Thymic rebound after treatment of childhood tumors

Cohen, M. M.; Hill, CA; Cangır, Ayten; Sullivan, Mary Pat

doi:10.2214/ajr.135.1.151

Cited by 86 publications

(36 citation statements)

References 2 publications

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“…In four cases, the patients were submitted to thoracotomy, with histopathological analysis disclosing the diagnosis of thymus hyperplasia (7). Another study reported two patients who underwent thoracotomy due to thymic masses that appeared after childhood chemotherapy (15). These cases exemplify the diagnostic dilemma that appears, especially in ACTH-dependent Cushing's syndrome where the source of ACTH production remains occult, as in the reported case.…”

Section: Discussionsupporting

confidence: 51%

Thymus hyperplasia after resolution of hypercortisolism in ACTH-dependent Cushing’s syndrome: the importance of thymic vein catheterization

Neto

Machado²,

Mesquita³

et al. 2006

eur j endocrinol

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Thymic hyperplasia has been described after the resolution of hypercortisolism from several etiologies, causing great diagnostic dilemmas. We describe a case where the catheterization of the thymic vein was essential for the differential diagnosis of a thymic enlargement in an adrenalectomized patient with ACTH-dependent Cushing's syndrome. The patient was a 48-year-old female with clinical and laboratorial data suggesting Cushing's disease. She underwent a transsphenoidal surgery with no tumor visualization and no remission of the syndrome. Histopathological studies disclosed a normal pituitary. She underwent a bilateral adrenalectomy and 8 months later a chest CT showed an increase of left thymic lobe, which was previously non-existent. After a negative 111 In-pentetreotide scintigraphy, the patient underwent simultaneous and bilateral catheterism of the petrosus sinuses and catheterization of the thymic and inominate veins and no ACTH gradient was shown among the sites of collection. She did not undergo thoracotomy and a follow-up was established. During the evolution, there was a spontaneous regression of the thymic lesion 38 months after the diagnosis. The ACTH gradient during the catheterization of thymic vein was essential for the differential diagnosis of the thymic enlargement tumor after hypercortisolism resolution in ACTH-dependent Cushing's syndrome, especially in this case, where the ACTH source was occult, thus avoiding an invasive surgical procedure for a benign entity with spontaneous resolution.European Journal of Endocrinology 154 807-811

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Section: Discussionsupporting

confidence: 51%

Thymus hyperplasia after resolution of hypercortisolism in ACTH-dependent Cushing’s syndrome: the importance of thymic vein catheterization

Neto

Machado²,

Mesquita³

et al. 2006

eur j endocrinol

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“…Current results show a lower incidence of 6% of thymic uptake and a lower SUVmax in studies performed during treatment, compared with baseline studies and mainly with findings after the completion of chemotherapy. A total of 40% of the T1 studies were seen early during follow-up (Table 2), whereas in previous reports the higher incidence of 18 F-FDG-avid thymus was found as a rule later during follow-up (12,22,23). There were no significant changes in either incidence or intensity of uptake when comparing serial studies performed on the same patient.…”

Section: Discussionmentioning

confidence: 70%

Physiologic Thymic Uptake of ¹⁸F-FDG in Children and Young Adults: A PET/CT Evaluation of Incidence, Patterns, and Relationship to Treatment

Jerushalmi¹,

Frenkel²,

Bar‐Shalom³

et al. 2009

J Nucl Med

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18 F-FDG uptake in the thymus, mainly related to hyperplasia after chemotherapy, has been described. Thymic uptake can challenge the accurate assessment of cancer patients by 18 F-FDG imaging. The present study defines the incidence, patterns, and intensity of thymic 18 F-FDG uptake in relationship to age and time after treatment in a large cohort of patients. Methods: A total of 559 consecutive 18 F-FDG PET/CT studies in 160 patients (86 men, 74 women; age, 3-40 y) performed at baseline, during treatment, at the end of treatment, and during follow-up were retrospectively reviewed. PET/CT studies were assessed for the presence or absence (T1 or T2, respectively), pattern, and intensity (SUVmax) of increased 18 F-FDG uptake in the anterior mediastinum, localized by the CT component to the thymus. The overall incidence of 18 F-FDG avidity in the thymus in relationship to the patient's age and time after treatment administration were statistically evaluated. Results: There were 137 of 559 T1 studies (25%), with equal sex distribution. T1 studies were found in significantly younger patients (20.6 6 9.3 y vs. 27.4 6 8.4 y, P , 0.001). Most T1 patients (60%) showed an inverted V pattern of thymic uptake, with additional unilateral mediastinal extension in 24% and focal midline uptake in 16% of studies. T1 studies were encountered in 80% of patients younger than 10 y, compared with 8% of patients in the 31-to 40-y age group. There were 17% T1 studies at baseline, 6% during treatment, 8% at the end of treatment, and 27%-40% during follow-up. The average SUVmax of thymic 18 F-FDG uptake was 3.73 6 1.22. Conclusion: Thymic 18 F-FDG uptake was found in 28% of the present study population, more frequently after treatment. T1 patients were significantly younger. Thymic uptake was found in 73% of untreated patients up to the age of 13 y and in 8% of patients in the fourth decade of life. Knowledge of this age-and treatmentrelated incidence of physiologic thymic 18 F-FDG avidity can reduce the number of potential pitfalls in reporting PET/CT studies in cancer patients.

