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      Non-Hodgkin’s Lymphoma of the Thyroid and Adrenal Glands

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          Abstract

          We report a case of non-Hodgkin’s lymphoma(NHL) with simultaneous involvement of both thyroid and bilateral adrenal glands. Literature review on a computerized search showed that this is an extremely rare condition. The final diagnosis of diffuse large B cell lymphoma was confirmed by biopsies of thyroid gland, enlarged cervical lymph node, and adrenal gland. The significant endocrine dysfunction of the thyroid, adrenal or other endocrine glands was absent in our case. The patient responded dramatically to three cycles of chemotherapy with no complication or endocrine dysfunction and continues to be followed.

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          Most cited references16

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          Malignant lymphomas of the thyroid gland. Analysis of 79 patients with emphasis on histologic prognostic factors.

          Prognostic factors in 79 patients with malignant lymphomas involving the thyroid gland were analyzed. These patients suffered from progressively enlarging goiter with over 6 months duration in 60% of patients. The age at operation ranged from 16 to 80 years (median, 58 years). Male to female ratio was 1:1.8. Serum tests for antithyroid antibodies were positive in 83% of the patients, who also showed histologic evidence of chronic lymphocytic thyroiditis. Histologically, 52 cases (66%) were germinal center cell tumors with follicular or follicular and diffuse pattern in 9 cases. By the Working Formulation, 5-year survival rate of immunoblastic type (IBL) (13%) was much poorer than those of intermediate (79%) and low grade cases (92%) (P less than 0.001). The cases of IBL usually had a goiter of short duration, and frequently presented as advanced disease.
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            Lymphoma of the thyroid.

            In 24 of 30 patients with lymphoma of the thyroid, the diagnosis was made preoperatively or without surgery; undifferentiated or poorly differentiated carcinoma was suspected in 3 other patients. Thirteen patients were under 60 years of age; 7 were under 40. An increase in the ratio of men to women was seen among younger patients. At presentation, a discrete nodule was found in 19 patients, and multinodular or diffuse goiters in 11. Seventy-six percent of patients with solitary nodules had enlargement of extranodular tissue. Imaging showed "cold" nodules, cold areas in diffuse goiters, or patchy uptake. Nine patients had obstructive complaints; 12 patients had subnormal thyroid function; 24 patients had coexistent Hashimoto's thyroiditis. Lymphoma of the thyroid was suggested by fine-needle biopsy results in 17 of 28 patients (undifferentiated carcinoma was suspected in 2); and by large-needle biopsy results in 21 of 23 (undifferentiated or poorly differentiated carcinoma was suspected in 2). Biopsy of diffuse Hashimoto's goiters is indicated for cold imaging defects, enlarging tender goiter, or goiter enlarging on thyroid hormone. Early diagnosis may improve prognosis for lymphoma of the thyroid, so that surgery or chemotherapy can be avoided.
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              Primary bilateral adrenal lymphoma.

              We report a case of primary bilateral adrenal non-Hodgkins lymphoma (NHL), with hypercalcemia at the time of presentation. Medical literature review showed that this is an extremely rare site for lymphoma, but presents a distinct clinical entity with many features that differ from NHL overall, extranodal NHL, and NHL in other endocrine organs. The diagnosis is frequently not suspected antemortem, and long delays between the onset of symptoms and the diagnosis are frequent. Adrenal insufficiency is also common, and may be a lethal complication of these tumors. Response to therapy and survival are extremely poor.
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                Author and article information

                Journal
                Korean J Intern Med
                Korean J. Intern. Med
                The Korean Journal of Internal Medicine
                Korean Association of Internal Medicine
                1226-3303
                2005-6648
                January 2000
                : 15
                : 1
                : 51-55
                Affiliations
                Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Medical School, Kwangju, Korea.
                [* ]Division of Hemato-oncology, Department of Internal Medicine, Chonnam University Medical School, Kwangju, Korea.
                Author notes
                Address reprint requests to: Min Young Chung, M.D., Department of Internal Medicine, Chonnam University Hospital, 8 Hakdong, Kwangju, 501-757, Korea
                Article
                kjim-15-1-51-9
                10.3904/kjim.2000.15.1.51
                4531734
                10714092
                a7515a29-673c-4dd2-92e4-fbdf71eea99e
                Copyright © 2000 The Korean Association of Internal Medicine

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Internal medicine
                non-hodgkin’s lymphoma: thyroid gland,adrenal glands
                Internal medicine
                non-hodgkin’s lymphoma: thyroid gland, adrenal glands

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