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Cancer

Hodgkins lymphoma remmission now thymoma

06/03/2011

Question:

I was diagnosed with Hodgkin’s Lymphoma Stage 4 in November 2005. (ABVD) then remission in June 2006. In September 2009 I had 3 suspicious fdg positive nodes on pet/ct in my mediastinum. In November 2009 a FNA was suspicious for recurrent Hodgkin’s. Was offered and approved for a stem cell transplant and then went for a second opinion at HUP. Drs at HUP had decided that MOPP and radiation would be the best option for me. We went back and forth with both Drs. and decided to let my Dr here treat with R-ICE and radiation but he wanted a new pet/ct to make sure it had not spread given that it had been a few months and his treatment would then be high dose chemotherapy and stem cell transplant. To everyone surprise two of the nodes went away but the one they had done a FNA on was still FDG positive. In January 2010, I had a core biopsy done on the same node and that revealed only normal thymic tissue. Against the wishes of the doctors at HUP but with approval from my doctor here I decided to wait and see. Pet/Ct every 6 months, the node continues to grow and a FDG positive area in the left hillar. New core biopsy says it is a thymoma. Size is now 38mm by 25mm. Does thymic rebound appear FDG positive? What is the difference between thymoma and thymic rebound?

Answer:

You have a very complicated case. You are getting expert opinions. I am sorry that cannot answer your questions. Perhaps you could get a second opinion on the thymoma by bringing the PET and biopsy slides for a second opinion.

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Response by:

Paula  Silverman, MD Paula Silverman, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University