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Differentiation between rebound thymic hyperplasia and thymic relapse after chemotherapy in pediatric Hodgkin lymphoma |
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| Authors: | Friedrich Christian Franke Adrian Damek Jonas Steglich Lars Kurch Dirk Hasenclever Thomas W Georgi Walther Alexander Wohlgemuth Christine Mauz-Körholz Dieter Körholz Regine Kluge Judith Landman-Parker William Hamish Wallace Alexander Fosså Dirk Vordermark Jonas Karlen Ana Fernández-Teijeiro Michaela Cepelova Tomasz Klekawka Andishe Attarbaschi Francesco Ceppi Andrea Hraskova Anne Uyttebroeck Auke Beishuizen Karin Dieckmann Thierry Leblanc Martin Moellers Boris Buerke Dietrich Stoevesandt |
| Institution: | 1. Department of Radiology, Diakoniekrankenhaus Halle, Halle (Saale), Germany;2. Department of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany;3. Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany;4. Institute of Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany;5. Department of Pediatric Hematology and Oncology, Justus-Liebig University, Gießen, Germany;6. Sorbonne Université/APHP hôpital Trousseau, Paris, France;7. Department of Paediatric Oncology, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, UK;8. Department of Medical Oncology and Radiotherapy, Oslo University Hospital, Oslo, Norway;9. Department of Radiation Oncology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany;10. Karolinska University Hospital, Astrid Lindgrens Childrens Hospital, Stockholm, Sweden;11. Pediatric Onco-Hematology Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain;12. Department of Pediatric Hematology and Oncology, University Hospital Motol and Second Medical Faculty of Charles University, Prague, Czech Republic;13. Pediatric Oncology and Hematology Department, University Children's Hospital of Krakow, Krakow, Poland;14. Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria;15. Division of Pediatrics, Department of Woman-Mother-Child, Pediatric Hematology-Oncology Unit, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland;16. Department of Pediatric Hematology and Oncology, National Institute of Paediatric Diseases, Bratislava, Slovakia;17. Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Leuven, Belgium;18. Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands;19. Department of Radiation Oncology, University Hospital Vienna, Vienna, Austria;20. Service d'Hématologie Pédiatrique, Hôpital Robert-Debré, Paris, France;21. Department Department of Pediatric Radiology, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany;22. Department of Clinical Radiology, University Hospital of Münster, Münster, Germany |
| Abstract: | BackgroundRebound thymic hyperplasia (RTH) is a common phenomenon caused by stress factors such as chemotherapy (CTX) or radiotherapy, with an incidence between 44% and 67.7% in pediatric lymphoma. Misinterpretation of RTH and thymic lymphoma relapse (LR) may lead to unnecessary diagnostic procedures including invasive biopsies or treatment intensification. The aim of this study was to identify parameters that differentiate between RTH and thymic LR in the anterior mediastinum.MethodsAfter completion of CTX, we analyzed computed tomographies (CTs) and magnetic resonance images (MRIs) of 291 patients with classical Hodgkin lymphoma (CHL) and adequate imaging available from the European Network for Pediatric Hodgkin lymphoma C1 trial. In all patients with biopsy-proven LR, an additional fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT was assessed. Structure and morphologic configuration in addition to calcifications and presence of multiple masses in the thymic region and signs of extrathymic LR were evaluated.ResultsAfter CTX, a significant volume increase of new or growing masses in the thymic space occurred in 133 of 291 patients. Without biopsy, only 98 patients could be identified as RTH or LR. No single finding related to thymic regrowth allowed differentiation between RTH and LR. However, the vast majority of cases with thymic LR presented with additional increasing tumor masses (33/34). All RTH patients (64/64) presented with isolated thymic growth.ConclusionIsolated thymic LR is very uncommon. CHL relapse should be suspected when increasing tumor masses are present in distant sites outside of the thymic area. Conversely, if regrowth of lymphoma in other sites can be excluded, isolated thymic mass after CTX likely represents RTH. |
| Keywords: | 18F-FDG-PET computed tomography Hodgkin lymphoma relapse thymus x-ray |