Thymic hyperplasia with hemorrhage simulating recurrent Hodgkin disease after chemotherapy‐induced complete remission

Background. Thymic hyperplasia after successful treatment of malignant disease is a well‐documented phenomenon, particularly in younger patients with testicular carcinoma. However, it has been reported only sporadically in association with Hodgkin disease. The authors report the first instance of an adult with nodular sclerosing Hodgkin disease who had thymic hyperplasia develop after clinical and radiographic complete remission (CR) with chemotherapy alone. Methods. In addition to the current case, 20 other instances of thymic hyperplasia have been culled from the literature and analyzed. Results. The median age of these 21 patients was 23 years of age (range, 8‐40 years of age). Thymic hyperplasia was noted after treatment was initiated or completed in all but two patients; and all did well, with one exception: a 17 year‐old boy who was inadvertently treated for relapsed Hodgkin disease and who died of fibrinous pneumonitis and nocardia, with pathologic CR noted at autopsy. Conclusions. Thymic hyperplasia in association with Hodgkin disease appears to be a favorable prognostic phenomenon, restricted to younger patients in the first modal peak of Hodgkin incidence. Prospective studies have yet to be performed.