Mediastinal fibrosis simulating residual Hodgkin's disease

A 28-year-old male with nodular sclerosing Hodgkin's disease and massive mediastinal adenopathy was treated with combination chemotherapy and radiotherapy. Following 1,300 rads and six cycles of chemotherapy the patient was felt, on the basis of chest x-ray and CT scan, to have extensive residual mediastinal and intrapericardial involvement with tumor. At thoracotomy he was found to have markedly enlarged mediastinal lymph nodes with the normal tissue being replaced by dense sclerotic material without tumor. In Hodgkin's disease, CT scanning has proved to be an extremely valuable tool in assisting in staging and treatment planning. This case emphasizes, however, that one must be cautious in the interpretation of persistent abnormalities following curative therapy. Carefully selected patient information obtained from exploratory thoracotomy continues to be helpful in defining disease status.