Lei Qiu1, Yi Zhao2, Yang Yang2, He Huang2, Zhen Cai2, Jingsong He3. 1. Hematology & Tumor Chemotherapy Center, Zhoushan Hospital of Zhejiang Province, School of Medicine, Zhejiang University, No. 739 DingShen Road, Lincheng, New District, Zhoushan, China. 2. Bone Marrow Transplantation Center, The First Afliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, China. 3. Bone Marrow Transplantation Center, The First Afliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, China. hejingsong@zju.edu.cn.
Abstract
BACKGROUND: Chemotherapy can cause thymic atrophy and reduce T-cell output in cancer patients. However, the thymus in young adult patients has regenerative potential after chemotherapy, manifesting as thymic hyperplasia which can be easily mistaken as residual disease or recurrence in patients suffering lymphoma. CASE PRESENTATION: This study reports a case of lymphoma in a young female adult who was initially diagnosed with an anterior mediastinal mass, and was found to have soft tissue occupying the anterior mediastinum repeatedly after chemotherapy, suggesting a lymphoma residue or disease progression. From discussions by a multi-disciplinary team (MDT), the anterior mediastinal mass of the patient was considered unknown and might be thymus tissue or tumor tissue, and it was eventually identified as thymus tissue via histopathology. CONCLUSIONS: The anterior mediastinal mass appearing after chemotherapy in patients with lymphoma can be considered as enlarged thymus, and such phenomenon is frequent in young adult patients who undergo chemotherapy or autologous hematopoietic stem cell transplantation. Additionally, detection of thymic output cells in peripheral blood might be a feasible approach to differentiate thymic hyperplasia from lymphoma.
BACKGROUND: Chemotherapy can cause thymic atrophy and reduce T-cell output in cancerpatients. However, the thymus in young adult patients has regenerative potential after chemotherapy, manifesting as thymic hyperplasia which can be easily mistaken as residual disease or recurrence in patients suffering lymphoma. CASE PRESENTATION: This study reports a case of lymphoma in a young female adult who was initially diagnosed with an anterior mediastinal mass, and was found to have soft tissue occupying the anterior mediastinum repeatedly after chemotherapy, suggesting a lymphoma residue or disease progression. From discussions by a multi-disciplinary team (MDT), the anterior mediastinal mass of the patient was considered unknown and might be thymus tissue or tumor tissue, and it was eventually identified as thymus tissue via histopathology. CONCLUSIONS: The anterior mediastinal mass appearing after chemotherapy in patients with lymphoma can be considered as enlarged thymus, and such phenomenon is frequent in young adult patients who undergo chemotherapy or autologous hematopoietic stem cell transplantation. Additionally, detection of thymic output cells in peripheral blood might be a feasible approach to differentiate thymic hyperplasia from lymphoma.
Entities:
Keywords:
Case report; Lymphoma; Misdiagnosis; Recent thymic emigrants; Thymic hyperplasia