Autoimmunity

Mucoepidermoid carcinoma (MEC) of the thymus is an exceedingly rare type of cancer and account for only 2% of thymic carcinoma. The co-existence of a thymic cancer and autoimmune hemolytic anemia (AIHA) is very rare with only few cases published in the literature. To our best knowledge this is the first case published in literature of mucoepidermoid thymic cancer that presented as autoimmune hemolytic anemia. We report a case of 67 years old man with a background of alopecia totalis who presented with fatigue, pallor and jaundice. Blood tests showed a picture of autoimmune hemolytic anemia and further imaging showed anterior mediastinal mass. The patient underwent thymectomy and the final pathologic diagnosis was low grade thymic mucoepidermoid carcinoma. In consequent follow up appointments there were no further hemolysis and no recurrence of the cancer. After thymectomy his hair started to re-grow again which indicate a strong connection between thymic cancer and autoimmune related disorders like alopecia totalis and AIHA. There is a strong correlation between autoimmunity and thymic cancer. Patients with autoimmune conditions develop neoplastic disease. In addition, malignancies are associated with autoimmune syndromes. Abnormalities in the thymic epithelial cells and the thymic stromal microenvironment can lead to autoimmune diseases. Because it is site of T-cell maturation and can form autoreactive T-cell clones that attack different organs and causing autoimmune disease. This correlation is so evident in this case report by the improvement of AIHA and alopecia totalis after the surgical resection of the thymic cancer.