OUTCOME OF RESIDUAL MEDIASTINAL MASSES OF THORACIC LYMPHOMAS IN CHILDREN - IMPACT ON MANAGEMENT AND RADIOLOGICAL FOLLOW-UP STRATEGY

Background. Following treatment with chemotherapy and radiotherapy, pa tients with thoracic lymphomas may demonstrate benign residual mediast inal masses, composed of inflammatory, fibrous or necrotic tissue. Bec ause of the potential risk of viable tumour cells within the mass, his tological verification of the nature of these masses may be requested. Objective. To study the outcome of thoracic lymphomas in children in order to optimise the radiological follow-up strategy of residual medi astinal masses (RMM). Materials and methods. A retrospective study of 39 children [24 with Hodgkin's disease (HD), 10 with non-Hodgkin's lym phoma (NHL), and 5 with anaplastic lymphoma (AL)]. The results of ches t X-rays (CXR) and thoracic CT performed at the time of re-assessment were compared with the histology of the residual masses (n = 11) or th e clinical course (n = 28). Results. At the time of re-evaluation, 16/ 39 patients had residual mediastinal enlargement (RME) on CXR, and 18/ 39 patients had RMM on CT. Good concordance was observed between the t wo imaging modalities (K = 0.69). Two children with a RMM died from ex tra-mediastinal progression. Two children with NHL had active residual mediastinal lesions but neither had RMM. Sixteen cases of RMM were ob served in the remaining 35 children and 9 of these masses were histolo gically verified as benign. A favourable course was observed in these 35 cases. Conclusions. RMM are frequent and generally benign. They are well shown on CXR and have a non-specific appearance on CT. Except wh en required by a treatment protocol, they could be submitted to furthe r radiological follow-up before contemplating surgical verification.