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Case report: Transient thymic calcification — Association with rebound enlargement
ClinicalRadiology (1991) 44, 428-429
Case Report: Transient Thymic Calcification- Association With Rebound Enlargement D. F O U L N E R
Department of Radiology, Red Cross Children's Hospital, Rondebosch, South Africa Thymic calcification is usually associated with a thymic neoplasm. A case is reported in which transient calcification preceded rebound thymic enlargement related to chemotherapy, in an otherwise normal thymus. F o u l n e r , D. (1991). Clinical Radiology 44, 428-429. Case Report: T r a n s i e n t T h y m i c Calcification - A s s o c i a t i o n W i t h R e b o u n d E n l a r g e m e n t
(a)
(c)
(b)
Fig. 1 A series of thoracic computed tomography. (a) Normal thymus (February 1989). (b) Thymic atrophy and calcification (May 1989). (c) Hypertrophic thymus (November 1989). No calcification. A case of transient thymic calcification is presented. This has n o t been described before.
This was confirmed on CT to arise in the thymus, which was no longer calcified. (Fig. lc). Biopsy a few days later showed a hypertrophic but otherwise normal thymus.
CASE REPORT
DISCUSSION
A 5-year-oldboy presented in February 1989with a limp and a 1week history of a swellingbehind the left knee, subsequentlydiagnosed as an osteogenic sarcoma of the femur Thoracic computed tomography (CT) demonstrated a metastasis adjacent to the right hemidiaphragm. The thymus at that time appeared normal (Figs la, 2a). In May 1989, after three courses of chemotherapy (Adriamycin and Cisplatinum), repeat thoracic CT showed calcification of an atrophic thymus (Fig. lb) in addition to the metastasis. Bone scintigraphy at this time showed no thymic uptake. Two weeks later the metastasis was removed. Further thoracic CT examinations in June and August 1989 showed the metastasis completely removed and the calcified atrophic thymus unchanged. Routine chest radiography in November demonstrated an enlarging anterior mediastinaI mass (Figs 2b,c) with rounded borders.
T h y m i c calcification is u n u s u a l , previously only recorded with t u m o u r s , e.g. t h y m o m a or p r i m a r y malign a n t germ cell t u m o u r s (Baron et al., 1982a). It was not seen in a large series of n o r m a l thymuses ( B a r o n et al_, 1982b) n o r in a series of paediat.ric m e d i a s t i n a l lesions (Siegel et al., 1982). R e b o u n d thymic e n l a r g e m e n t has been recorded following t r e a t m e n t for cardiac m a l f o r m a t i o n s a n d after c h e m o t h e r a p y for childhood m a l i g n a n c y b o t h with and w i t h o u t steroids (Cohen et al., 1980; Bode a n d Scheidt, 1988). The o r g a n often becomes larger a n d m o r e r o u n d e d t h a n before t r e a t m e n t (Bode a n d Scheidt, 1988) but a n t e c e d e n t calcification has n o t been previously reported in association with this p h e n o m e n o n .
Correspondence to: Dr D. Foulner, c/o Breidahl and Associates, 8 Colin Street, West Perth, Western Australia 6005, Australia.
429
TRANSIENT THYMIC CALCIFICATION
(a)
(b)
(c)
Fig. 2 A series of chest radiographs. (a) PA. Normal thymus (February 1989). (b) PA. Hypertrophic thymus (November 1989). (c) Lateral. Rounded enlarged thymus (November 1989).
REFERENCES
Baron, RL, Lee, JKT, Sagel, SS & Levitt, RG (1982a). Computed tomography of the abnormal thymus. Radiology, 142, 127-134. Baron, RL, Lee, JKT, Sagel, SS & Petersen, RR (1982b). Computed tomography of the normal thymus. Radiology, 142, 121-125. Bode, U & Scheidt, W (1988). Change of thymic size during and following cytotoxic therapy in young patients. Pediatric Radiology, 18, 20 23.
Cohen, M, Hill, CA, Congir, A & Sullivan, MP (1980). Thymic rebound after treatment of childhood tumours. American Journal of Roentgenology, 135, 151 156. Siegel, MJ, Sagel, SS & Reed, K (1982). The value of computed tomography in the diagnosis and management of pediatric mediastinal abnormalities. Radiology, 142, 149-155.
