Hematology & Tumor Chemotherapy Center, Zhoushan Hospital of Zhejiang Province, School of Medicine, Zhejiang University, No. 739 DingShen Road, Lincheng, New District, Zhoushan, China.
Bone Marrow Transplantation Center, The First Afliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, China.
BMC Surg. 2021 Jan 14;21(1):38. doi: 10.1186/s12893-021-01048-y.
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.
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.
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.
化疗可导致癌症患者的胸腺萎缩和 T 细胞输出减少。然而，年轻成年患者的胸腺在化疗后具有再生潜能，表现为胸腺增生，这容易被误诊为淋巴瘤患者的残留疾病或复发。
本研究报告了一例年轻女性成年患者的淋巴瘤病例，该患者最初被诊断为前纵隔肿块，在化疗后反复发现软组织占据前纵隔，提示淋巴瘤残留或疾病进展。多学科团队（MDT）讨论认为，患者的前纵隔肿块原因不明，可能是胸腺组织或肿瘤组织，最终通过组织病理学检查确定为胸腺组织。
淋巴瘤患者化疗后出现的前纵隔肿块可考虑为胸腺肿大，这种现象在接受化疗或自体造血干细胞移植的年轻成年患者中较为常见。此外，外周血中胸腺输出细胞的检测可能是区分胸腺增生和淋巴瘤的一种可行方法。
