Diffuse large B-cell lymphoma in the thyroid gland associated with primary hyperparathyroidism

We report a case of primary hyperparathyroidism associated with a malignant lymphoma in the thyroid gland. A 68-year-old woman was admitted to hospital with a cervical mass. Ultrasound and computed tomography (CT) revealed a hypoechoic, multinodular tumor in the left thyroid gland. A gallium-67 citrate scintigram revealed intense radioisotope uptake in the thyroid tumor. Histological examination of biopsy specimens indicated that this tumor was a large B-cell lymphoma. The coexistence of parathyroid adenoma in this patient was revealed by a sestamibi scintigram, performed prior to chemotherapy. Following the complete remission of the lymphoma by chemotherapy, we carried out an excision of the single parathyroid adenoma. To our knowledge, this is the first report to describe a malignant thyroid lymphoma associated with primary hyperparathyroidism.     

晚期甲状腺癌的放射治疗临床分析

目的：回顾我科1978年1月～1993年6月收治的36例晚期甲状腺癌的放射治疗，对影响预后的因素进行分析。方法：36例均经病理证实的晚期甲状腺癌，术后残留者25例（肉眼残留17例，镜下残留8例），肿瘤晚期无法手术仅行活检11例。全部采用60钻或60钴与电子线混合治疗。结果：3、5、10、15年生存率分别为69．4％、52．8％、38．9％和25％。结论：放射治疗可以提高晚期甲状腺癌的生存率和生存质量，预后与病理类型、放射剂量及残存肿瘤的大小有关，放射剂量以50～60Gy为宜。     

Malignant lymphoma of the thyroid gland

During the past 14 years, 14 cases involving a malignant lymphoma of the thyroid have been treated at our department. These cases have been histologically reviewed and reclassified, according to the Working Formulation. Four cases involved a low grade malignancy (LGM), 9 cases an intermediate malignancy (IGM), and 4 cases a high grade malignancy (HGM). Thirteen lymphomas were of the B-cell type, and the remaining lymphoma was of the T-cell type. The coexistence of a chronic thyroiditis was noted in 9 cases. Survivors were only found in the LGM and IGM groups. We consider it necessary to treat malignant lymphomas of the thyroid according to the subtype of the Working Formulation.     

Radiotherapeutic management of primary thyroid lymphoma

The purpose of this study was to evaluate the radiotherapeutic management of 38 patients, with malignant lymphoma of the thyroid, seen at the Mayo Clinic between 1965 and 1979. There were 8 males and 30 females with ages ranging from 34 to 90 years (mean age of 65 years). A tissue diagnosis was made in all patients and tissue was available for reclassification under the "Working Formulation" in 31 of the 38 patients. Twenty-six patients had intermediate grade histology, four low grade and one indeterminate. Twenty patients were clinical Stage IE, 14 patients Stage IIE, one patient Stage IIIE, one patient Stage IV and two patients were unstaged. All patients were treated with approximately 4000 rad megavoltage irradiation (range 2400-6000 rad) to the neck only (10 patients) or neck and mediastinum (28 patients). Twenty patients received subdiaphragmatic radiotherapy and four patients received adjuvant chemotherapy. Median follow-up was 56 months with minimum follow-up of 30 months. Overall disease-free survival at five years was 59%. Of 14 patients who experienced a recurrence, 10 (71%) failed in two or more sites. The most common site of failure was in para-aortic lymph nodes. One year survival following recurrence was 29%; however, four of six patients receiving salvage therapy survived at least two years. Patients receiving radiation treatment to the neck and mediastinum and those with no gross residual disease at the initiation of radiotherapy were less likely to develop a recurrence. Patients receiving a planned break during the course of therapy did not have reduced overall disease-free survival. However, 4 of 20 patients (20%) who received split course therapy failed within the radiation fields compared to 2 of 18 patients (11%) who had no treatment break. Only 1 of 4 patients (25%) receiving adjuvant chemotherapy survived one year. Side effects of radiotherapy were minimal. We believe the radiotherapeutic management of clinical Stage IE and IIE primary thyroid lymphoma should include treatment of the neck, axillae and mediastinum to a dose of approximately 4000 rad using a continuous course technique. Additionally, gross total removal of the disease surgically may be beneficial.     

