a useful method for the treatment of the hemangioma to control bleeding during the operation.
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  • Takuma Tsukioka, Kiyotoshi Inoue, Takashi Iwata, Shinjiro Mizuguchi, R ...
    2006 Volume 20 Issue 5 Pages 756-759
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    The patient was a 64-year-old man who had left hemiparesis due to a brain infarction. He had severe hypertension and his serum adrenocorticotropic hormone (ACTH) level was high. A chest roentgenogram and a chest computed tomographic scan revealed a right lung tumor. Histology from a bronchoscopic examination revealed a lung adenocarcinoma (C-T2N0M0 stage IB). A right lower lobectomy with a mediastinal lymph node dissection was performed. Immunohistochemical staining for ACTH was positive in the cancer cells and we diagnosed an ACTH-producing lung adenocarcinoma (p-T2N0M0 stage IB). After the operation, his serum ACTH level decreased and we decreased the antihypertensive drugs. Paraneoplastic syndrome caused by ectopic ACTH production has been reported in association with a variety of malignant tumors. However, most cases involving this syndrome are associated with neuroendocrine tumors such as a small-cell carcinoma or carcinoid of the lung. An ACTH producing lung adenocarcinoma is a rare case. To the best of our knowledge, this is the fifth reported case of an ACTH producing lung adenocarcinoma and the second for which resection had been performed.
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  • Yoshitaka Shiina, Ken Takahashi
    2006 Volume 20 Issue 5 Pages 760-763
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    A 63-year-old man who had alcoholic liver cirrhosis suffered from hemoptysis. Preoperative chest CT scan demonstrated a mass shadow with infiltration in the left lower lobe. Hemoptysis did not improve after treatment with antibiotics. This patient was classified as having Child-Pugh class A liver cirrhosis. Because lung cancer was suspected, a lower lobectomy was performed. Actinomycosis was detected by pathological study of the excised specimen with no evidence of cancer. The patient is doing well without recurrence of actinomycosis after the surgery.
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  • Hitoshi Suzuki, Keizo Tanaka, Shinji Kanemitsu, Toshiya Tokui
    2006 Volume 20 Issue 5 Pages 764-767
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    It is unclear whether Basedow's thymomegaly represents an epiphenomenon related to immune dysfunction or whether it is another direct consequence of the thyrotoxicosis. We present two cases who had abnormal mediastinal shadow on chest X-ray film during antithyroid medication for Basedow's disease. Operations were performed and histological examinations revealed thymic hyperplasia. One case was referred to our hospital for recurrence of hyperthyroidism and increased size of the mediastinal tumor. Total thymectomy and subtotal thyroidectomy were performed. In another case, her thyroid function was gradually normalized, but the size of the tumor was unchanged and the biopsy of the tumor was performed. The mechanism for the production of thymomegaly may be different in two cases because one case was lymphoid hyperplasia and another case was true hyperplasia.
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  • Hisashi Oishi, Yasushi Hoshikawa, Yoshinori Okada, Tetsu Sado, Satoshi ...
    2006 Volume 20 Issue 5 Pages 768-772
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    The determination of plasma (1→3)-β-D-glucan is widely used for the diagnosis of deep mycosis, but it is often affected by various factors. We experienced a case with markedly increased plasma (1→3)-β-D-glucan after bilateral lung transplantation for pulmonary lymphangiomyomatosis. The patient's plasma (1→3)-β-D-glucan increased up to 2964 pg/ml the day after transplantation. We searched for the reason for this increase and it was suspected that blood from the surgical field, which contained gauze, returning to the circulation through a heart-lung machine might have caused the increase in plasma (1→3)-β-D-glucan. To examine this hypothesis, we experimentally measured the (1→3)-β-D-glucan level in saline in which gauze had been immersed. The result implies that (1→3)-β-D-glucan might have been eluted from the gauze. If large amounts of gauze are used in the surgical field and the blood aspirated is returned to the circulation, the postoperative plasma (1→3)-β-D-glucan level should be carefully interpreted.
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  • Yoshihiro Suzuki, Haruhiko Ishii, Naoki Ishiwa, Nobuo Ogawa, Hiroyuki ...
    2006 Volume 20 Issue 5 Pages 773-776
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    Malignant mesothelioma has poor prognosis in general and a radical cure is difficult. We report on a case of malignant mesotheloma which obtained the fifth grade after extrapleural pneumonectomy. A 52 year-old female complained of right chest pain. She had no history of exposure to asbestos. On December 1998, she visited another hospital and right pleural effusion was found. On January 1999, pleural biopsy was performed under video-asisted thoracic surgery. She was diagnosed with malignant mesothelioma in situ. She visited our center and extrapleural pneumonectomy was performed on March 3, 1999. Pathological diagnosis after the operation was malignant mesothelioma, T2N0M0 stage I (TNM Classification by IMIG). There is a no reoccurrence six years after the operation. Diagnosis at an early stage is indispensable for the radical cure of malignant mesothelioma. Therefore, when pleural effusion of an uncertain cause is found, it is necessary to perform pleural biopsy under video-asisted thoracic surgery positively and to make a diagnosis. Moreover, a radical cure for malignant mesothelioma in situ can be achieved by extrapleural pneumonectomy.
