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1.
True thymic hyperplasia (enlarged gland composed of histologically unremarkable cortical and medullary parenchyma) and lymphoid hyperplasia (medullary lymphoid follicles in the clinical setting of autoimmunity) usually develop as independent pathologic processes. We reviewed the clinical features and gross and microscopic pathology of 2 hyperthyroid patients with features of both thymic hyperplasia and lymphoid hyperplasia. The diagnosis of thymic hyperplasia was supported by thymic weights greater than two standard deviations above the mean weight for age and histologic evidence of expanded cortical and medullary parenchyma. The diagnosis of lymphoid hyperplasia was supported by the increased number and size of medullary lymphoid follicles and the association with Grave's disease. This unusual combination results from two separate pathogenic mechanisms operating simultaneously in hyperthyroid patients. Elevated thyroid hormones directly stimulate the proliferation of thymic epithelium, producing thymic hyperplasia. The immune abnormalities underlying Grave's disease can also result in lymphoid hyperplasia of the thymus.  相似文献   

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A female adolescent with hyperthyroidism was found to have an anterior mediastinal mass. Radiological investigation of this mass was consistent with thymic enlargement. Chest roentgenograms one year after treatment showed resolution of the mediastinal mass. A non-invasive investigational approach to such patients is suggested based on a review of the pathological literature.  相似文献   

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Thymic epithelial neoplasms consist of thymomas, thymic carcinoids, and thymic carcinomas. Carcinomas are malignant tumors of the thymus characterized by obvious cytological anaplasia. They constitute only 4%-14% of thymic epithelial neoplams. Thymic carcinoma rarely occurs in children. Research in the English literature carried out for the present study revealed only 14 cases younger than 18 years-of-age. Here we have reported a 16-year old girl who presented with respiratory distress due to huge anterior mediastinal mass. Histological and immunohistochemical studies confirmed lymphoepithelioma-like thymic carcinoma. She received systemic chemotherapy and radiotherapy. However, she died within 15 months due to progressive disease.  相似文献   

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We report the first case of a thymic cyst appearing in the course of treatment for non-Hodgkin lymphoma of the anterior mediastinum. The patient was a 9-year-old child in whom an abnormal contour of the left cardiac border persisted after chemotherapy, suggesting residual disease. The mass was found at thoracotomy to be a benign thymic cyst. The lesion was not present 2 years previously, and most likely represented cystic degeneration of the thymus, secondary to lymphomatous involvement. CT scan was not helpful in distinguishing the cystic lesion from residual lymphoma.  相似文献   

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As far as we know, this is the first report of a non-Hodgkin lymphoma developing after successful treatment of neuroblastoma. A boy was found to have a mediastinal T-cell lymphoma at the age of 5. He had been treated for a neuroblastoma of the left adrenal region 4 years before, when by intensive chemotherapy and radiation a complete remission of the primary tumor was achieved. The second malignancy has also been controlled without evidence of recurrence 1 year after termination of treatment. We conclude that treatment of a neuroblastoma by cytostatic drugs and radiation may lead to a non-Hodgkin lymphoma as a second malignancy. Med. Pediatr. Oncol. 30:18–21, 1998. © 1998 Wiley-Liss, Inc.  相似文献   

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Thymic carcinoma, which is a thymic epithelial neoplasm with obvious cytologic atypia, is a rare neoplasm. The authors report on a 10-year-old boy who presented with respiratory distress due to bulky anterior mediastinal mass. Histological and immunohistochemical studies confirmed a lymphoepithelioma-like pattern thymic carcinoma. In addition, evaluation of the specimen showed foci of caseation and multiple granulomas with extensive central necrosis within the thymic tissue. The child received chemotherapy, followed by surgery and radiotherapy. To rule out difficulties of tuberculosis he also received antituberculosis therapy. Two years after cessation of treatment, he is still in remission for thymic carcinoma.  相似文献   

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Survivors of childhood acute lymphoblastic leukemia (ALL) treated with radiotherapy are at risk for impaired fertility. Whether chemotherapy alone is also long‐term gonadotoxic is unclear. We assessed gonadal function in 11 male ALL‐survivors treated with the same chemotherapy regimen and compared sperm analysis to healthy men. While sex hormone levels were normal in all subjects, 5/11 survivors showed pathological sperm concentration and 4/11 a decreased total sperm count compared to WHO criteria. Compared to healthy controls, all quantitative parameters in semen analysis of survivors were decreased. This suggests that treatment with chemotherapeutic agents alone, even in moderate doses, might have a gonadotoxic effect. Pediatr Blood Cancer 2010;55:208–210. © 2010 Wiley‐Liss, Inc.  相似文献   

9.
Four months after termination of successful chemotherapy for epipharyngeal B-non-Hodgkin lymphoma, an enlarging anterior mediastinal mass was discovered in a 15-year-old boy. There was no other suspicion of tumour recurrence. A simple thymic rebound was likely and a conservative management was chosen. Follow up for more than 12 months was uneventful. The frequency of thymic hyperplasia after termination of chemotherapy is discussed. It is a benign immunological rebound phenomenon and does not require operative intervention.  相似文献   

10.
A 17-month-old female was first admitted to our hospital at 7 months of age because of an anterior mediastinal mass associated with mild respiratory symptoms. She underwent a biopsy of the mass that disclosed benign thymic hyperplasia. She came back 8 months later with a larger mass of the mediastinum obstructing the airway. She was intubated and underwent excision of the mass; the histological diagnosis was malignant mesenchymoma. From this experience, it is suggested that more aggressive follow-up, including repeated biopsy, must be considered for a persistent large thymic mass. Offprint requests to: T. Muraji  相似文献   

