Myasthenia gravis associated with renal cell carcinoma: a paraneoplastic syndrome or just a coincidence

BMC Neurology

Table 1 The clinical data of these six MG patients with RCC

	Age/sex	MG onset Age	Initial symptoms	MGFA class	Thymoma	Anti-AChR	Anti-titin	Anti-RyR	Anti-MUSK	Presenting symptoms of RCC	Sequence of MG and RCC	Histology, grading and size of RCC	Drugs for MG	Follow-up
1	83/M	71	Ptosis and diplopia	I	-	+	+	+	-	Renal dysfunction	RCC was detected 7 years after MG onset	Clear cell and chromophobe, G1, 4.1 cm3.5 cm3 cm	Pyridostigmine, prednisolone and azathioprine	Unchanged, stable, occasional ptosis after radical nephrectomy
2	76/F	68	Ptosis	IVb	-	+	-	-	-	Asymptomatic	RCC was detected 4 years after MG onset	Clear cell, G1, 4.1 cm3.1 cm4.2 cm	Pyridostigmine, prednisolone, tacrolimus and IVIg	Unchanged after radiofrequency therapy for RCC
3	59/M	57	Ptosis and diplopia	IIB	-	+	-	-	-	Hematuria	MG developed 1 month after radical nephrectomy	Clear cell, G1, 8.5 cm7.5 cm7 cm	Pyridostigmine	Complete stable remission for one year
4	44/M	39	Limb weakness	IIa	+	+	-	-	-	Asymptomatic	MG developed 5 months after partial nephrectomy and 1 months after thymectomy	Clear cell, G1 and G2, 3.3 cm3 cm2.7 cm	Pyridostigmine and prednisolone	Improved, stable, mild weakness
5	62/M	57	Ptosis and diplopia	IIIb	-	+	+	+	-	Flank pain	MG developed 6 years after radical nephrectomy	Clear cell, G1, 8.5 cm6.5 cm4 cm	Pyridostigmine, prednisolone and IVIg	Improved, but died of RCC metastasis at the age of 62
6	77/M	76	Ptosis	IVb	-	+	NA	NA	NA	Asymptomatic	synchronous	Clear cell, G1, 5 cm4.2 cm4 cm	Pyridostigmine, tacrolimus/mycophenolate mofetil, and IVIg	Improved; fluctuated, persistent ptosis

Abbreviations: MG Myasthenia gravis, RCC Renal cell carcinoma, M Male, F Female, AChR Aacetylcholine receptor, RyR Ryanodine receptor, MUSK Muscle-specific tyrosine kinase, NA Not available, IVIg Intravenous immune globulin

ISSN: 1471-2377