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  • Toru Itaya, Hiroshi Neyatani, Katsuyuki Asai, Tsuyoshi Takahashi
    2006 Volume 20 Issue 5 Pages 777-780
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    A 15-year-old female consulted our hospital with chief complaints of cough and hemoptysis. After admission, those symptoms became aggravated, and the chest CT revealed complete atelectasis of the left lung and the presence of a tumor, 3cm in diameter, in the left lower lobe. Due to a large amount of the airway hemorrhage, both an intubation into the right main bronchus and an embolization of the bronchial artery feeding the tumor were performed. Then, we performed a left lower lobectomy. The tumor was pathologically diagnosed as low-grade malignant mucoepidermoid carcinoma. Although mucoepidermoid carcinoma is a hemorrhagic tumor, a large amount of hemorrhage in the respiratory tract requiring endotracheal intubation or vascular embolization is very rare.
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  • Masahiro Sakaguchi, Kenji Nakamura, Osamu Takahashi, Yoshiyuki Susaki
    2006 Volume 20 Issue 5 Pages 781-785
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    The patient was a 31-year-old woman with intractable and recurrent pneumothorax. She had been diagnosed with tuberous sclerosis and renal angiomyolipoma at 21 years old. She underwent bullectomy for the right pneumothorax by thoracoscopic surgery at 26 years old, and LAM was diagnosed histopathologically. In spite of anti-hormone therapy for LAM, she was admitted to our hospital because of recurrence of the left pneumothorax pooly controlled by tube drainage. Multiple air cysts and three apparent thin-walled bullae were recognized on the surface of the lung. Bullectomy was performed, however, left pneumothorax recurred three months later. Although lung transplan-tation was considered, chemical pleurodesis was performed along with the direct closure of the pulmonary fistula. She has remained well with no evidence of recurrence of pneumothorax for 18 months. Pleural adhesion has been regarded as a relative contraindication for lung transplantation in Japan, but chemical pleurodesis may be acceptable before transplantation to maintain the patient's QOL or to prevent life-threatening respiratory failure due to intractable and recurrent pneumothorax associated with LAM.
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  • Masakazu Kawabe, Masaharu Nakade, Hirokazu Tanaka, Hiroyoshi Watanabe
    2006 Volume 20 Issue 5 Pages 786-789
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    A 54-year-old female was referred to our hospital due to an abnormal chest CT shadow. Her chest CT showed a 4 cm diameter mass in the anterior mediastinum. Preoperative diagnosis was a benign mediastinal tumor (neurogenic suspected). Surgery confirmed that the tumor originated from the right phrenic nerve. The tumor was removed without resecting the phrenic nerve. Histopathological findings showed a schwannoma originating from the right phrenic nerve. Postoperatively, the right diaphragm was not elevated. Such tumors are rare, and only 19 cases have been reported in Japan.
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  • Keisei Tachibana, Tomohiko Ikeya, Nobumasa Takahashi, Katsumi Murai, K ...
    2006 Volume 20 Issue 5 Pages 790-794
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    A 38-year-old woman was referred to our hospital because of pneumothorax related to menstruation. Thoracoscopy on the 22nd day of the menstrual cycle revealed the presence of diffuse, brown lesions in the visceral and parietal pleurae in the left thoracic cavity. Histopathological findings of visceral and parietal pleurae did not contradict endometriosis. On the 3rd postoperative day, she was diagnosed as having right pneumothorax just after menstruation and was treated with a chest tube. Postoperatively she has been symptom free for a year on hormonal therapy. We examined thoracic endometriosis before shedding, because thoracoscopy was performed just before menstruation. The physiological mechanism of this case was suspected to be that the endometriotic tissue invaded from the abdominal cavity to the left thoracic cavity. The endometriotic tissue was implanted in the visceral pleura and sloughed in synchrony with the menstrual cycle. Endometriosis in the parietal pleura is very rare. When we consider the physiological mechanism of catamenial pneumothorax, this case is very interesting and valuable.
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  • Yasushi Sakamaki, Tetsuo Kido, Motoaki Yasukawa, Akira Tomokuni
    2006 Volume 20 Issue 5 Pages 795-798
    Published: July 15, 2006
    Released: March 11, 2008
    JOURNALS FREE ACCESS
    Post-thymomectomy myasthenia gravis (PTMG) occurred 4 months postoperatively in a 37-year-old woman who had undergone complete removal of a non-invasive (Masaoka stage I) thymoma by thoracoscopic left hemithymectomy. The diagnosis of PTMG was made based on the clinical symptoms, wanning of the extremities, and an abnormally elevated titer of serum anti-acetylcholine receptor antibody. Four months after onset of PTMG (Osserman IIB), she underwent completion thymectomy (extirpation of the remnant thymus and the perithymic adipose tissue) by video-assisted thoracoscopic procedure from the right side, which resulted in complete remission of MG 6 months postoperatively. The incidence of PTMG is unpredictable and therefore warrants a therapeutic strategy designed for treating patients with non-myasthenic thymomas, including indication of completion thymectomy.
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