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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
Extranodal marginal lymphomas (MALT) are the most common indolent lymphomas of the thyroid gland, with follicular lymphoma being the second most common. There is almost always pre-existing Hashimoto's thyroiditis. Patients typically present with a nodule within the gland or diffuse enlargement of the gland. Cervical lymphadenopathy occurs in a third of cases. Females are more commonly affected than males (3:1). Treatment of stage I and II is with low-dose radiotherapy (24–30 Gy, fractionated over 2–4 weeks), covering the thyroid and draining cervical nodes. Prognosis is excellent, with local control rates greater than 95% and long-term disease-free survival >90%. If lymphoma is confined to the thyroid, then surgical resection is also a treatment option.
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
A 36-year-old man was referred with a 4-day history of ulceration in the mouth and soreness and crusting of the lips and surrounding skin. Twenty days previously, his lower left first premolar tooth had been extracted under general anaesthesia because of a periapical abscess. After 15 days, alveolar osteitis was diagnosed and the socket was packed with ribbon gauze impregnated with bismuth subnitrate and iodoform paste (iodoform 33%, bismuth subnitrate 17% and liquid paraffin 50%, abbreviated BIPP). On the following day, the patient developed mouth ulceration, swelling of the tongue and inflammation of the lips and perioral skin. He remembered having had a rash from iodine antiseptic previously. On examination, the patient had a severe left-sided stomatitis with ulceration of the left side of the tongue with an acute cheilitis and dermatitis of the perioral skin. Cervical lymphadenopathy was present. After successful treatment, an open patch test with BIPP gauze produced an area of erythema and edema 8x7 centimeter with central vesiculation after 2 days, persisting at D4, but without the vesiculation. Later, patch tests were positive to potassium iodide 5% pet. (6).
Head and Neck Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Lorcan O’Toole, Nicholas D. Stafford
RT is mainly employed as post-operative adjuvant therapy for such advanced cases. In some cases, neoadjuvant or adjuvant CRT is considered, extrapolating from results at other HNC sites. As in the nasal cavity the complexity of the target volume and close proximity of other vital structures lead either to compromises or increased risks. The field will often include the ipsilateral orbit and/or the adjacent skull base. Neck lymph nodes are included in the presence of cervical lymphadenopathy. In some centers, elective radiotherapy to the ipsilateral submandibular and upper cervical nodes is recommended in negative neck for T3/T4 tumors.
Complications in lymph node excision in the head and neck area
Published in Acta Oto-Laryngologica, 2022
Minna Rehell, Timo Atula, Laura K. Tapiovaara, Leif J. J. Bäck, Anni I. M. Koskinen, Johanna Ruohoalho, Katri L. S. Aro
Patient’s medical history, symptoms, and clinical examination including endoscopies are the cornerstones in diagnostics of cervical lymphadenopathy. Ultrasonography (US) combined with fine needle aspiration biopsy (FNAB), or core needle biopsy (CNB) is widely used in diagnostics and helps to differentiate between benign and malignant etiology [1,2]. As pathological techniques have evolved, FNAB/CNB can even provide reliable and a specific diagnosis. Nevertheless, approximately 5% of CNB [3] and up to 30% of FNAB [4] remain inadequate in the head and neck area. Especially in the work-up of lymphoma, needle biopsies do not often provide sufficient yield to specifically categorize the disease. Thus, National Comprehensive Cancer Network (NCCN) still recommends lymph node excision (LNE) in lymphoma diagnostics [5]. WHO classification of tumors of the hematopoietic and lymphoid tissue is also based on the histologic specimen [6].
Thyroid storm secondary to acute Streptococcus pyogenes pharyngitis
Published in Baylor University Medical Center Proceedings, 2022
Valeria Hanson, Subaina Naeem Khalid, Glenn Ratmeyer, Abu Baker Sheikh
A 24-year-old healthy woman presented with 2 days of palpitations, chest tightness, a sore throat, dizziness, nausea, and subjective fevers. Upon arrival, she had supraventricular tachycardia with a heart rate of 188 beats/min. She received adenosine 6 mg with no response and another 12 mg with improvement of her heart rate to the 140s. Following adenosine conversion, she was transferred to our hospital. At presentation, her tachycardia in the 140s persisted with stable blood pressure. Physical exam revealed tender cervical lymphadenopathy with a grossly erythematous, purulent posterior oropharynx and nontender goiter and tremors. Laboratory evaluation showed an undetectably low thyroid-stimulating hormone level of <0.007 μIU/mL (reference range 0.36–3.74) and increased free T4 of >8 ng/dL (reference range 0.7–1.6). Antithyroglobulin antibody, thyroid peroxidase antibody, and total T3 were all within normal limits. A rapid antigen test for group A Streptococcus by DNA probe was positive. She had slightly elevated liver function tests and a brain natriuretic peptide level of 2026 pg/mL. An echocardiogram was negative for cardiomyopathy and heart failure.
Thyroid gland involvement in secondary syphilis: a case report
Published in Acta Clinica Belgica, 2022
Thomas Strypens, Gudrun Alliet, Greet Roef, Linsey Winne
The first symptoms started 4 months before hospitalization with a skin rash diffusely spread throughout the body. The skin lesions were red, flaking and pruritic. After the appearance of the skin lesions, a progressive loss of vision of the right eye occurred. She complained of blurry vision, floaters and occasional light flashes. When admitted at the emergency department, the patient had increased blurry vision of the right eye. Inspection of the neck showed a cervical lymphadenopathy in the third neck region present since 1 month. A nodular, painful, inflamed neck swelling was located at the level of the isthmus of the thyroid gland. There was a rapid increase in the degree of swelling over the last few days. Other symptoms were weight loss of 9 kilograms over a period of 6 days and night sweats. No other complaints were mentioned. The patient did not take any medication. She had a history of illicit drug and alcohol abuse. This implied the daily use of amphetamines and a history of heroin use. She drank 10 units of alcohol each day. She smoked 4 to 5 cigarettes a day whereas she used to smoke up to 30 cigarettes a day. She started smoking at the age of 12.