BEGUILED BY THE GALLIUM - THYMIC REBOUND IN AN ADULT AFTER CHEMOTHERAPY FOR HODGKINS-DISEASE

An 18-year-old woman was diagnosed as having Hodgkin's disease involvi ng the mediastinal lymph nodes and lung parenchyma. A pretreatment gal lium 67 scan showed increased uptake in the mediastinum. Chest radiogr aph and chest computed tomographic (CT) scans after chemotherapy demon strated resolution of disease, and a repeated gallium scan was normal. Four months later, a surveillance gallium scan showed increased activ ity in the mediastinal and hilar regions with corresponding chest CT a nd magnetic resonance imaging (MRI) showing a retrosternal mass. Prior to committing the patient to aggressive treatment for presumed diseas e relapse, a biopsy of the mass was performed and a specimen showed no rmal thymus tissue. The patient has continued in remission without fur ther therapy 3 years after her initial treatment, with subsequent norm al gallium scans and a stable mass on CT and MRI. Thymic enlargement f ollowing chemotherapy can occur with Hodgkin's disease in young adults , and interpretation of imaging studies, including gallium scanning, m ust be made with this consideration in mind.