[Malignant thyroid lymphoma--diagnostic and treatment problems].

UNLABELLED

The aim of this study was to present our experience in the diagnostics and treatment of primary malignant thyroid lymphoma (PMTL). Five patients at the age of 48-72 years with PMTL were treated at the Department of General Surgery in Bytom in the years 1988-1999. They made up 0.04% of patients operated on at this time in our Department because of different types of goiter and 1.05% because of thyroid carcinoma. The clinical examinations included ultrasonography, radioisotope diagnostics, preoperative thin needle biopsy and hormonal examination of thyroid gland. All patients were operated on under general anesthesia and with intraoperative histopathological examination. They were treated with chemo- and/or radiotherapy in postoperative period. The appearance of PMTL was preceded by nodular goiter or Hashimoto disease. In three cases we observed neck compression symptoms and in two the dramatic course of disease. Ultrasonography revealed hypoechogenic thyroid gland with nodular structures characterized by the decreased J131 uptake. In one case thin needle biopsy confirmed the diagnosis of PMTL. Evident hypothyreosis was diagnosed in one and subclinical in two patients. Surgical treatment--partial excision of neoplastic tumor--was complicated by tracheostomy in two cases. One case with almost total resection of thyroid gland was complicated by lesion of esophagus which was sutured. After operation one patient was treated with chemotherapy, one with radiotherapy and two cases using both of methods. Three patients died: in 3rd, 32nd day and after 3 months since surgery. We confirmed the remission of the disease in two the youngest patients with not advanced state. One of them was treated with Co 60 therapy and the second one with chemotherapy according to COP and radiotherapy.

CONCLUSIONS

PMTL is a rare disease and difficult to diagnose. The biopsy is useful. The treatment of PMTL combined, including surgical treatment, chemo- and radiotherapy. The prognosis is uncertain and depends on the disease period.