Background: Thymoma is a malignant tumor originating from the thymic epithelium and can be associated with over 100 paraneoplastic syndromes (PNSs). Due to the low incidence of thymoma and the relative rarity of alopecia areata (AA) as an associated autoimmune disease, patients with thymoma combined with AA are relatively uncommon in clinical practice. As a result, the clinicopathological features and pathogenesis of such patients have been rarely investigated. Methods: This study retrospectively analyzed the clinical records of thymoma patients who underwent surgical treatment at Peking Union Medical College Hospital and Beijing Tongren Hospital from August 2014 to July 2019, with a focus on the clinicopathological features of thymoma patients with AA. Propensity score matching (PSM) was employed to create a 1:5 matched comparison group with thymoma patients without AA. Results: A total of 428 thymoma patients were included, among which 9 had AA. Using PSM, we matched 45 control patients without AA based on age and gender. The analysis revealed that thymoma patients with AA had a significantly higher proportion of myasthenia gravis (MG) [100.00% (9/9) vs. 66.67% (30/45),p= 0.049], although there were no significant differences between the AChR antibodies, Titin antibodies, MG severity, and the incidence of postoperative myasthenic crisis. However, the proportion of thymoma patients with AA who also had other PNSs besides MG was significantly higher [88.89% (8/9) vs. 6.67% (3/45),p< 0.001]. Additionally, CD4+/CD8+T-cell inversion in the serum was observed at a much higher rate in thymoma patients with AA [100.00% (9/9) vs. 24.44% (11/45),p< 0.001]. Conclusions: We hypothesize that the pathogenesis of thymoma with AA differs from that of thymoma with MG, though there may be a correlation. The etiology of thymoma with AA may be attributed to abnormal autoimmune CD8+T lymphocytes produced by the thymoma, which can also lead to other cytotoxic T-cell-mediated autoimmune diseases.
背景：胸腺瘤是一种起源于胸腺上皮的恶性肿瘤，可伴发超过100种副肿瘤综合征。由于胸腺瘤发病率较低，且斑秃作为一种相关自身免疫性疾病相对罕见，胸腺瘤合并斑秃患者在临床上较为少见。因此，此类患者的临床病理特征及发病机制研究甚少。方法：本研究回顾性分析了2014年8月至2019年7月在北京协和医院及北京同仁医院接受手术治疗的胸腺瘤患者的临床资料，重点探讨了合并斑秃的胸腺瘤患者的临床病理特征。采用倾向性评分匹配法，以1:5的比例构建了无斑秃的胸腺瘤患者作为匹配对照组。结果：共纳入428例胸腺瘤患者，其中9例合并斑秃。通过倾向性评分匹配，我们根据年龄和性别匹配了45例无斑秃的对照患者。分析显示，合并斑秃的胸腺瘤患者中重症肌无力的比例显著更高[100.00% (9/9) 对比 66.67% (30/45), p=0.049]，尽管在乙酰胆碱受体抗体、Titin抗体、重症肌无力严重程度以及术后肌无力危象发生率方面无显著差异。然而，合并斑秃的胸腺瘤患者同时伴有重症肌无力之外的其他副肿瘤综合征的比例显著更高[88.89% (8/9) 对比 6.67% (3/45), p<0.001]。此外，合并斑秃的胸腺瘤患者血清中CD4+/CD8+T细胞比例倒置的发生率也显著更高[100.00% (9/9) 对比 24.44% (11/45), p<0.001]。结论：我们推测胸腺瘤合并斑秃的发病机制与胸腺瘤合并重症肌无力不同，尽管两者可能存在关联。胸腺瘤合并斑秃的病因可能归因于胸腺瘤产生的异常自身免疫性CD8+T淋巴细胞，这也可能导致其他细胞毒性T细胞介导的自身免疫性疾病。
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