Mediastinal Hodgkin disease in children: response to therapy.
OBJECTIVE
To determine the frequency of thymic and nodal enlargement at computed tomography (CT) in pediatric patients with Hodgkin disease, time to resolution of mediastinal disease, frequency of residual masses, and ability to distinguish between thymic hyperplasia and residual fibrosis with CT.


METHODS
CT scans of 60 pediatric patients with Hodgkin disease were reviewed. Diagnosis of a residual or recurrent mass was based on surgical, gallium-67 scintigraphic, and clinical findings.


RESULTS
In 18 (78%) of 23 patients who underwent serial chest CT, the mediastinum reverted to normal within a mean of 6.3 months. Of these 18 patients, four developed recurrent mediastinal widening due to thymic hyperplasia. Five patients had residual mediastinal masses. Benign fibrosis was confirmed in two patients at biopsy and presumed in three patients on the basis of Ga-67 scintigraphic findings. Recurrent lymphoma was not identified.


CONCLUSIONS
Mediastinal masses resolve in the majority of pediatric patients with Hodgkin disease. Residual mediastinal widening is indicative of fibrosis, while an enlarged thymus at follow-up more likely represents hyperplasia rather than recurrent disease.
Luker
G D
GD
Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
Siegel
M J
MJ
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D013952:Thymus Hyperplasia / Q000000981:diagnostic imaging*; D013997:Time Factors; D014057:Tomography, X-Ray Computed