Dysphagia: An uncommon manifestation oh thymoma

Abstract

Myasthenia gravis is an immunological disease of neuromuscular
transmission. It seldom presents bulbar symptoms. In about 15%
of cases it is associated with thymoma. In such cases is regarded
as a paraneoplastic syndrome.
The authors present the case of a 51 years-old man, admitted
because of progressive dysphagia of recent onset. He was previously asymptomatic. Physical examination and laboratory tests
were normal. A slight enlargement of the mediastinum was noted
on chest radiography. Thoracic CT-scan revealed a tumor of the
anterior mediastinum. Upper gastroesophageal endoscopy and
echoendoscopy were normal. A disorder of esophageal motility
was then suspected. The electromyography revealed signs of
Myasthenia gravis. Treatment with pyridostigmine was started
and dysphagia disappeared. Biopsy of mediastinal tumor under
thoracoscopy confirmed a thymoma. The patient was treated
with neo-adjuvant chemotherapy and later tumoral excision was
performed. Since then a marked improvement was noted.