Management of Anaplastic Thyroid Cancer/Lymphoma
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
Thyroid lymphoma with aggressive histology is the most common, accounting for 65–70% of cases.36, 37, 45 It usually presents with a rapidly enlarging mass, sometimes growing to 10 cm or even larger when diagnosed. It can arise de novo or from pre-existing indolent lymphoma or Hashimoto’s thyroiditis, recognized as histological transformation to aggressive disease with a poorer prognosis. There is a female predominance with typical presenting age of over 65 years.37, 46 Cervical lymph nodes are commonly involved (20–50%).45, 46 The most frequent histology is diffuse large B-cell lymphoma (DLBCL)37 (Figure 64.2) for which standard therapy has been well established based on phase III clinical trials. Other types of aggressive lymphomas (e.g. T-cell lymphomas) rarely present in the thyroid and the management is based on a similar philosophy of treatment with combined modality therapy (CMT) and functional preservation.
Lymphoma
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
NLPHL primarily affects males aged 30–50, who present with stage I or II peripheral adenopathy affecting axillary, cervical, or inguinal groups. It has an indolent course, with high relapse rates but excellent overall survival. CHL accounts for 95% of all cases. The cervical lymph nodes are involved in over 75% of cases. Overall, the incidence of splenic and bone marrow involvement at presentation is relatively low (25% and 5%, respectively). Nodular sclerosing HL, where lymphoid nodules are separated by dense bands of collagen, is the only form of HL without a male preponderance. Anterior mediastinal disease, often bulky, occurs in 80% of cases. Disease is usually confined to two contiguous nodal regions at presentation; ‘B’ symptoms are frequent. Mixed cellularity HL is the subtype most commonly associated with EBV positivity and is more common in HIV-positive patients and in developing countries. Advanced-stage disease and B symptoms are common. Peripheral nodal disease is frequent; mediastinal disease is uncommon. Lymphocyte-rich CHL primarily affects older patients and has a good prognosis. Limited peripheral nodal disease is typical, without mediastinal involvement or B symptoms. Lymphocyte-depleted HL is the rarest subtype, affecting mostly males with a median age of 35–40 years. It is often associated with HIV infection and tends to involve abdominal organs, retroperitoneal nodes, and bone marrow. Around 80% have advanced disease and B symptoms. Most HIV-positive cases have aggressive clinical courses.
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%.
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.
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).
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.