The role of PET-CT in the differential diagnosis of thymic mass after treatment of patients with lymphoma.
Thymic hyperplasia is a common phenomenon in both children and young adults after chemotherapy and may explain the finding of a mediastinal mass in patients with malignant lymphoma after complete remission. In the present study, we report 5 cases with malignant lymphoma presenting with a mediastinal mass on CT scan after completion of chemotherapy diagnosed as thymic hyperplasia by PET-CT imaging. We retrospectively analyzed 5 patients who presented with anterior mediastinal masses a median of 4 months (range 3-6) after achieving complete remission following successful treatment for malignant lymphoma. Three patients were diagnosed with Hodgkin's lymphoma (HL) and the others with non-Hodgkin's lymphoma (NHL). The median age of the patients was 23 (range of 18-47). PET-CT was performed on these patients to determine the characteristics of a mass which had been detected on CT. PET-CT was performed for all patients, and the thymic masses demonstrated only mild FDG uptake considered to be consistent with thymic hyperplasia. During a median of 24 months of follow-up, all patients were recurrence-free with a median survival of 15 months (range 10-26 months). It is important to be aware of the possibility of thymic hyperplasia after chemotherapy to avoid misdiagnosis or over-staging of disease, as well as unnecessary biopsies, especially when the presenting anterior mediastinal mass was originally located near the thymus on CT scan. Mild FDG PET uptake was sufficient for the diagnosis of benign disease in the cases in this study.
Department of Medical Oncology, Dr Lütfi Kırdar Kartal Education and Research Hospital, Selimiye Mah, Şair Nesimi sok, Kardeşler Apt No 1, Daire 4, 34668 Üsküdar, Istanbul, Turkey. basakoven@yahoo.com
Bala Basak Oven
BB
Ustaalioglu
Mesut
M
Seker
Ahmet
A
Bilici
Nesrin
N
Canpolat
Emre
E
Yıldirim
Umut
U
Kefeli
Recep
R
Ustaalioglu
Burçak Erkol
BE
Yilmaz
Taflan
T
Salepci
Nagehan
N
Ozdemir
Mahmut
M
Gumus
D000293:Adolescent; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000175:diagnosis*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis*; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis*; D008875:Middle Aged; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012074:Remission Induction; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18