Non-Hodgkin's lymphoma of the thyroid: A retrospective review of all patients diagnosed in Nottinghamshire from 1973 to 1992

The pathological and clinical features were reviewed of all primary non-Hodgkin's lymphomas (NHL) of the thyroid gland diagnosed between 1973 and 1992 in the population (1.1 million) served by the Nottingham and North Nottinghamshire Health Authorities. Of the 43 patients with histologically proven NHL, three had low grade mucosa associated lymphoid tissue (MALT) lymphomas (Stage I_eA, 2; Stage II_eA, 1), 35 had intermediate or high grade lymphomas, Stage I_ea or II_eA (intermediate MALT, 2; high grade MALT, 14; B-cell diffuse centroblastic, 17; anaplastic large cell (Ki-1) of null cell type, 1; high grade unclassifiable, 1), and one had unclassifiable NHL Stage II_eA. One patient had Stage III_eA disease (high grade MALT) and three had stage IVA disease (high grade MALT, 2; B-cell diffuse centroblastic, 1). The median age was 68 years (range 45–86) with a female : male ratio of 6:1. For the 35 patients with intermediate or high grade thyroid NHL (Stages I_eA and II_eA) the 5- and 10-year cause specific survival was 60%. The 21 patients treated between 1985 and 1992 initially with chemotherapy (except stage I_eA (<5 cm diameter) had a 5-year cause specific survival of 69% (95% CI 48–90) compared with 46% (95% CI 19–73) for the 14 patients treated between 1973 and 1984 with initial radiotherapy (χ² = 1.62). The survival of those patients with intermediate or high grade MALT lymphomas was not significantly greater than of those patients with B-cell diffuse centroblastic NHL.     

中枢神经系统恶性淋巴瘤

中枢神经系统恶性淋巴瘤是一种罕见神经系统肿瘤。本文报告１２例，其中男８例，女４例。单发１１例，其中幕上７例，幕下４例；多发１例。临床表现无特殊性。好发部位幕上为额叶，幕下为小脑半球，且常累及脑室，胼胝体，硬膜和大脑镰。肿瘤病理组织学表现同身体其他部位恶性淋巴瘤，治疗采用手术和放疗为主，化疗为辅的原则，但病人预后差。     

Primary T-cell lymphoma of the thyroid: case report and review of the literature

Here we report a rare case of primary T-cell lymphoma of the thyroid gland. A 32-year-old Chinese man was admitted to our hospital because of marked goiter and subcutaneous nodules. Computed tomography (CT) scan of the neck disclosed diffuse enlargement of the thyroid gland. A diagnosis of peripheral T-cell lymphoma was made according to cytopathological findings of fine-needle aspiration (FNA) of the thyroid gland and skin biopsy. Immunohistochemistry stain showed that the tumor was positive for CD3 and negative for CD20. Clonal T-cell receptor (TCR-γ) gene rearrangements were demonstrated by polymerase chain reaction. After six cycles of combination chemotherapy (bleomycin, cyclophosphamide, doxorubicin, vincristine, and prednisone), the thyroid retracted to normal size gradually.     

Malignant lymphoma occurring in the residual stomach following gastrectomy: plus discussion based on the literature in Japan

