Carcinoma of the male breast following thymic irradiation.

A white male teenager with carcinoma of the breast had received radiation therapy for an asymptomatic enlarged thymus on the second, fourth and seventh days of life. The dose delivered to the infant breasts, the latent period, and the unusually young age of the patient suggest that the malignancy was related to the course of radiotherapy.     

Benign thymic enlargement in adults after chemotherapy: CT demonstration

Serial computed tomographic (CT) scans of 200 patients with malignant testicular teratomas were reviewed. Of the 200 patients, 120 were treated with chemotherapy for metastatic disease; 80 patients with no evidence of metastases (stage I disease) received no treatment and served as a control group. CT was performed at regular intervals for ongoing follow-up in both groups. Thymic enlargement occurred 3-14 months after initiation of treatment in 14 of the 120 patients (11.6%) who received chemotherapy but in only one patient in the control group. Histologic examination in one patient who received chemotherapy revealed that the thymic enlargement represented true hyperplasia. Thirteen of the 14 patients (93%) with thymic enlargement after chemotherapy were well and disease free on mean follow-up of 45 months, compared with 78% of the group that did not show thymic enlargement after chemotherapy (P less than .02). Rebound thymic hyperplasia in adults after chemotherapy for metastatic testicular teratoma may be a good prognostic feature and should be considered when an anterior mediastinal mass develops after chemotherapy for metastatic malignancy.     

Reactive thymic hyperplasia following treatment of ACTH-producing tumors

Summary Surgical or conservative treatment of ACTH-producing tumors results in acute drop of the previously excessively high cortisol levels. The following associated pathophysiological changes also occur in the organism's recovery from stress, such as trauma, operation or chemotherapy of tumors. Both cases result in a regeneration of the immune system, which might even be exalted. The corresponding radiographic feature is the ”rebound” enlargement of the thymus occuring about six months after remission of hypercortisolism. Histological examination reveals benign thymus hyperplasia. Especially in cases of still unkown primary tumor the appereance of this anterior mediastinal mass can lead to misdiagnosis. We present the cases of two patients with diffuse thymic hyperplasia following surgical and medical correction of hypercortisolism. One patient suffered from classic Cushing's disease responding to transsphenoidal resection of an ACTH-secreting pituitary microadenoma. Six months later CT of the chest incidentally demonstrated an anterior mediastinal mass known as thymic hyperplasia. The second patient presented with an ectopic, still unkown source of ACTH-production. Six months after medical correction of hypercortisolism CT of the thorax showed an enlargement of the anterior mediastinum. Thymectomy was performed in order to exclude thymus carcinoid. Histological examination revealed benign thymus hyperplasia with negative immunostaining. Conclusion: Radiologists and clinicians should be familiar with the pathophysiological changes resulting from precipitously dropping cortisol levels in order to prevent diagnostic errors and unnecessary operations. Eingegangen am 26. Mai 1997 Angenommen am 26. August 1997     

Benign thymic cyst following mantle radiotherapy for Hodgkin's disease

The case history of a patient who was treated for Stage IA Hodgkin's disease involving the left supraclavicular region is presented. Shortly after mantle field radiation therapy she developed a mass in the anterior mediastinum. Histological examination of the lesion revealed it to be a benign cyst of the thymus. We consider it important that the possibility of the existence of such a benign growth be considered when a mediastinal mass appears in a patient treated for Hodgkin's disease, before more intensive tumour therapy is given.