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The risk of second malignancies after successful treatment for Hodgkin disease can be considerable. The most common malignancies are solid tumors arising in irradiated sites, such as the breast and thyroid gland after mantle field radiation. Sarcomas and other musculoskeletal tumors are also seen. We describe a young woman who developed an intra-abdominal desmoid tumor more than 4 years after completing therapy for Stage IIB Hodgkin disease, treated with combination chemotherapy (ABVD) and mantle irradiation. The tumor did not occur at either a surgical site or within a radiation field. She did not carry a mutation for familial adenomatosis polypoli.  相似文献   

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A 7-year-old leukemic girl developed pancytopenia following chemotherapy and was given several transfusions of nonirradiated blood. Within 2 weeks she developed a maculopapular rash, fever, abnormal liver function, diarrhea, and wasting. She became septic and died 6 weeks later. Transfusion-associated graft-versus-host disease (GVHD) was suspected clinically. At autopsy, changes diagnostic of GVHD were present in the skin and liver. The remarkable feature of the case was the histopathology of the thymus, which was morphologically “dysplastic,” i.e., minute, lymphoid depleted, devoid of a corticomedullary demarcation, and completely lacking in Hassall's corpuscles. These changes were virtually identical to those seen in the thymus of children with severe combined immunodeficiency disease (SCID). There was no evidence of preexisting immune deficiency. There is compelling experimental evidence that GVHD can produce changes in the thymus that are identical to those of “thymic dysplasia.” These observations have led to the hypothesis that immunodeficiency associated with GVHD may stem, in part, from injury to thymic epithelium resulting in defective T cell maturation. As a corollary of this hypothesis, it has been suggested that the pathogenesis of some forms of SCID may involve GVHD-associated injury to the thymus by a maternal allograft acquired in utero. This report further documents thymic pathology in human GVHD and discusses these changes in the light of these ideas.  相似文献   

14.
A predisposition to developing immune thrombocytopenia (ITP) has not been reported in survivors of childhood cancer. We report a case series of childhood cancer survivors who developed an isolated thrombocytopenia in the presence of a normocellular bone marrow. Five children, two with endodermal sinus tumors and three with acute lymphoblastic leukemia, developed ITP at a median of 4 years (range: 0.2-8 years) after completion of therapy. We suggest the association of ITP in survivors of childhood malignancy may not be co-incidental as chemotherapy may cause persistent immune dysfunction.  相似文献   

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The aim of this study was to document gender difference in aerobic capacity after cure from malignant disease in childhood. We studied 18 males and 17 females aged 11–19 years and 10–18 years, respectively. They had all completed their treatment at least two years previously. Twelve males and 11 females received anthracyclines in comparable doses (range 150–500 mg/m2). Maximal exercise tests were performed on a cycle ergometer. Maximal oxygen consumption (ml/min/kg) was significantly ( p < 0.001) lower only in females when compared to their controls. We postulate two causes: girls are smaller than their controls, possibly related to their higher vulnerability to cranial irradiation than boys; and girls were less involved than boys in sports. The influence of anthracycline treatment on aerobic capacity was only observed in males and not in females. This could be related to the higher exercise level in boys than in girls.  相似文献   

17.
目的探讨儿童肾脏恶性横纹肌样瘤(malignant rhabdoid tumor of the kidney,MRTK)的临床及病理特点。方法回顾性分析2009年1月至2015年4月本院收治的15例MRTK患儿临床、病理及随访资料。结果 15例患儿中,男性7例,女性8例,年龄3~28个月,平均年龄12.6个月。左侧6例,右侧9例。血尿10例,腹部包块4例,超声发现1例。按NWTS 3进行肿瘤分期:Ⅰ期2例,Ⅱ期5例,Ⅲ期5例,Ⅳ期3例。术前予化疗1例,肾动脉栓塞1例。予保留肾单位的肿瘤剜除术1例,瘤肾切除14例。病理检查结果均提示肾脏恶性横纹肌样瘤。术后化疗14例,放疗4例。11例获随访,9例死亡,2例无瘤存活分别2年、6年,4例失访。结论儿童肾脏恶性横纹肌样瘤好发于婴幼儿,血尿多见,进展迅速,恶性度高,易发生肺脑转移,需要手术+化疗+放疗的综合治疗,预后差。  相似文献   

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目的 对儿童血液系统恶性肿瘤化疗后导致骨坏死进行危险因素分析.方法 回顾性分析2005年6月至2010年6月在我院住院治疗105例血液系统恶性肿瘤患儿(包括急性淋巴细胞白血病、急性髓系白血病和非霍奇金淋巴瘤).男55例,女50例,年龄1.6~17.8岁,平均8.25岁,对患儿治疗过程和随访情况进行临床观察和记录,统计患儿接受的化疗方案,发生骨坏死的比例,部位,针对骨坏死治疗方法和预后.结果 10例患儿发生了骨坏死,男5例,女5例,发病年龄9.8~16.8岁,平均14.4岁,发生骨坏死的平均年龄大于未发生骨坏死的平均年龄(P<0.05).接受化疗时间平均10.8个月(8~49个月),发生骨坏死的部位共有16个部位,其中14个发生在股骨头.接受激素治疗剂量为折合强的松4 425~9 599 mg,平均5 967 mg.95例患儿未发生骨坏死,年龄1.6~17.8岁,平均7.2岁,接受强的松的剂量为0~18 585 mg,平均3 943 mg.骨坏死的发生与激素的摄入量比较,有统计学差异(P<0.05).发生骨坏死与性别无统计学差异(P<0.05).结论 儿童血液系统恶性肿瘤化疗后造成的骨坏死多发生在负重关节,与激素摄入量、年龄密切相关,与性别无关.  相似文献   

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