Case Report: Transient Thymic Calcification- Association With Rebound Enlargement D. F O U L N E R
Department of Radiology, Red Cross Children's Hospital, Rondebosch, South Africa Thymic calcification is usually associated with a thymic neoplasm. A case is reported in which transient calcification preceded rebound thymic enlargement related to chemotherapy, in an otherwise normal thymus. F o u l n e r , D. (1991). Clinical Radiology 44, 428-429. Case Report: T r a n s i e n t T h y m i c Calcification - A s s o c i a t i o n W i t h R e b o u n d E n l a r g e m e n t
(a)
(c)
(b)
Fig. 1 A series of thoracic computed tomography. (a) Normal thymus (February 1989). (b) Thymic atrophy and calcification (May 1989). (c) Hypertrophic thymus (November 1989). No calcification. A case of transient thymic calcification is presented. This has n o t been described before.
This was confirmed on CT to arise in the thymus, which was no longer calcified. (Fig. lc). Biopsy a few days later showed a hypertrophic but otherwise normal thymus.
CASE REPORT
DISCUSSION
A 5-year-oldboy presented in February 1989with a limp and a 1week history of a swellingbehind the left knee, subsequentlydiagnosed as an osteogenic sarcoma of the femur Thoracic computed tomography (CT) demonstrated a metastasis adjacent to the right hemidiaphragm. The thymus at that time appeared normal (Figs la, 2a). In May 1989, after three courses of chemotherapy (Adriamycin and Cisplatinum), repeat thoracic CT showed calcification of an atrophic thymus (Fig. lb) in addition to the metastasis. Bone scintigraphy at this time showed no thymic uptake. Two weeks later the metastasis was removed. Further thoracic CT examinations in June and August 1989 showed the metastasis completely removed and the calcified atrophic thymus unchanged. Routine chest radiography in November demonstrated an enlarging anterior mediastinaI mass (Figs 2b,c) with rounded borders.
T h y m i c calcification is u n u s u a l , previously only recorded with t u m o u r s , e.g. t h y m o m a or p r i m a r y malign a n t germ cell t u m o u r s (Baron et al., 1982a). It was not seen in a large series of n o r m a l thymuses ( B a r o n et al_, 1982b) n o r in a series of paediat.ric m e d i a s t i n a l lesions (Siegel et al., 1982). R e b o u n d thymic e n l a r g e m e n t has been recorded following t r e a t m e n t for cardiac m a l f o r m a t i o n s a n d after c h e m o t h e r a p y for childhood m a l i g n a n c y b o t h with and w i t h o u t steroids (Cohen et al., 1980; Bode a n d Scheidt, 1988). The o r g a n often becomes larger a n d m o r e r o u n d e d t h a n before t r e a t m e n t (Bode a n d Scheidt, 1988) but a n t e c e d e n t calcification has n o t been previously reported in association with this p h e n o m e n o n .
Correspondence to: Dr D. Foulner, c/o Breidahl and Associates, 8 Colin Street, West Perth, Western Australia 6005, Australia.
429
TRANSIENT THYMIC CALCIFICATION
(a)
(b)
(c)
Fig. 2 A series of chest radiographs. (a) PA. Normal thymus (February 1989). (b) PA. Hypertrophic thymus (November 1989). (c) Lateral. Rounded enlarged thymus (November 1989).
REFERENCES
Baron, RL, Lee, JKT, Sagel, SS & Levitt, RG (1982a). Computed tomography of the abnormal thymus. Radiology, 142, 127-134. Baron, RL, Lee, JKT, Sagel, SS & Petersen, RR (1982b). Computed tomography of the normal thymus. Radiology, 142, 121-125. Bode, U & Scheidt, W (1988). Change of thymic size during and following cytotoxic therapy in young patients. Pediatric Radiology, 18, 20 23.
Cohen, M, Hill, CA, Congir, A & Sullivan, MP (1980). Thymic rebound after treatment of childhood tumours. American Journal of Roentgenology, 135, 151 156. Siegel, MJ, Sagel, SS & Reed, K (1982). The value of computed tomography in the diagnosis and management of pediatric mediastinal abnormalities. Radiology, 142, 149-155.