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OBJECTIVES: To analyse the clinical and computed tomography (CT) findings related to reactive thymic hyperplasia in order to improve the recognition of this phenomenon and avert over-treatment. METHODS: Fifty-two children with pathologically proven lymphoma developed reactive thymic hyperplasia following chemotherapy, which was confirmed with long-term review and follow-up. The clinical and CT findings of these 52 children were retrospectively analysed. RESULTS: The median follow-up period for the whole study group was 32.9 months. Fifty-one children survived free of disease; 23 of these had been with tumour invasion and the remaining 29 without. The median period from complete remission (CR) of the mediastinal lesions to the date of recurrent mediastinal masses was 8.6 months, which was not statistically significantly different from that of 9.5 months from commencement of treatment to the date of newly developed mediastinal masses (P = 0.495). The median maximal diameters of the recurrent and newly developed mediastinal masses were not significantly different (P = 0.091). All of the 52 cases presented with a single mediastinal mass; 42 masses (42/52, 81%) of those showed trapezoidal or triangular shapes and were well-circumscribed; 10 masses (10/52, 19%) manifested diffuse shapes and were ill-circumscribed. Forty-two masses (42/52, 81%) showed homogeneous density. All of the masses revealed mild enhancement after contrast administration. Forty-two masses (42/52, 81%) slightly displaced and 10 masses (10/52, 19%) partly surrounded adjacent vessels. After long-term follow-up, 42 masses (42/52, 81%) shrank naturally, and 10 (10/52, 19%) remained unchanged. CONCLUSIONS: Reactive thymic hyperplasia can, and often does, occur in children receiving regular chemotherapy for lymphoma, regardless of whether the tumour initially invades the mediastinum. Knowing the characteristic CT findings of this benign entity is helpful in differentiating it from residual or recurrent lymphoma and averting unnecessary treatment. [ABSTRACT FROM AUTHOR]

Background: Intensity-modulated radiation therapy (IMRT) has represented a technical milestone that has facilitated the clinical implementation. The purpose of this study was to evaluate the prognostic value of maximum primary tumor diameter (MPTD) in patients with nasopharyngeal carcinoma (NPC) treated using IMRT. Methods: Five-hundred and sixty-six patients with non-metastatic, histologically-confirmed NPC were retrospectively reviewed. MPTD was measured using magnetic resonance imaging (MRI). All patients were treated using IMRT; 87.5% (456/521) of patients with Stage T3-T4/N1-N3 disease also received cisplatin-based chemotherapy. Receiver operating characteristic (ROC) curves were used to identify the optimal MPTD cut-off point and examine the prognostic value of combining MPTD with the current T classification criteria. Results: Median follow-up for all patients was 36 months (range, 1-52 months). The 3-year overall survival (OS), failure-free survival (FFS), distant metastasis-free survival (DMFS), and local relapse-free survival (LRFS) rates for patients with a MPTD ≤41 vs. >41 mm were 96.1% vs. 85.4%, 93.7% vs. 74.7%, 96.1% vs. 79.7%, and 98.1% vs. 92.9%, respectively (all P < 0.05). In multivariate analysis, MPTD was an independent prognostic factor for OS, FFS, DMFS and LRFS in all patients (all P < 0.05). Among stage T3-T4 patients, the 3-year OS, FFS, DMFS, and LRFS rates for patients with a MPTD ≤41 vs. >41 mm were 96.9% vs. 84.5%, 95.4% vs. 73.5%, 96.1% vs. 79.2%, and 99.3% vs. 92.6%, respectively (all P < 0.05). In multivariate analysis, MPTD was also an independent prognostic factor for OS, FFS and DMFS in stage T3-T4 patients (all P < 0.05), and the difference in LRFS was almost statistically significant (P = 0.05). ROC curves verified that inclusion of MPTD improved the predictive value of the current T classification criteria (P < 0.001). Conclusions: MPTD was an independent prognostic factor in patients with NPC treated using IMRT, and significantly improved the prognostic value of the current T classification criteria for NPC. [ABSTRACT FROM AUTHOR]