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Franke FC, Damek A, Steglich J, Kurch L, Hasenclever D, Georgi TW, Wohlgemuth WA, Mauz-Körholz C, Körholz D, Kluge R, Landman-Parker J, Wallace WH, Fosså A, Vordermark D, Karlen J, Fernández-Teijeiro A, Cepelova M, Klekawka T, Attarbaschi A, Ceppi F, Hraskova A, Uyttebroeck A, Beishuizen A, Dieckmann K, Leblanc T, Moellers M, Buerke B, Stoevesandt D. Differentiation between rebound thymic hyperplasia and thymic relapse after chemotherapy in pediatric Hodgkin lymphoma. Pediatr Blood Cancer 2023; 70:e30421. [PMID: 37243889 DOI: 10.1002/pbc.30421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Rebound thymic hyperplasia (RTH) is a common phenomenon caused by stress factors such as chemotherapy (CTX) or radiotherapy, with an incidence between 44% and 67.7% in pediatric lymphoma. Misinterpretation of RTH and thymic lymphoma relapse (LR) may lead to unnecessary diagnostic procedures including invasive biopsies or treatment intensification. The aim of this study was to identify parameters that differentiate between RTH and thymic LR in the anterior mediastinum. METHODS After completion of CTX, we analyzed computed tomographies (CTs) and magnetic resonance images (MRIs) of 291 patients with classical Hodgkin lymphoma (CHL) and adequate imaging available from the European Network for Pediatric Hodgkin lymphoma C1 trial. In all patients with biopsy-proven LR, an additional fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT was assessed. Structure and morphologic configuration in addition to calcifications and presence of multiple masses in the thymic region and signs of extrathymic LR were evaluated. RESULTS After CTX, a significant volume increase of new or growing masses in the thymic space occurred in 133 of 291 patients. Without biopsy, only 98 patients could be identified as RTH or LR. No single finding related to thymic regrowth allowed differentiation between RTH and LR. However, the vast majority of cases with thymic LR presented with additional increasing tumor masses (33/34). All RTH patients (64/64) presented with isolated thymic growth. CONCLUSION Isolated thymic LR is very uncommon. CHL relapse should be suspected when increasing tumor masses are present in distant sites outside of the thymic area. Conversely, if regrowth of lymphoma in other sites can be excluded, isolated thymic mass after CTX likely represents RTH.
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Affiliation(s)
| | - Adrian Damek
- Department of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Jonas Steglich
- Department of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Dirk Hasenclever
- Institute of Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Thomas W Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | - Christine Mauz-Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University, Gießen, Germany
| | - Dieter Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University, Gießen, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | - William Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, UK
| | - Alexander Fosså
- Department of Medical Oncology and Radiotherapy, Oslo University Hospital, Oslo, Norway
| | - Dirk Vordermark
- Department of Radiation Oncology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | - Jonas Karlen
- Karolinska University Hospital, Astrid Lindgrens Childrens Hospital, Stockholm, Sweden
| | | | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, University Hospital Motol and Second Medical Faculty of Charles University, Prague, Czech Republic
| | - Tomasz Klekawka
- Pediatric Oncology and Hematology Department, University Children's Hospital of Krakow, Krakow, Poland
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Francesco Ceppi
- Division of Pediatrics, Department of Woman-Mother-Child, Pediatric Hematology-Oncology Unit, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Andrea Hraskova
- Department of Pediatric Hematology and Oncology, National Institute of Paediatric Diseases, Bratislava, Slovakia
| | - Anne Uyttebroeck
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Auke Beishuizen
- Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Karin Dieckmann
- Department of Radiation Oncology, University Hospital Vienna, Vienna, Austria
| | - Thierry Leblanc
- Service d'Hématologie Pédiatrique, Hôpital Robert-Debré, Paris, France
| | - Martin Moellers
- Department Department of Pediatric Radiology, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Boris Buerke
- Department of Clinical Radiology, University Hospital of Münster, Münster, Germany
| | - Dietrich Stoevesandt
- Department of Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
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