Malignant lymphoma of the remnant stomach was diagnosed in a 53-year-old man 8 years after gastrectomy for a perforated gastric ulcer. Endoscopic examination demonstrated protruding lesions spreading over the entire residual stomach, and biopsy revealed malignant lymphoma. Rectal cancer was diagnosed simultaneously. The residual stomach was completely excised, with splenectomy, in parallel with low anterior resection of the rectum. Histological studies revealed that the lesion in the residual stomach was a lymphoma of the diffuse, large-cell type, according to the Lymphoma–Leukemia Study Group (LSG) classification, with positivity for CD20 and CD45RA, leading to a diagnosis of B-cell lymphoma. Helicobacter pylori microorganisms were found on the luminal surface of the tumor. Despite postoperative chemotherapy, the patient died of disseminated lymphoma 34 months later. Although malignant lymphoma occurring in the residual stomach following gastrectomy is rare, particular attention should be given to the possible presence of a malignant tumor when examining the residual stomach following gastrectomy. Received: April 3, 2002 / Accepted: November 28, 2002 Offprint requests to: H. Oshita     

Malignant lymphoma in Hawaii-Japanese: a retrospective morphologic survey

A retrospective morphologic survey (1973-1983) of 146 cases of malignant lymphoma among the Hawaii-Japanese (migrant Japanese and their offspring) was conducted to determine whether differences in the incidence and cytologic types of malignant lymphoma exist when compared to those of native Japanese (lifetime residents of Japan). The age-adjusted incidence rates for malignant lymphoma among the Hawaii-Japanese were similar to rates for U.S. whites. However, higher rates for follicular centre cell (FCC) lymphoma with a follicular pattern were observed in the Hawaii-Japanese population when compared with rates for native Japanese. On the basis of the cytologic types of the Lukes-Collins classification, non-Hodgkin's lymphomas among the Hawaii-Japanese resembled those of Western countries, rather than those of Japan. B-cell lymphomas predominated (72 per cent), while T-cell types comprised 23 per cent of cases. Follicular centre cell types were encountered most often (59 per cent), and the small cleaved FCC subtype was the most common (30 per cent). The high degree of follicularity (29 per cent) was at variance with the consistently low rates reported in Japan. This may be explained, in part, by higher rates of nodal lymphomas among the Hawaii-Japanese. Of the T-cell lymphomas, diffuse large cell types (T-cell immunoblastic sarcoma, T-IBS), often with cytologic pleomorphism, were relatively frequently encountered (16 per cent), and comprised 15 per cent of non-Hodgkin's lymphomas; this observation necessitates special clinical and epidemiologic consideration in view of the large Japanese migration to Hawaii from HTLV-I endemic regions of southern Japan. No registered cases of non-Hodgkin's lymphoma or of Hodgkin's disease were documented in Hawaii-Japanese subjects under the age of 15 years. The age-adjusted incidence rates for Hodgkin's disease among the Hawaii-Japanese were similar with those of native Japanese. Nodular sclerosis was the most frequent histologic subtype. The difficulty in distinguishing between Hodgkin's disease and non-Hodgkin's lymphoma, particularly when immunologic cell surface markers are not available, is addressed. Low rates for chronic lymphocytic leukemia among the Hawaii-Japanese were confirmed. Not one well-documented case was identified in the 11-year period surveyed.     

原发性恶性甲状腺淋巴瘤的诊断与治疗

原发性恶性甲状腺淋巴瘤是一种罕见病，约占甲状腺恶性疾病的1%-3%，甚至不到非何杰金氏淋巴瘤的1%。根据改良的Ann-Arbor分类法对原发性甲状腺淋巴瘤所下的定义，此类淋巴瘤或局限于甲状腺（ⅠE期），或累及甲状腺与其邻近的膈上淋巴结（ⅡE期）。原发性甲状腺淋巴瘤是一种异源性疾病，它包括许多淋巴瘤的特性。本文的重点在于原发性甲状腺淋巴瘤的诊断和治疗。     

63例恶性淋巴瘤误诊分析

恶性淋巴瘤（ＭＬ）初诊时误诊率较高。我院５年间收治ＭＬ９３例，早期发生误诊６３例，占６７．７４％，与国内文献统计的误诊率３４．７～９０％。平均６６．５％一致［１］。误诊为慢性淋巴结炎、淋巴结结核、转移癌、肺结核、变应性亚败血症、乳腺癌、睾丸癌等多种疾病。     

