Management of Anaplastic Thyroid Cancer and Lymphoma
R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne in 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%.
Francisella
Dongyou Liu in Handbook of Foodborne Diseases, 2018
In foodborne tularemia, a typical case will present with a history of sudden febrile disease onset accompanied with a sore throat. Often, the symptom that brings the patient to a physician is swelling of the cervical lymph nodes. When examined, there may be findings of stomatitis and exudative pharyngitis or tonsillitis. The disease may easily be mistaken for other causes of cervical lymph node swelling including lymphoma or tubercular cervical lymphadenitis.118,128 Multiple medical specialties may be engaged before the correct diagnosis is revealed. Intestinal primary infections with ulceration of the small intestines exist but are rarely reported, partially this may be because it is hard to distinguish if tularemia pathology in the mucosa and lymphoid tissues of the small intestine is the result of a local primary infection or a result of hematogenous spread of the bacterium.120,129 Anorexia, nausea, vomiting, diarrhea, and abdominal pain with tenderness may be caused by primary F. tularensis infection of the intestines, or may signify severe tularemia with sepsis regardless of the portal of entry of the infectious agent. In severe cases of tularemia, there may be signs of acute liver dysfunction with jaundice.120,130
Clinical Examination of the Neck
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
The majority of clinical neck examinations are performed to assess the cervical lymph nodes. The site, size, number, consistency, fixity to surrounding structures and overlying skin appearances should be assessed. For lymph nodes considered to contain metastatic head and neck malignancy, the affected site or sites should be classified according to the level(s) of the neck. The concept of ‘levels’ of the neck was first proposed by Shah in 1990.4 Subsequently the Committee for Neck Dissection Classification of the American Head and Neck Society published several consensus documents further defining these levels.5, 6 The most recent anatomical boundaries of the neck levels are summarized in Table 36.2 (Figure 36.4). Physical examination alone has a sensitivity of 81% and specificity of 77% in detecting metastatic lymphadenopathy.7
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.
Intra-arterial chemotherapy targeting metastatic cervical lymph nodes in head and neck cancer
Published in Acta Oto-Laryngologica, 2021
Shigeyuki Murono, Takeshi Komori, Kazuhira Endo, Satoru Kondo, Naohiro Wakisaka, Tomokazu Yoshizaki
A total of 68 patients with stage III to IVB untreated laryngeal and hypopharyngeal squamous cell carcinoma with metastatic cervical lymph nodes were treated with the less intensive RADPLAT protocol between August 1999 and August 2010. T, N, and M classifications and stage were determined according to the 7th edition of the UICC TNM Classification. Among them, 41 patients with cervical lymph nodes of more than 20 mm were enrolled in this retrospective study (Table 1). Eligibility criteria included a performance status of 0 to 2 according to the Eastern Cooperative Oncology Group, a white blood cell count of more than 3500/mm3, a platelet count of more than 100,000/mm3, a total bilirubin level of less than 1.5 mg/dL, aspartate transaminase and alanine transaminase levels of less than three times the normal upper limits, and creatinine clearance of more than 60 mg/min. The exclusion criteria included a history of stroke, severe arteriosclerosis, or arrhythmia. This study was approved by the Ethics committee of Kanazawa University Hospital (2008-108).
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.