MEDIASTINAL HODGKIN DISEASE IN CHILDREN - RESPONSE TO THERAPY

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 masse s, and ability to distinguish between thymic hyperplasia and residual fibrosis with CT. MATERIALS AND METHODS: CT scans of 60 pediatric pati ents with Hodgkin disease were reviewed. Diagnosis of a residual or re current mass was based on surgical, gallium-67 scintigraphic, and clin ical findings. RESULTS: In 18 (78%) of 23 patients who underwent seria l chest CT, the mediastinum reverted to normal within a mean of 6.3 mo nths. Of these 18 patients, four developed recurrent mediastinal widen ing due to thymic hyperplasia. Five patients had residual mediastinal masses. Benign fibrosis was confirmed in two patients at biopsy and pr esumed 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. R esidual mediastinal widening is indicative of fibrosis, while an enlar ged thymus at follow-up more likely represents hyperplasia rather than recurrent disease.