|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 1 | Page : 214-215
Thymoma: Clinical experience from a tertiary care institute from North India
Ritesh Agrawal, Balaguruswamy Kanchana, Gobichettipalayam Kanniappan Venkatachalam, Udit Narayan
Department of General Surgery, Aarupadai Veedu Medical College, Kirumampakkam, Puducherry, India
|Date of Web Publication||23-Apr-2014|
Endocrine and Breast Surgeon, Department of General Surgery, Aarupadai Veedu Medical College, Puducherry - 607 402
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agrawal R, Kanchana B, Venkatachalam GK, Narayan U. Thymoma: Clinical experience from a tertiary care institute from North India. J Can Res Ther 2014;10:214-5
We read the manuscript with interest and discussed it in our journal club.  We would like to congratulate the authors for highlighting an untold story. Series on thymoma are sparse from India and authors have done a commendable job.
However, there are certain observations in the article which need further clarification and comments.
For myasthenia gravis, thymus can have hyperplasia or a thymoma. Thymus can also be normal or may contain a cyst in cases of myasthenia gravis. A large series had been published on surgical outcome of thymectomy on myasthenia gravis from a nearby geographic area from the same country by Kumar et al.,  They had highlighted the different pathologic phenomenon within the thymus gland. Thymoma is considered to have poorer prognosis as compared to hyperplasia. Were there any patients in which histopathology revealed thymic hyperplasia instead of thymoma? Had the authors compared their results of surgery for thymic hyperplasia versus thymoma in cases of myasthenia gravis?
The patients with Cushing's syndrome form a special subset because they are most likely to have a thymic carcinoid. Was this possibility considered and whether histopathology slides were reviewed by an expert pathologist? Thymic carcinoids, though rare, form an important component of multiple endocrine neoplasia type I (MEN1) syndrome. Were these patients having thymoma with Cushing's syndrome evaluated for MEN1 syndrome?
Can the authors elaborate on the results of treatment for myasthenia gravis and Cushing's syndrome separately?
What was the author's strategy for managing a thymoma? Do they offer surgery in every patient of a thymoma regardless of size, diagnosis, and stage or they select patients for surgery. If yes, what was the selection criteria used?
Few patients (nine) were not operated. It is important to know their profile. What was the reason for not performing surgery in nine patients? Was surgery offered to them also and they denied or whether they were advanced tumors? If they were advanced tumors, it will form a subset and their inclusion in overall data will provide aberrant analysis.
| > References|| |
|1.||Kumar N, Kumar R, Bera A, Ghoshal S, Kapoor R, Radotra BD, et al. Thymoma: Clinical experince from a tertiary care institute from North India. J Cancer Res Ther 2013;9:235-9. |
|2.||Kumar N, Verma AK, Mishra A, Agrawal G, Agrawal A, Mishra UK, et al. Factors predicting surgical outcome of thymectomy in myasthenia gravis: A 16-year experience. Ann Indian Acad Neurol 2011;14:267-71. |