Thyroid gland lymphoma: symptoms, prognosis and treatment
Thyroid gland lymphoma is a fairly rare malignant tumor.It develops in the proliferation( pathological proliferation) of lymphoid tissue.This neoplasm is more often diagnosed in elderly and senile patients( mostly older than 60-70 years).In young people, it is revealed only in individual cases.
Important: incidence among women is almost three times higher than among men.Table of Contents: Characteristics and Classification Causes Symptoms of thyroid gland lymphoma Diagnosis Treatment and prognosis for thyroid lymphoma
Characteristics and classification
Lymphoma is characterized by active diffuse( disseminated) proliferation with the formation of large formations in the form of nodes.Due to them, iron increases in volume by 2-4 times.A very overgrown tumor occupies almost the entire area of the neck.In the vast majority of cases, the tumor process affects the regional( cervical) lymph nodes.
In this malignant neoplasm the secretory activity of the thyroid gland suffers, that is, the production of hormones decreases sharply, and the patient develops hypothyroidism.
According to the classification accepted in modern endocrinology, two main types of thyroid lymphoma are distinguished:
- Primary( B- or T-cell).
In the structure of independent thyroid tumors, primary lymphomas account for between 2% and 8%.
Secondary malignant neoplasms are more common( up to 10% of cases).They appear against the background of other lymphoid neoplasias( including leukemia).
Important: lymphomas do not produce metastases, but the formations themselves are rarely single.Most often, several foci are detected in the lymphoid tissue.
As a rule, thyroid lymphoma occurs when lymphoid tissue proliferates against a background of chronic inflammation of the gland - an autoimmune thyroiditis( goiter Hashimoto ).This disease is present in anamnesis in more than 80% of patients with lymphoid neoplasia.According to experts, the transformation of lymphocytes with their subsequent growth and formation of a tumor is caused by prolonged antigenic stimulation of these cells.
Predisposing factors include:
- chemical carcinogens;
- viral infections;
- ionizing and microwave radiation.
There are four stages of development of lymphoma:
- IE - primary tumor localized within the organ;
- IIE - the process involves iron and cervical lymph nodes;
- IIIE - the tumor sprouts into adjacent tissues and organs and affects the lymph nodes below and above the diaphragm;
- IV - lung, digestive tract, liver, etc. are diagnosed
In each of the stages sub-stages A and B are identified:
- Sub-stage A is the absence of night sweats, fever and cachexia.
- Substage B is characterized by significant loss of body weight, febrile reactions and intoxication.
Symptoms of thyroid gland
Note: usually lymphoma occurs in one of the lobes of the gland or additionally captures the isthmus.Often patients themselves turn to a specialist-endocrinologist, noticing an asymmetric change in the configuration of the neck.
Signs of a non-epithelial malignant tumor are a noticeable one-sided enlargement of the neck and regional lymph nodes during examination.
In the course of palpation( probing), a high( "woody") density of the neoplasm and the impossibility of its displacement relative to the trachea are determined.
Patients show signs of compression of adjacent structures:
- violation of swallowing act( dysphagia);
- dysphonia( hoarseness of the voice in the lesion of the vocal cords);
- dyspnea( dyspnea associated with compression of the trachea);
- displacement of the trachea and esophagus laterally.
The compression and germination of adjacent tissues is detected early in the development of lymphoma.Patients often complain of general weakness, sweats at night and a sharp decrease in weight( cachexia).
Clinical signs of secretory deficiency of the endocrine gland are detected in about 50% of cases.
Diagnosis of lymphoid neoplasia is based on a physical examination, anamnesis, data from a hardware examination and laboratory biopsy analysis results.
When examined, special attention is paid to increasing the size of the gland and regional lymph nodes.When polling find out when the first signs of growth appeared, and how quickly it increased in size.
The most informative diagnostic methods are ultrasound scan of the thyroid gland and computed tomography of the cervical region.Chest X-ray is also performed.
A fine tissue sample is sampled by fine needle biopsy for subsequent histological, cytological and immunological examination.
To confirm or exclude the spread of the process to the bone marrow, resort to trepanobiopsy( the material is taken from the iliac bone).
To verify the diagnosis, a blood test is required for biochemistry and UAC. Special attention is paid to the concentration of uric acid and lactic acid dehydrogenase in plasma.In addition, the level of thyroid hormones - triiodothyronine( T3) and thyroxine( T4) is determined.
Differential diagnostics with the following pathologies are performed:
- autoimmune thyroiditis;
- glandular nodes;
- is a cancer of the thyroid gland.
Note: , the absence of secondary metastases is an important difference between lymphoma and anaplastic cancer.
Treatment and prognosis for thyroid lymphoma
Medical tactics are defined by the morphological variant of the pathology and the degree of spread of the tumor process.
In extrathyroid( ie, beyond the thyroid) lymphoma, chemotherapy or combined treatment involving chemotherapy( cytostatics) and radiotherapy( irradiation) is most often used.
Localized forms of lymphoid neoplasia are indications for surgical intervention of , during which thyroidectomy is performed - excision of thyroid gland and lymph node dissection - removal of lymph nodes with surrounding fiber.Thyroidectomy can be complete( extirpation) or partial( resection).
In the postoperative period, additional radiation or chemotherapy is required.
The most effective chemotherapy:
After chemotherapy, the patient needs immunocorrection. To combat postoperative thyroid hormone and parathyroid hormone deficiency hormone replacement therapy is conducted.
Combination therapy is accepted as the standard of treatment, as its use increases the 5-year survival rate to 90%, with no recurrence occurring in this period.
Plisov Vladimir, medical reviewer