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Management of Anaplastic Thyroid Cancer and Lymphoma
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Thyroid lymphoma with aggressive histology is the most common, accounting for 65–70% of cases. Patients are more often female, with the mean age at presentation being 65. Patients typically present with a rapidly enlarging mass that is often as much as 10 cm+ when diagnosed. Cervical lymph nodes are frequently involved. Aggressive lymphoma can arise de novo or in pre-existing Hashimoto's thyroiditis. Diffuse large B-cell lymphoma is the most frequent histology, for which there is a well-established treatment, combining chemotherapy and radiotherapy. Systemic treatment is used, given the high rate of occult systemic disease. Patients will typically receive the CHOP-R regimen (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab), with chemotherapy given for 3–6 cycles followed by radiotherapy (30–40 Gy) 3–6 weeks later. This systemic treatment can achieve cure rates of 70–85%. Radiotherapy coverage and volume are dependent on the stage at presentation; stage IE patients can have radiotherapy limited to the primary thyroid disease only, without cover of the cervical lymph nodes, while stage IIE patients will typically have radiotherapy coverage of the thyroid primary site and the draining lymph nodes (Levels III–VI). Long-term cure is 75%.
General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
You find a dominant nodule in the left-hand side of the goitre. How would you assess it?FNAC should be performed, ideally under ultrasound guidance.Ultrasonography may also demonstrate enlarged cervical lymph nodes.The use of the U1−U5 scoring/grading system is recommended for assessing risk of malignancy and guiding FNAC of thyroid nodules (British Thyroid Association Guidelines 2014). If US appearances are equivocal, indeterminate or suspicious of malignancy (U3-5), an US-guided FNAC should be performed.Further management would then be dictated by the FNA results, which should contain a descriptive section interpreting the findings followed by the Thy numerical category as defined by RCPath (British Thyroid Association Guidelines 2014) or diagnostic groups outlined in the Bethesda System for Reporting Thyroid Cytopathology (American Thyroid Association Guidelines 2015).If cytology is malignant, oncologic surgery should be planned, if the cytology result is indeterminate (Thy 3) diagnostic surgery may be recommended.
Infection and immunology
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
5.11. A child of 8 years has had a fever of 40°C (104°F) for 2 days. The tonsils are enlarged and inflamed and partly covered by a mucopurulent exudate. The cervical lymph nodes are enlarged and tender. Which of the following is/are true?A negative Paul-Bunnell test would exclude glandular fever.Hypertrophy of the lingual papillae and a confluent desquamating skin rash indicates haemolytic streptococcal infection.If streptococci are grown from the throat swab, tetracycline is the treatment of choice in patients with penicillin allergy.Palatal paralysis would indicate the need for immediate isolation.Tonsillectomy should be advised following recovery.
Throat infections and use of streptococcal antigen test and antibiotic treatment in general practice; a web-based survey
Published in Scandinavian Journal of Primary Health Care, 2022
Hanne Puntervoll, Pål Jenum, Sigurd Høye, Mette Tollånes
A web-based survey describing three cases of sore throat (Figure 1) was distributed to the 4700 practicing GPs registered as members of the Norwegian College of General Practice (Supplementary material (1). The cases fulfilled the four Centor criteria to different degrees. The criteria are (i) fever >38.5 °C, (ii) swollen and tender anterior cervical lymph nodes, (iii) tonsillar exudate and (iv) absence of cough. The survey was open for invited GPs only and was conducted between September 17 and October 17, 2020. After being presented to each case, the participants were asked if they would perform a streptococcal antigen test and whether they would prescribe antibiotics. In cases 1 and 2, responders that would recommend antibiotic treatment were presented to the follow-up questions: ‘Which antibiotic treatment would you offer?’ and ‘For how many days would you prescribe antibiotic therapy?’. Additionally, in cases 1 and 2, patient temperatures were measured in the armpit. Temperatures measured axillary are lower than temperatures measured in the ear, under the tongue or rectal, which means that the patient in case 2 probably had a fever >38.5 °C.
Ultrasonography-guided radiofrequency ablation for the treatment of T2N0M0 papillary thyroid carcinoma: a preliminary study
Published in International Journal of Hyperthermia, 2021
Jing Xiao, Yan Zhang, Mingbo Zhang, Fang Xie, Lin Yan, Yukun Luo, Jie Tang
US was performed 1, 3, 6 and 12 months after RFA, and every 6–12 months thereafter. The size, volume and vascularity of the ablation zones as well as new tumors in the thyroid were carefully evaluated. The volume reduction rate (VRR) was calculated as follows: VRR=([initial volume – final volume] × 100)/initial volume. If there was new suspicious tumor in thyroid, US-guided CNB was performed to exclude PTC. Cervical lymph nodes were carefully evaluated. In case that there were any suspicious characteristics (i.e., microcalcifications, cystic aspects, peripheral vascularity, hyperechogenicity and/or round shape) [27] in cervical lymph nodes, US-guided CNB was performed to determine whether the nodes were metastatic or reactive. If there were suspicious symptoms of distant metastasis, computed tomography (CT), positron emission tomography or bone scan was performed.
The Prognostic Significance of IGF-1R and the Predictive Risk Value of Circulating IGF-1 in Tunisian Patients with Laryngeal Carcinoma
Published in Cancer Investigation, 2020
Mariem Ben Elhadj, Aida Goucha, Asma Fourati, Olfa Adouni, Sawsen Dhambri, Mohamed Hsairi, Michèle-Veronique El May, Nehla Mokni Baizig
The prospective study population consisted of 75 males with a mean age of 61 years (SD+/− 8.93, 42–82). The histological grading (G1–G3) of tumors was evaluated as following: G1: 50 carcinomas (66.7%), G2: 24 carcinomas (32%), G3: 1 carcinoma (1.3%). According to the stage T of tumor, we found that the majority of patients 56 (74.66%) were in advanced stage (T3 + T4) and 17 (22.66%) patients were in T1 and T2 stage. According to TNM stage, 57 patients (76%) were in the advanced TNM stage (III + IV) and 16 (21.3%) patients were in the TNM stage I and II. Twenty six (34.7%) of the 75 tumors invade all the larynx, twenty (26.7%) tumors invade two sites of the larynx (glottic and subglottic or glottic and supraglottic) and twenty eight (37.3%) tumors invade only one site of the larynx (subglottic or glottic or supraglottic). Cervical lymph node metastases were detected in 15 patients (20%) (Table 2).