Non-Hodgkin's lymphoma of the thyroid gland occurring after treated Hodgkin's lymphoma.

OBJECTIVE: To present a case report of the occurrence of non-Hodgkin's lymphoma in the thyroid gland of a patient who had previously undergone successful treatment of Hodgkin's lymphoma. METHODS: We describe pertinent historical features and current symptoms and laboratory findings in a 62-year-old man who had had successful treatment of Hodgkin's lymphoma 10 years previously and had been free of disease for a decade. We also review the related medical literature on the course of patients after therapy for Hodgkin's lymphoma. RESULTS: Because of a progressively enlarging anterior neck mass, hoarseness, and difficulty with breathing, a patient sought medical attention. Ten years previously, he had undergone irradiation and splenectomy for treatment of Hodgkin's lymphoma. In the current assessment, fine-needle aspiration and open biopsy yielded the diagnosis of non-Hodgkin's lymphoma, for which the patient received irradiation and chemotherapy. Review of the literature pertaining to diseases after treated Hodgkin's lymphoma, including second cancers, failed to identify any such prior reported case. CONCLUSION: Because the clinical profile of our patient was consistent with primary non-Hodgkin's lymphoma of the thyroid gland developing after radiation-treated Hodgkin's lymphoma, we conclude that this represents the first such reported example.

Prostatic abscess due to histoplasma capsulatum in the acquired immunodeficiency syndrome.

We report a case of prostate abscess due to Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome. The diagnosis and management are discussed, and the literature is reviewed.

Chronic lymphocytic leukemia with hypothalamic invasion.

Headaches and a state of confusion developed in a patient with chronic lymphocytic leukemia (CLL). A computed tomography (CT) scan of the head showed a hyperdense lesion in the hypothalamus with obstruction of the foramina of Monro. Leukemic cells with monoclonal lambda B-cell markers were identified in the ventricular fluid at the time of surgical decompression. Similar cells were identified in the peripheral blood. This lesion has not been described as a complication of CLL, a disease that, unlike other leukemias, rarely has central nervous system manifestations.

Value of aspiration cytology of the thyroid in metastatic disease.

Metastases may simulate primary malignant tumors of the thyroid, causing problems in the diagnosis and management of patients with a history of cancer. In the seven-year period of July 1978 through June 1985, 8 of 549 needle aspirates of the thyroid contained metastatic tumor, 6 of which were subsequently confirmed by histologic study. The primary sites of origin were the breast, kidney, colon and stomach as well as lymphoma. The cytologic features observed in the aspiration biopsy material from the six cases were characteristic of each of the primary tumors. Three of the patients had had prior resections of carcinomas (breast, colon and stomach) while in three patients the cytologic diagnosis of the thyroid aspirates led to the discovery of the primary tumor (kidney and two lymphomas). One case of lymphoma/leukemia and one case of previously biopsied lung carcinoma were confirmed on clinical grounds. It is of critical importance that primary thyroid neoplasms occurring in patients known to have primary tumors elsewhere be distinguished from disseminated tumors involving the thyroid. Our experience suggests that fine needle aspiration is of considerable value in this differential diagnosis. Needle aspirates of the thyroid are also of value in leading to the diagnosis of unsuspected nonthyroidal primary cancer.

Prostatic carcinoma metastasis to the kidney: diagnosis by thin needle aspiration biopsy.

Renal metastasis of prostatic origin is uncommon. The routes of metastatic spread are discussed. The efficacy and safety of thin needle aspiration biopsy in obtaining a premortem diagnosis are stressed.

Detection of endometrial carcinoma and hyperplasia in asymptomatic women.

Occult endometrial carcinoma is a detectable disease using commercially available sampling devices and cytohistologic techniques. A cohort of 2586 asymptomatic women (98% past the age of 45, 78% caucasian) was screened. Of these women, 1567 were screened twice, and 187 were screened three times. The prevalence and incidence rates of endometrial carcinoma, as defined in the present study, including four missed cases, were 6.96 per 1000 and 1.71 per 1000 women years, respectively. The prevalence rate was 7.38 per 1000 for caucasian women and 5.40 per 1000 for women of other races. An epidemiologic evaluation suggested that the onset of menopause past the age of 49 was the only statistically significant risk factor, whereas race, parity, estrogen intake, and obesity, as calculated by the Quetelet index, were not statistically significant. The present study strongly suggests that in asymptomatic women past the age of 50, endometrial hyperplasia does not necessarily precede or accompany the development of endometrial carcinoma. Two distinct mechanisms may be responsible for the onset of endometrial cancer: endometrial hyperplasia occurring in the symptomatic and younger woman; and endometrial adenocarcinoma occurring ab initio in the older patient.

Screening of asymptomatic women for endometrial cancer.

This report describes the preliminary results of a feasibility study of detection of endometrial carcinoma in an asymptomatic population of women aged 45 and above. The initial sample of 1,280 women was evaluated by several cytologic smear techniques and by two endometrial sampling methods assigned by computer. The clinical approaches and the techniques used are detailed. During this initial period of study, eight histologically proved endometrial cancers were diagnosed, two of which were deeply invasive. With one exception, the eight patients were either obese or had a history of treatment with conjugated estrogens. A relatively small number of women with endometrial hyperplasia of various types were also identified. The accuracy of the detection methods and their long-term impact on morbidity and mortality cannot be assessed as yet. Incidentally, a small number of cancers and precancerous states of organs other than the endometrium have also been diagnosed.

Screening of asymptomatic women for endometrial cancer.

This report describes the preliminary results of a feasibility study of detection of endometrial carcinoma in an asymptomatic population of women aged 45 and above. The initial sample of 1280 women was evaluated by several cytologic smear techniques and by 2 endometrial sampling methods assigned by computer. The clinical approaches and the techniques used are detailed. During this initial period of study 8 histologically proved endometrial cancers were diagnosed, 2 of which were deeply invasive. With 1 exception, the 8 patients were either obese or had a past history of treatment with conjugated estrogens. A relatively small number of women with endometrial hyperplasia of various types were also identified. The accuracy of the detection methods and their long-term impact on morbidity and mortality cannot be assessed as yet. Incidentally, a small number of cancers and precancerous states of organs other than the endometrium have also been diagnosed.