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 masses, and ability to distinguish between thymic hyperplasia and residual fibrosis with CT. MATERIALS AND METHODS: CT scans of 60 pediatric patients with Hodgkin disease were reviewed. Diagnosis of a residual or recurrent mass was based on surgical, gallium-67 scintigraphic, and clinical findings. RESULTS: In 18 (78%) of 23 patients who underwent serial chest CT, the mediastinum reverted to normal within a mean of 6.3 months. Of these 18 patients, four developed recurrent mediastinal widening due to thymic hyperplasia. Five patients had residual mediastinal masses. Benign fibrosis was confirmed in two patients at biopsy and presumed 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. Residual mediastinal widening is indicative of fibrosis, while an enlarged thymus at follow-up more likely represents hyperplasia rather than recurrent disease.