甲状腺癌术后残留和复发病灶的放射治疗

目的 :分析甲状腺术后残余癌的预后因素及探讨放疗的价值 (包括术后复发 18例 )。材料与方法 :196 5年 1月～ 1987年 12月间对 10 9例 (包括术后复发 18例 )甲状腺术后残余癌患者全部行放射治疗。结果 :其 5 ,10 ,15 ,2 0 ,2 5年生存率分别为 93.6 %、91.7%、88.7%、87.6 %、87.6 % ;无瘤生存率分别为 90 .8%、89.8%、85 .6 %、84 .1%、84 .1%。影响预后因素分析结果显示 :肿瘤的临床分期是影响生存率的决定性因素。年龄、性别、组织学类型、、放射剂量均影响预后。结论 :甲状腺癌术后如有残留需补充放疗 ,不但能增加局部肿瘤的控制率且能提高生存率。最佳剂量为 4 5～ 6 5 Gy。     

Bilateral primary malignant lymphoma of the ureter

We report the case of a 68-year-old Japanese man who presented with postrenal azotemia due to bilateral upper ureteral stenosis. The patient's right kidney was nonfunctional; therefore, right nephroureterectomy was performed for the purpose of pathologic diagnosis. Histopathologic examination revealed follicular lymphoma with diffuse change in the ureter. With chemotherapy for malignant lymphoma, the stenosis of the left ureter was alleviated, and left renal function was preserved. Primary malignant lymphoma of the ureter is extremely rare. In cases of ureteral stenosis with ureteral wall thickening for which the cause is uncertain, the possibility of malignant lymphoma of the ureter should be considered.     

Malignant fibrous histiocytoma following radiation therapy and chemotherapy for Hodgkin's lymphoma

Malignant fibrous histiocytoma (MFH) originates from primitive mesenchymal cells and has the capacity for dual differentiation into histiocytes and fibroblasts. MFH occurring as a secondary malignancy following radio-chemotherapy is rare and its exact incidence is not yet known. Here we report a case of a 42-year-old man who developed MFH in his right knee over a period of more than 10 years after radio (44 Gy)-chemotherapy to treat Hodgkin's lymphoma. After the diagnosis the patient did not return and was lost to follow-up. This is a rare case with unusual presentation, and it highlights the importance of the awareness and prevention of such secondary tumors.     

原发性甲状腺淋巴瘤的临床和CT表现

背景与目的：原发性甲状腺淋巴瘤(primary thyroid lymphoma,PTL)较为少见,临床处理不同于甲状腺其他恶性肿瘤,因此,认识PTL具有重要意义。该研究旨在分析PTL的临床及CT表现。方法：收集22例经病理证实为PTL患者的临床和影像学资料,回顾性分析其临床症状,包括肿瘤的部位、大小、形态、边缘、CT密度及强化方式、与周围组织关系和颈部淋巴结情况。结果：22例患者中男性8例,女性14例,年龄范围39~77岁,平均年龄60岁。临床症状表现为短期内肿块迅速增大者12例。肿瘤累及双侧11例,累及单侧8例,同时累及右侧及峡部3例。肿瘤长径范围12～104 mm,短径范围11～71 mm。弥漫型、多发结节型和孤立结节型分别为12、5和5例。CT平扫15例低密度,7例等密度,肿瘤内部发现钙化0例,坏死5例。增强后19/22例轻中度强化,3/22例明显强化。CT增强均质密度13例,混杂密度9例。17例气管受压,5例食管受压,12例病灶突入前上纵隔内,8例颈部见肿大淋巴结。结论：老年女性颈部肿块迅速增大,CT表现为均质、低密度、轻中度强化、弥漫性肿大的实质性肿块,伴有邻近组织的压迫及侵犯,提示PTL可能。     

