Terapevticheskii arkhivTerapevticheskii arkhiv0040-36602309-5342LLC Obyedinennaya Redaktsiya30882Differential diagnosis of thymic hyperplasia and mediastinal tumor in patients with Hodgkin's lymphoma after chemotherapyMoiseevaTat'yana Nikolaevnataniamoiseeva@mail.ruAl'-RadiLyubov' Sattarovnaalradi@blood.ruShitarevaIrina Vadimovna-ShevelevAleksandr Abramovichasw_99@mail.ruKostinaIrina Eduardovnaikost@list.ruKravchenkoS Kkrav@blood.ruKremenetskayaA M-TsybaN Ntsyba@blood.ruMoiseevaT NHematological Research Center, Moscow-Al-RadiL SHematological Research Center, Moscow-ShitarevaI VHematological Research Center, Moscow-ShevelevA AHematological Research Center, Moscow-KostinaI EHematological Research Center, Moscow-KravchenkoS KHematological Research Center, Moscow-KremenetskayaA MHematological Research Center, Moscow-TsybaN NHematological Research Center, Moscow-Hematological Research Center, Moscow15072011837475010042020Copyright © 2011, Consilium Medicum2011Aim. To make differential diagnosis of thymic hyperplasia and mediastinal tumor after chemotherapy (CT) in patients with Hodgkin's disease (HD).
Material and methods. The examination of 182 HD patients aged 16-71 years (median 28 years) included chest x-ray computed tomography (XCT) at baseline, during treatment, each 3 months, ultrasound investigation of the chest and abdominal cavity. All the patients received 6-8 courses of the treatment according to the program BEACOPP-14 followed by radiotherapy on the residual tumor in 137 patients, or not followed in 45 patients.
Results. Soft tissue tumor in the anterior mediastinum was detected in 14 (31%) from 45 unirradiated patients (age 19-31 years, median 24 years) 1 to 10 months (median 3.5 months) after chemotherapy. The analysis of the data of ultrasound investigation and tomography identified a mediastinal lesion as thymic hyperplasia. The patients are now in remission with follow-up median 21 months (13-36 months). No recurrence was registered.
Conclusion. Young HD patients with unirradiated mediastinum develop thymic hyperplasia in 31% cases within one year after chemotherapy. In view of this, detection of the lesion in the anterior mediastinum after CT demands complex examination for differential diagnosis of thymic hyperplasia with tumor recurrence to avoid unwanted intensification of the treatment.lymphogranulomatosismediastinumchemotherapythymic hyperplasiaлимфогранулематозсредостениехимиотерапиягиперплазия тимуса[Castleman В. Tumors of the thymus gland. In: Atlas of tumor pathology. Fasc. l9: Armed forces Institute of Pathology. Washington; 1955.][Rosai J., Levine G. Tumors of the thymus. In: Atlas of tumor pathology. Fasc. 13. Armed forces Institute of Pathology. Washington; 1976.][Goldstein G. Thymitis and myasthenia gravis. Lancet 1996; 2: 1164-1167.][Gelfand D. W., Goldman A. C., Law E. J. et al. Thymic hyperplasia in children recovering from thermal burns. J. Trauma 1972; 12: 813-817.][Rizk G., Gueto L., Amplatz K. et al. Rebound enlargement of the thymus after successful corrective surgery for transpositions of the great vessels. Am. J. Roentgenol. 1972; 116: 528-530.][Maiorana A., Reggiani-Bonetti L. Hyperplastic and inflammatory pathology of the thymus. In: Thymus gland pathology - clinical, diagnostic and therapeutic features. Springer-Verlag; Italia. 2008. 39-67.][Choyke P. L., Zeman R. K., Gootenberg J. E. et al. Thymic athrofy and regrouth in response to chemotherapy: CT evaluation. Am. J. Roentgenol. 1987; 149: 269-272.][Kissin S. M., Husband J. E., Nicholas D. et al. Begin thymic enlargement in adults after chemotherapy: CT demonstration. Radiology 1987; 163: 67-70.][Rüther U., Müller H. A., Nunnensiek C. et al. Thymic hyperplasia in patients with malignant testicular tumors. Med. Clin. (Münich) 1990; 85: 72-77.][Null J. A., Livolsi V. A., Glenn W. W. Hodgkin's disease of the thymus (granulomatous thymoma) and myasthenia gravis: a unique association. Am. J. Clin. Pathol. 1977; 67(6): 521-525.][Katz A., Lattes R. Granulomatous thymoma or Hodgkin's disease of the thymus? A clinical and histologic study and a reevaluation. Cancer 1969; 23(1): 1-15.][Nemoto K., Ishikawa H., Ohnishi Y. et al. Hodgkin's disease accompanied with thymoma. Acta Pathol. Jpn 1987; 37(9): 1505-1512.][Hermann R., Greminger P., Dommann-Scherrer C. et al. Diffuse thymus hyperplasia following chemotherapy for nodular sclerosing Hodgkin lymphoma. Schweiz. Med. Wschr. 1994; 124(38): 1666-1671.][Zhen Z. J., Sun X. F., Xia Y. et al. Clinical analysis of reactive thymic hyperplasia following chemotherapy for childhood malignant lymphoma. Ai Zheng 2006; 25(4):471-475.][Zhen Z. J., Sun X. F., Xia Y. et al. Clinical analysis of thymic regrowth following chemotherapy in children and adolescents with malignant lymphoma. Jpn J. Clin. Oncol. 2010; 40(12): 1128-1134.][Wernecke K., Diederich S. Sonographic features of mediastinal tumors. Am. J. Roentgenol. 1994; 163: 1357-1364.][Shevelev A. A., Moiseeva T. N. Role of ultrasonography (US) in differential diagnosis of mediastinal mass enlargement after therapy of patients with advanced stages of Hodgkin disease (HD) treated by BEACOPP-14 cycles without subsequent irradiation. Haematologica 2010; 95(s4): 47.]