Reactions 1219 - 13 Sep 2008

Antineoplastics

Rebound thymic hyperplasia?: case reportA 19-year-old man developed rebound thymic hyperplasia

after receiving chemotherapy, which included ifosfamide anddoxorubicin [Adriamycin], for a primary synovial sarcoma ofthe left lung.

The man received four cycles of neoadjuvant ifosfamide anddoxorubicin [dosages not stated] and, 2 weeks afterchemotherapy completion, a CT scan and fluorodeoxyglucosepositron emission tomography (FDG PET) revealed adecreased size of his left upper lobe mass with no significantmetabolic activity within the lesion or elsewhere in his thorax;peak standardised uptake value was 1.3 for the lesion. He thenunderwent left pneumonectomy and thoracic lymph nodedissection and, 11 weeks postsurgery, he received 2 cycles ofadjuvant chemotherapy [drugs and dosages not stated]. Fivemonths after completion of adjuvant chemotherapy, arestaging chest CT scan revealed a new soft tissue mass,measuring 5.6 × 3.5cm, in the apical region of his lefthemithorax [duration of treatment to reaction onset notstated]. FDG PET and CT scan showed a hypermetabolic softtissue mass in the left apical hemithorax with maximumstandardised uptake value of 3.3.

A CT-guided biopsy, attempted in the prone position,resulted in a left pneumothorax with anterior displacement ofthe lesion. A second pass, attempted in a supine position,revealed a well-circumscribed lobular mass in the anatomiclocation of the thymus. A subsequent core biopsy revealednormal, mature thymic tissue without neoplastic evidence.Follow-up chest CT scans, performed 4 and 9 months afteradjuvant chemotherapy completion, revealed no evidence ofrecurrent or metastatic disease and a complete resolution ofthe mass.

Author comment: "[M]ost cases of true thymic hyperplasiausually result from rebound growth after chemotherapy,especially after treatment for lymphoma and malignant germcell neoplasms."Ford ME, et al. Rebound thymic hyperplasia after pneumonectomy andchemotherapy for primary synovial sarcoma. Journal of Thoracic Imaging 23:178-181, No. 3, Aug 2008 - USA 801117831

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Reactions 13 Sep 2008 No. 12190114-9954/10/1219-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved