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      Clinicopathological characteristics and treatment outcomes of 38 cases of primary thyroid lymphoma: a multicenter study

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          Abstract

          Purpose

          Primary thyroid lymphoma (PTL) is a rare disease and it has been investigated in a limited number of studies. The present multicenter study evaluated the clinical features and treatment outcomes of PTL.

          Methods

          The medical records of patients diagnosed with PTL between 2000 and 2013 in three centers were retrospectively reviewed.

          Results

          The study included 11 men and 27 women with a median age of 63.3 years (range, 42-83 years). The median follow-up was 56.0 months (range, 3-156 months). Of the 38 patients included, 16 had mucosa-associated lymphoid tissue (MALT) lymphoma, six had mixed MALT and diffuse large B-cell lymphoma (DLBCL), and 16 had DLBCL. Thirty-five patients (92.1%) had early stage (stage I/II) disease. Of the 16 MALT lymphoma patients, 14 were treated by surgery, and radiotherapy (RT) or chemotherapy was combined in five patients. Two patients received RT or chemotherapy alone. Of the six mixed MALT and DLBCL patients, three underwent surgery with chemotherapy and three underwent chemotherapy alone, RT alone, or surgery with RT. All of the 16 DLBCL patients received chemotherapy, and surgery and RT was combined in 4 and 1 patients, respectively. The 5-year survival was 100% for MALT lymphoma (7 of 7) and mixed MALT and DLBCL patients (5 of 5) and 87.5% for DLBCL patients (7 of 8).

          Conclusion

          Early stage PTL has an excellent prognosis when managed by single or combined treatment modalities. Clinicians should consider PTL in patients with underlying Hashimoto's thyroiditis presenting with an enlarging thyroid mass.

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          Most cited references22

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          Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas: a randomised controlled trial (RICOVER-60).

          Cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) is used to treat patients with non-Hodgkin lymphoma. Interval decrease from 3 weeks of treatment (CHOP-21) to 2 weeks (CHOP-14), and addition of rituximab to CHOP-21 (R-CHOP-21) has been shown to improve outcome in elderly patients with diffuse large B-cell lymphoma (DLBCL). This randomised trial assessed whether six or eight cycles of R-CHOP-14 can improve outcome of these patients compared with six or eight cycles of CHOP-14. 1222 elderly patients (aged 61-80 years) were randomly assigned to six or eight cycles of CHOP-14 with or without rituximab. Radiotherapy was planned to sites of initial bulky disease with or without extranodal involvement. The primary endpoint was event-free survival; secondary endpoints were response, progression during treatment, progression-free survival, overall survival, and frequency of toxic effects. Analyses were done by intention to treat. The trial is registered on National Cancer Institute website, number NCT00052936 and as EU-20243. 3-year event-free survival was 47.2% after six cycles of CHOP-14 (95% CI 41.2-53.3), 53.0% (47.0-59.1) after eight cycles of CHOP-14, 66.5% (60.9-72.0) after six cycles of R-CHOP-14, and 63.1% (57.4-68.8) after eight cycles of R-CHOP-14. Compared with six cycles of CHOP-14, the improvement in 3-year event-free survival was 5.8% (-2.8-14.4) for eight cycles of CHOP-14, 19.3% (11.1-27.5) for six cycles of R-CHOP-14, and 15.9% (7.6-24.2) for eight cycles of R-CHOP-14. 3-year overall survival was 67.7% (62.0-73.5) for six cycles of CHOP-14, 66.0% (60.1-71.9) for eight cycles of CHOP-14, 78.1% (73.2-83.0) for six cycles of R-CHOP-14, and 72.5% (67.1-77.9) for eight cycles of R-CHOP-14. Compared with treatment with six cycles of CHOP-14, overall survival improved by -1.7% (-10.0-6.6) after eight cycles of CHOP-14, 10.4% (2.8-18.0) after six cycles of R-CHOP-14, and 4.8% (-3.1-12.7) after eight cycles of R-CHOP-14. In a multivariate analysis that used six cycles of CHOP-14 without rituximab as the reference, and adjusting for known prognostic factors, all three intensified regimens improved 3-year event-free survival (eight cycles of CHOP-14: RR [relative risk] 0.76 [0.60-0.95], p=0.0172; six cycles of R-CHOP-14: RR 0.51 [0.40-0.65], p<0.0001; eight cycles of R-CHOP-14: RR 0.54 [0.43-0.69], p<0.0001). Progression-free survival improved after six cycles of R-CHOP-14 (RR 0.50 [0.38-0.67], p<0.0001), and eight cycles of R-CHOP-14 (RR 0.59 [0.45-0.77], p=0.0001). Overall survival improved only after six cycles of R-CHOP-14 (RR 0.63 [0.46-0.85], p=0.0031). In patients with a partial response after four cycles of chemotherapy, eight cycles were not better than six cycles. Six cycles of R-CHOP-14 significantly improved event-free, progression-free, and overall survival over six cycles of CHOP-14 treatment. Response-adapted addition of chemotherapy beyond six cycles, though widely practiced, is not justified. Of the four regimens assessed in this study, six cycles of R-CHOP-14 is the preferred treatment for elderly patients, with which other approaches should be compared.
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            Cancer risks in patients with chronic lymphocytic thyroiditis.

            The incidence of malignant tumors and leukemia was analyzed in 829 patients with chronic lymphocytic thyroiditis and in 829 individually age-matched and sex-matched patients with colloid goiter. Diagnoses were based on cytologic studies of specimens obtained by fine-needle aspiration biopsy. The patients were examined between 1959 and 1978 and were followed in the Swedish Cancer Register between 1959 and 1981. There was no increased risk for the total number of tumors in the thyroiditis group (53 observed vs. 52.7 expected) or in the colloid-goiter group (40 vs. 53.2, respectively; P not significant). There were six lung cancers in the thyroiditis group (2.9 expected, P not significant), and one in the group with colloid goiter. Patients with thyroiditis had an increased risk of myeloproliferative and lymphoproliferative neoplasms (12 observed vs. 3.0 expected, P less than 0.001). The risk of malignant thyroid lymphoma was greatly increased, with an estimated relative risk of 67 (4 observed vs. 0.06 expected, P less than 0.000001). There was no increased risk for any type of tumor among patients with colloid goiter.
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              Primary thyroid lymphoma: a clinical review.

              Although primary thyroid lymphoma is a rare cause of both thyroid malignancy and extranodal lymphoma, awareness of this disease is important in order to achieve an early diagnosis and implement treatment. We review the epidemiology, clinical presentation, diagnosis, and treatment of this rare disorder.

                Author and article information

                Journal
                Ann Surg Treat Res
                Ann Surg Treat Res
                ASTR
                Annals of Surgical Treatment and Research
                The Korean Surgical Society
                2288-6575
                2288-6796
                December 2015
                27 November 2015
                : 89
                : 6
                : 295-299
                Affiliations
                [1 ]Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea.
                [2 ]Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
                [3 ]Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
                [4 ]Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
                [5 ]Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
                Author notes
                Corresponding Author: Kyu Eun Lee. Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-2072-2081, Fax: +82-2-766-3975, kyueunlee@ 123456snu.ac.kr

                *Young Jun Chai and Jun Hyun Hong contributed equally to this study as cofirst authors.

                Article
                10.4174/astr.2015.89.6.295
                4672092
                26665123
                c2633976-1a1c-481b-8567-2aca4466eb30
                Copyright © 2015, the Korean Surgical Society

                Annals of Surgical Treatment and Research is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 June 2015
                : 11 August 2015
                : 17 August 2015
                Funding
                Funded by: Korean Foundation for Cancer Research
                Award ID: CB-2011-03-01
                Categories
                Original Article

                lymphoma,thyroid lymphoma,primary thyroid lymphoma,marginal zone b-cell lymphoma,diffuse large b-cell lymphoma

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