Thymus hyperplasia after lymphoma drug therapy: the role of PET/CT


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Abstract

Background. The thymus is a lymphoid organ where mature and naive T-lymphocytes are synthesized. A number of factors (age, stress, toxic effects, including chemotherapy, radiation therapy, surgery, hormone therapy, etc.) can lead to a violation of its structure and functional activity in cancer patients. This manifests itself in the form of hyperplasia, which can be interpreted as a residual tumor, or a recurrence of the disease. Due to the plasticity of the thymus, this process is reversible. Objective. Evaluation of the role of PET/CT in the diagnosis of thymic hyperplasia after drug therapy for lymphomas. Methods. We performed a retrospective analysis of the results of PET/CT with 18F-fluorodeoxyglucose in 103 patients with stage II-III Hodgkin’s lymphoma and non-Hodgkin’s lymphoma after drug treatment for 2018-2020. PET/CT scanning was performed on an Optima PET/CT 560 (GE) tomograph at various stages of treatment and follow-up. Results. Thymus hyperplasia was detected in 10 patients (9.7%) in the age group from 26 to 56 years, the median was 35.7 years. The vast majority of patients were under the age of 40 years - 8/80%, among them 9 women and 1 man. Hodgkin’s lymphoma was observed in 7 patients, non-Hodgkin’s lymphoma - in 3 cases. Patients underwent polychemotherapy according to BEACOPP schemes for Hodgkin’s lymphoma or R-CHOP immunochemotherapy for non-Hodgkin’s lymphomas. Thymus hyperplasia was detected, according to PET/CT data, 5-12 months (on average 8.4 months) after complete clinical and metabolic remission. The maximum standardized uptake value SUVmax ranged from 1.98 to 3.28; median - 2.52. Patients were followed-up for an average of 26 months, with no signs of recurrence of the disease. Conclusion. Thymus hyperplasia after effective drug therapy in patients with lymphomas was observed in 9.7% of cases. It was characterized by the appearance of a volumetric formation in the anterior superior mediastinum, which had a triangular shape, the apex facing the sternum, a heterogeneous or soft tissue structure with fixation of 18F-fluorodeoxyglucose. The median SUVmax was 2.52. Hyperplasia developed after an average of 8.4 months after completion of therapy. PET/CTis considered the method of choice for the differential diagnosis of thymus hyperplasia and the exclusion of the progression of the tumor process.

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About the authors

I. V Poddubnaya

Russian Medical Academy of Continuous Professional Education

Moscow, Russia

Nikolay A. Ognerubov

G.R. Derzhavin Tambov State University

Email: ognerubov_n.a@mail.ru
Dr. Sci. (Med.), Cand. Sci (Law), Professor, Honored Worker of the Higher School of the Russian Federation, Honored Doctor of the Russian Federation, Head of the Department of Oncology Tambov, Russia

T. S Antipova

Center for Nuclear Medicine “Center for PET Technology"

Tambov, Russia

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