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“…As the reports of RTHP have accumulated, various modalities for imaging RTHP have been proposed. For example, Cohen et al demonstrated RTHP on plain radiography and CT after chemotherapy in a 3-year-old boy with Wilm's tumor in 1980 (15). Subsequently, histology confirmed RTHP was reported in an adult cancer case in which RTHP was detected on CT (16), and in a patient with lymphoma in whom an anterior mediastinal mass was detected on MRI after chemotherapy (17).…”

Section: Discussionmentioning

confidence: 97%

Rebound Thymic Hyperplasia Detected by¹⁸F-FDG PET/CT After Radioactive Iodine Ablation Therapy for Thyroid Cancer

Jeon

Lee

et al. 2014

Thyroid

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Background: Rebound thymic hyperplasia (RTHP) is not an uncommon finding after radiation or chemotherapy in patients with various malignancies. However, there are limited case reports of this phenomenon after radioactive iodine ablation therapy (RIAT) in differentiated thyroid cancer (DTC). The goal of this study was to evaluate the incidence, patterns, and factors affecting RTHP after RIAT using 18 F-FDG PET/CT. Methods: The study design was a retrospective review of 2550 patients (568 men, 1982 women; age 13-79 years) who underwent FDG PET/CT imaging after total thyroidectomy and RIAT from June 2009 through June 2012. Patients were divided into four age-related subgroups. Overall incidence, age-related incidences, and sex distribution were evaluated in patients with thymic FDG uptake on PET/CT (RTHP + ). The correlation between incidence of RTHP and age was assessed using the Cochran-Armitage trend test. The Wilcoxon rank-sum test and multiple regression were applied to investigate the effect of applied dose of radioactive iodine (RAI) and age on the incidence of RTHP. Correlations of standardized uptake value (SUV) and thymic volume with age and morphologic type were also evaluated. Results: Overall incidence of RTHP after RIAT was 1.49%, and all of the RTHP + patients except one were female. The Cochran-Armitage trend test revealed significantly decreased incidence from the second to fifth decade (8.84%, 1.74%, 0.98%, and 0.39% respectively; p < 0.001). In each age-related subgroup, the RAI dose was significantly higher in the RTHP + than RTHP -group ( p < 0.001), while there was no difference in RAI dose in RTHP + patients among age-related subgroups ( p = 0.838). SUV mean and SUV max of RTHP revealed no meaningful correlation with RAI dose or age. There were no differences among morphologic patterns of RTHP in age distribution and ablation dose. Conclusions: RTHP after RIAT showed a strong female predominance, despite the higher administration dose of RAI in male patients. Although the decreased incidence of RTHP after RIAT with age is similar to the pattern of RTHP induced by other causes, the fact that older patients, even sixth decade patients, can present with RTHP after RIAT is noteworthy in the management of DTC.

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Thymic rebound after treatment of childhood tumors

Cited by 86 publications

References 2 publications

Thymus hyperplasia after resolution of hypercortisolism in ACTH-dependent Cushing’s syndrome: the importance of thymic vein catheterization

Thymus hyperplasia after resolution of hypercortisolism in ACTH-dependent Cushing’s syndrome: the importance of thymic vein catheterization

Physiologic Thymic Uptake of ¹⁸F-FDG in Children and Young Adults: A PET/CT Evaluation of Incidence, Patterns, and Relationship to Treatment

Rebound Thymic Hyperplasia Detected by¹⁸F-FDG PET/CT After Radioactive Iodine Ablation Therapy for Thyroid Cancer

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Thymic rebound after treatment of childhood tumors

Cited by 86 publications

References 2 publications

Thymus hyperplasia after resolution of hypercortisolism in ACTH-dependent Cushing’s syndrome: the importance of thymic vein catheterization

Thymus hyperplasia after resolution of hypercortisolism in ACTH-dependent Cushing’s syndrome: the importance of thymic vein catheterization

Physiologic Thymic Uptake of 18F-FDG in Children and Young Adults: A PET/CT Evaluation of Incidence, Patterns, and Relationship to Treatment

Rebound Thymic Hyperplasia Detected by18F-FDG PET/CT After Radioactive Iodine Ablation Therapy for Thyroid Cancer

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Physiologic Thymic Uptake of ¹⁸F-FDG in Children and Young Adults: A PET/CT Evaluation of Incidence, Patterns, and Relationship to Treatment

Rebound Thymic Hyperplasia Detected by¹⁸F-FDG PET/CT After Radioactive Iodine Ablation Therapy for Thyroid Cancer