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A Rare Case of Thymic Rebound Hyperplasia
Disorders of the Mediastinum SESSION TITLE: Disorders of the Mediastinum 2 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM
A Rare Case of Thymic Rebound Hyperplasia Prarthna Chandar* Sakthidev Kulandaisamy Mangalore Amith Shenoy Shyam Shankar Pavan Irukulla Benhoor Shamian Yizhak Kupfer Kabu Chawla and Michael Bergman Maimonides Medical Center, Brooklyn, NY INTRODUCTION: Thymic enlargement, while a rare phenomenon in adults, may occur, mainly after chemotherapy. We present here, to our knowledge, the first case in literature of thymic rebound hyperplasia in an elderly woman with rheumatoid arthritis (RA)
DISCUSSION: Thymic rebound hyperplasia is a rare but known phenomenon observed more commonly at a younger age. It is usually observed following chemotherapy for various malignancies. One study also reported this phenomenon following radiotherapy for thyroid malignancy. It commonly occurs in children and young adults and more common among females. The thymus appears to atrophy during the administration of chemotherapy and regrow during the recovery phase of chemotherapy. It is a benign immunological rebound phenomenon and does not require operative intervention. This case is unique since it is the first reported case of thymic rebound hyperplasia following immune suppressants in an elderly patient with RA. CONCLUSIONS: Thymic enlargement, while a rare phenomenon in adults, may occur, mainly after chemotherapy. This phenomenon should be included in the differential diagnosis of a soft tissue mass appearing in the anterior mediastinum on CT in adult patients particularly following treatment for malignancy or following chemotherapy for any cause. Reference #1: Rebound thymic enlargement on CT in adults.Yarom N1, Zissin R.Int J Clin Pract. 2007 Apr;61(4):562-8. Epub 2007 Jan 29. DISCLOSURE: The following authors have nothing to disclose: Prarthna Chandar, Sakthidev Kulandaisamy, Mangalore Amith Shenoy, Shyam Shankar, Pavan Irukulla, Benhoor Shamian, Yizhak Kupfer, Kabu Chawla, Michael Bergman No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.531
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
chestjournal.org
503A
DISORDERS OF THE MEDIASTINUM
CASE PRESENTATION: A 60 year old woman with past medical history of rheumatoid arthritis presented to our chest clinic with complaints of chest pain and dyspnea on exertion. Detailed history revealed patient has a long standing h/o rheumatoid arthritis and has been on various immune suppressants including steroids, methotrexate and tofacitinib but currently taking only NSAIDS for the past 2 months prior to clinic visit. Examination revealed the chest pain mostly of costochondritic nature likely related to her arthritis and she had RA related changes in her fingers and joints. A pulmonary function test revealed restrictive pattern and decreased lung volumes with decreased diffusion capacity, findings likely related to her RA. A CT chest was also obtained to evaluate for connective disease associated ILD which showed an anterior mediastinal mass with morphological and radiological features suggestive of thymic hyperplasia. Patient was closely followed up and subsequent CT’s showed decreasing size of the thymus while the patient remained off chemotherapy for her RA.
A Rare Case of Thymic Rebound Hyperplasia Prarthna Chandar* Sakthidev Kulandaisamy Mangalore Amith Shenoy Shyam Shankar Pavan Irukulla Benhoor Shamian Yizhak Kupfer Kabu Chawla and Michael Bergman Maimonides Medical Center, Brooklyn, NY INTRODUCTION: Thymic enlargement, while a rare phenomenon in adults, may occur, mainly after chemotherapy. We present here, to our knowledge, the first case in literature of thymic rebound hyperplasia in an elderly woman with rheumatoid arthritis (RA)
DISCUSSION: Thymic rebound hyperplasia is a rare but known phenomenon observed more commonly at a younger age. It is usually observed following chemotherapy for various malignancies. One study also reported this phenomenon following radiotherapy for thyroid malignancy. It commonly occurs in children and young adults and more common among females. The thymus appears to atrophy during the administration of chemotherapy and regrow during the recovery phase of chemotherapy. It is a benign immunological rebound phenomenon and does not require operative intervention. This case is unique since it is the first reported case of thymic rebound hyperplasia following immune suppressants in an elderly patient with RA. CONCLUSIONS: Thymic enlargement, while a rare phenomenon in adults, may occur, mainly after chemotherapy. This phenomenon should be included in the differential diagnosis of a soft tissue mass appearing in the anterior mediastinum on CT in adult patients particularly following treatment for malignancy or following chemotherapy for any cause. Reference #1: Rebound thymic enlargement on CT in adults.Yarom N1, Zissin R.Int J Clin Pract. 2007 Apr;61(4):562-8. Epub 2007 Jan 29. DISCLOSURE: The following authors have nothing to disclose: Prarthna Chandar, Sakthidev Kulandaisamy, Mangalore Amith Shenoy, Shyam Shankar, Pavan Irukulla, Benhoor Shamian, Yizhak Kupfer, Kabu Chawla, Michael Bergman No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.531
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
chestjournal.org
503A
DISORDERS OF THE MEDIASTINUM
CASE PRESENTATION: A 60 year old woman with past medical history of rheumatoid arthritis presented to our chest clinic with complaints of chest pain and dyspnea on exertion. Detailed history revealed patient has a long standing h/o rheumatoid arthritis and has been on various immune suppressants including steroids, methotrexate and tofacitinib but currently taking only NSAIDS for the past 2 months prior to clinic visit. Examination revealed the chest pain mostly of costochondritic nature likely related to her arthritis and she had RA related changes in her fingers and joints. A pulmonary function test revealed restrictive pattern and decreased lung volumes with decreased diffusion capacity, findings likely related to her RA. A CT chest was also obtained to evaluate for connective disease associated ILD which showed an anterior mediastinal mass with morphological and radiological features suggestive of thymic hyperplasia. Patient was closely followed up and subsequent CT’s showed decreasing size of the thymus while the patient remained off chemotherapy for her RA.