Thymoma 20 Years After Hodgkin’s Lymphoma Radiation Therapy: A Case Study

Abstract

We present a case of a 48-year-old female who, over the course of 2 years, developed a recurrence of thymoma. She presented in 2013 with nausea and scalp pruritis, which progressed to generalized body pruritis. Examination was normal except for erythroderma noted on both arms and trunk sparing the lower limbs. A CT scan was performed which showed a 2.5 cm anterior mediastinal lymph node mass. A biopsy was performed which indicated a stage 2b thymoma. Her previous medical history was significant for a 1A nodular lymphocyte predominant Hodgkin’s lymphoma in 1992 for which she received mantle field radiation. Her presenting symptoms were thought to be of paraneoplastic origin. Thymectomy and excision of the pleural seeding occurred in 2013 with good results. A year later, a follow-up PET scan revealed a recurrence of her thymoma. Chemotherapy was started with good regression; however, in 2015 the thymoma had spread to the lungs, adjacent pleura and pericardium. Second line chemotherapy was initiated. This case report highlights the possible association between mantle field radiation for Hodgkin’s lymphoma leading to a future thymoma. It emphasizes the need to consider secondary malignancies in the differential diagnosis for patients presenting with unexplained symptoms and a previous history of radiation therapy. J Med Cases. 2016;7(4):153-154 doi: https://doi.org/10.14740/jmc2466w