Aplastic Anemia and Good Syndrome in a Heavily Treated Stage IV Thymoma Patient: A Case Report and Review of the Literature

Table 1

All reported cases of concomitant Good syndrome and aplastic anemia. The table is divided into seven horizontal rows illustrating reported cases including ours and twelve vertical columns illustrating literature, patient age and sex, disease progression, year of presentation of AA in relation to the diagnosis of thymoma, type of thymoma according to available WHO or traditional classification, bone marrow histology, information on serum immunoglobulins and lymphocyte subtypes, related manifestations, information on treatment received for thymoma, treatment for AA, and outcome and cause of death.

Report	Age (years) sex	Disease progression	Aplastic anemia and diagnosis of thymoma	Thymoma histology and stage	Bone marrow	Gammaglobulin and lymphocytes	Related features	Therapy for thymoma	Therapy for AA	Outcome	Cause of death
Chapin [16]	67 M	PRCA^1, GS^2, aplastic anemia	10 years after the onset of thymoma	Spindle cell thymoma	Aplasia with lymphoid infiltrate	Hypogamma	Na	None	Steroids	Death	Hemorrhage
Korn et al. [17]	75 M	GS^2+ agenerative anemia, pancytopenia	7 years after the onset of thymoma	Mixed thymoma with plasmacytoid cells locally invasive	Aplasia + aggregates of mature lymphocytes	Hypogamma and severe impairment of cell immunity	Anti-AchR+^‡	Surgery and nitrogen mustard instillation after the onset of anemia	Steroids and hormones	Death	Pulmonary embolus
Rogers et al. [14]	60 F	GS^2+ aplastic anemia	Simultaneous	Spindle cell encapsulated thymoma	Marked hyopoplasia + few lymphocytes and plasma cells	Hypogamma	Ana+^†	Surgery after the onset of anemia	Steroids and hormones	Death	Pneumonia and sepsis
Burrows and Carroll [15]	90 M	GS^2+ aplastic anemia	Simultaneous	Spindle cell locally invasive	Marked hypoplasia + aggregates mature lymphocytes	Slightly hypogamma	None	None	Steroids	Death	Sepsis
Mir et al. [18]	68 M	GS^2+ aplastic anemia	Simultaneous	Na	Hypoplasia	Hypogamma and lymphopenia	Na	None	Na	Death	Na
Kristiansen et al. [19]	61 M	GS^2, pancytopenia	3 years after the onset of thymoma	Na	Hypoplasia + T lymphocytosis	Hypogamma CD4/CD8 inverted	None	Surgery before the onset of aplastic anemia	ATG^α, steroids, CSA^β, CTX^γ, ivIG^δ, G-CSF^ε, eltrombopag	Response to eltrombopag + G-CSF#
Our case	53 M	GS^2,, PRCA^1, AATP^3, aplastic anemia	34 years after the onset of thymoma	Thymoma B2-B3 IV stage	Aplasia with modest lymphoid infiltrate	Hypogamma CD4/CD8 inverted absent B lymphocytes	Anti-AchR+^‡	Surgery radiation and chemotherapy before the onset of aplastic anemia	Steroids, ivIG^δ, G CSF^ε, eltrombopag	Death	Sepsis

Na: not available; 1 PRCA: pure red cell aplasia; 2 GS: Good syndrome; 3 AATP: amegakaryocytic thrombocytopenia; ^†Ana+: antinuclear antibodies positive; ^‡AchR+: acetylcholine receptor antibodies positive; ^αATG: antithymocyte globulin; ^βCSA: cyclosporine; ^γCTX: cyclophosphamide; ^δivIG: intravenous gammaglobulin; ^εG-CSF: granulocyte colony-stimulating factor.