[LYMPHOMATOUS THYROIDITIS (HASHIMOTO'S DISEASE). PRESENTATION OF 14 CASES].
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A case of a 37-year old female patient suffering from Wegener's granulomatosis is reported. The chest x-ray showed a tumorous consolidation of the right upper lobe and of the apical segment of the right lower lobe. The histological examination of the lung, the kidney and the spleen revealed necrotising granulomas typical of Wegener's granulomatosis. Additionally, a thyroiditis lymphomatosa Hashimoto was diagnosed. So far, coincidence of thyroiditis Hashimoto and Wegener's granulomatosis has not been reported in the literature. The involvement of the spleen was a rare manifestation of Wegener's granulomatosis.
Hashimoto's thyroiditis, a rather rare disease in endemic goiter areas like Switzerland, seems to become more frequent under iodine prophylaxis. To obtain more precise data we reviewed the microscopic slides of surgical thyroid specimens with indications of any type of inflammation from two 10-year periods with respectively lower (1940-1949) and higher (1973-1982) iodination of salt. From 1940-1949 Hashimoto's disease was never diagnosed histopathologically. A review of the histological slides, however, showed typical signs of Hashimoto's disease in 9 out of 6836 thyroid specimens, or 0.13%. In the second period, from 1973-1982, the same diagnosis was established in 32 of 4088 thyroid specimens, or 0.78%. This 6-fold increase in frequency of Hashimoto's disease seems to be due in part to a real increase, and in part to a change in the surgical material. At present fewer nodular goiters are seen than in the first period. Inflammatory infiltration in Hashimoto's disease, however, involves not the nodule but the non-nodular thyroid tissue found to a larger extent in present-day thyroid surgical specimens.
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Extranodal thyroid lymphomatous involvement is rare in childhood. We report here 2 children, 1 with vertical transmission-acquired human immunodeficiency virus (HIV), presenting with lymphomatous infiltration of the thyroid gland at diagnosis. One child had infra-clinical endocrine impairment and both responded well to chemotherapy. Although the cases are too scarce to be affirmative, thyroid gland involvement doesn't seem to alter the good prognosis of childhood Burkitt's lymphoma. The third child's cancer in frequency is Non-Hodgkin Lymphomas. Presenting as the initial AIDS event in 1 patient, this case report also highlights the need to systematically propose antiretroviral therapy in vertically HIV infected children.
Clinical and laboratory characteristics of 224 patients with thyroidal infection reported since 1900 are reviewed. Much of the prior literature on this subject has assumed that most instances of thyroiditis are infectious and that all lymphomatous thyroiditis is tuberculous. Similarly, thyroiditis occurring with syphilis was often equated with treponemal invasion of the gland. Acute bacterial thyroiditis is rapid in onset and more likely than tuberculous infection to produce fever, pain, and tenderness. Suppurative and mycobacterial infections are most common among women with preexisting thyroid disorders. Mortality due to infectious thyroiditis is lower in cases covered by this review than has been previously reported. Gummatous and fungal infections of the thyroid are generally diagnosed only at biopsy or necropsy. Frequent thyroidal involvement in disseminated aspergillosis warrants careful investigation of the gland in patients with this infection. Echinococcosis of the thyroid is a chronic process that is generally diagnosed only following excision.
We report the case of a 42-yr-old man with primary thyroid lymphoma arising from mucosa-associated lymphoid tissue (MALT-lymphoma, maltoma). The patient underwent a hemithyroidectomy for a growing mass in the right lobe of the thyroid while being treated with 1-thyroxine for Hashimoto's thyroiditis. The clinical diagnosis of Hashimoto's disease was confirmed by aspiration biopsy of the mass during the course of L-thyroxine treatment. Postoperatively, histology showed atypical lymphoproliferative infiltrates suspicious of low-grade non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue-type, coexisting with a reactive process typical of chronic lymphocytic thyroiditis. Immunophenotyping showed a mixed B- and T-lymphocyte population, which was nondiagnostic. However, Southern blot analysis revealed a clonal rearrangement of the Ig heavy chain gene. This case demonstrates that cytology or histology may not distinguish between reactive or low-grade lymphomatous thyroid processes. The use of molecular technique was essential to prove clonality and the presence of lymphoma.
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