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Mediastinal Hodgkin disease in children: response to therapy
1Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
Insights
Mediastinal masses in pediatric Hodgkin disease typically resolve within months. Follow-up CT scans can help differentiate thymic hyperplasia from residual fibrosis, aiding in accurate diagnosis.
Area of Science:
- Pediatric Oncology
- Radiology
- Medical Imaging
Background:
- Hodgkin disease commonly affects pediatric patients.
- Mediastinal involvement is frequent in pediatric Hodgkin disease.
- Accurate assessment of mediastinal changes is crucial for treatment monitoring.
Purpose of the Study:
- To evaluate computed tomography (CT) findings in pediatric Hodgkin disease patients.
- To determine the frequency of thymic and nodal enlargement.
- To assess the resolution of mediastinal disease and distinguish between thymic hyperplasia and fibrosis.
Main Methods:
- Retrospective review of CT scans from 60 pediatric Hodgkin disease patients.
- Analysis of mediastinal changes, including size and resolution.
- Correlation of CT findings with surgical, scintigraphic, and clinical data for mass characterization.
Main Results:
- Mediastinal masses resolved in the majority of patients within a mean of 6.3 months.
- Residual mediastinal widening was often due to benign fibrosis.
- Enlarged thymus at follow-up CT was more indicative of hyperplasia than recurrent disease.
Conclusions:
- Mediastinal masses in pediatric Hodgkin disease generally resolve.
- CT is valuable in differentiating thymic hyperplasia from residual fibrosis.
- Distinguishing between benign and malignant mediastinal changes is essential for patient management.
Purpose:
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.
Materials And 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.
Conclusion:
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.