绿脓杆菌MSHA菌毛株菌苗对恶性淋巴瘤的治疗及其机制初探

绿脓杆菌MSHA菌毛株菌苗是一种新型的微生物免疫调节剂，首次应用于恶性淋巴瘤化疗的辅助治疗。结果显示：在化疗同时进行菌苗治疗组其治疗有效率（95．56％）明显高于仅进行化疗的对照组（69．77％），而感染率（17．78％）则明显低于对照组（37．21％），P值均小于0．05。菌苗治疗组IL－2水平，NK细胞活性及CD4 ／CD8 比值也明显高于对照组，且其抵抗多种不同菌属的革兰氏阴性杆菌抗体水平亦显著高于对照组，提示该菌苗是通过调整或增强患者自身细胞免疫或体液免疫水平，达到抗肿瘤．抗感染的功效。作者认为该菌苗是恶性淋巴瘤患者化疗的良好辅助药物。     

脑恶性胶质瘤放射治疗临床研究进展

脑恶性胶质瘤是成人最常见的颅内原发恶性肿瘤,其致残率和病死率均很高。术后辅助放疗是恶性胶质瘤的标准治疗手段之一,可延长患者的生存期。近年来,随着放疗技术和方法的不断发展,恶性胶质瘤的术后放疗发生了很大的变化。本文将对恶性胶质瘤的放射治疗临床研究进展进行复习。     

恶性胶质瘤的放射治疗进展

恶性胶质瘤是最常见的原发中枢神经系统恶性肿瘤,其死亡率和致残率均很高,术后辅助放疗是恶性胶质瘤的标准治疗手段,可延长患者的生存期。近年来,随着放疗技术和方法的不断发展,恶性胶质瘤的术后放疗发生了很大的变化。本文将对恶性胶质瘤的放射治疗现状和进展进行综述。     

原发性甲状腺恶性淋巴瘤28例临床分析

背景与目的：原发性甲状腺恶性淋巴瘤很少见,其临床治疗方案和预后评判尚无统一标准。本文探讨原发性甲状腺恶性淋巴瘤的临床表现、诊断、治疗和影响预后的主要因素。方法：回顾28例原发性甲状腺恶性淋巴瘤患者的一般临床资料、临床病理分型、治疗方法、组织病理分型,并结合随访资料进行分析。结果：不足40岁组3例均为腺内型;40～60岁组9例中7例为腺内型,2例为腺外型;60岁以上组16例中,7例为腺内型,9例为腺外型。有随访的24例原发性甲状腺恶性淋巴瘤的中位随访期3年(1～14年),15例腺内型中2例死亡(13．33％),而9例腺外型中6例(66．67％)死亡;20例颈部肿物被完全切除者均生存达1年以上,而4例肿物未能彻底切除者均生存不足1年。肿瘤组织病理分型属B大细胞型的44例中,仍生存8例,其最长生存期达68个月;而滤泡Ⅱ型的3例均死于本病,最长生存期仅18个月。本组病例的1年生存率为61.54％,3年生存率为43．31％,5年生存率为27．35％。结论：原发甲状腺恶性淋巴瘤肿物彻底切除辅以治疗量的放疗和化疗是较合理的治疗方法。发病时的年龄、肿瘤的临床分型(肿瘤侵犯程度)和肿物切除是否彻底是影响原发甲状腺恶性淋巴瘤预后的主要因素;肿瘤的组织病理分型与预后无关。     

恶性淋巴瘤的生物治疗进展

 近几十年来,恶性淋巴瘤的发病率逐年上升,尽管它对化疗非常敏感,新的化疗药物及化疗方案也不断涌现,但其远期生存率仍徘徊在40 % ~ 50 %之间。近20年来,随着免疫学的发展,生物治疗在淋巴瘤治疗中的地位正日益引起关注,并成为其综合治疗的重要组成部分。目前常用于淋巴瘤治疗的生物治疗手段包括：单克隆抗体的治疗、放射免疫治疗、主动免疫治疗、过继免疫治疗、靶向bcl-2的基因治疗、特异性小分子靶向药物治疗等。合理使用这些方法并与其他治疗手段有机地结合将有助于提高淋巴瘤的近期疗效和远期生存率。