Malignant lymphomas of the thyroid: a clinical pathologic study of 35 patients including ultrastructural observations

Primary malignant lymphoma of the thyroid--a tumour of mucosa-associated lymphoid tissue: review of seventy-six cases

Seventy-six cases of primary thyroid lymphoma have been reviewed employing the Kiel classification. These lymphomas are almost entirely of follicle centre cell origin, occur predominantly in elderly females, and are frequently associated with lymphocytic thyroiditis or Hashimoto's disease. The overall prognosis is variable, with long-term survival in a substantial number of cases following thyroidectomy and radiotherapy. Results of histological examination including immunoperoxidase studies are described. It is proposed that thyroid lymphoma represents a neoplasm of mucosa-associated lymphoid tissue (MALT), and the implications of this are discussed.

Immunoblastic sarcoma of B-cells in a 24-month-old child. Report of a case

Immunoblastic sarcoma is a malignancy of transformed lymphocytes with a high association of occurrence in patients with immune disorders. The youngest previously reported case occurred in a 6-year-old child with immunoblastic lymphadenopathy. The authors report the finding of immunoblastic sarcoma of B-cells in a previously healthy 24-month-old boy. This represents the youngest reported patient with this lymphoma.

Gastric pseudolymphoma. A challenging clinical problem

Gastric pseudolymphoma is a benign inflammatory condition that is usually associated with chronic gastric ulcer and often mimics gastric carcinoma or malignant lymphoma. Our experience with 12 histologically documented gastric pseudolymphomas at the Medical College of Virginia is presented with an emphasis on the approach to both diagnosis and surgical management. Preoperative diagnoses in this series ranged from benign gastric ulcer to gastric cancer. Treatment was by gastric resection in all cases and it included, as a minimum, antrectomy and excision of the lesion with an adequate gross margin. Of 11 cases with adequate follow-up, there are eight asymptomatic patients without recurrence and one patient who died of other causes without recurrence 5 years after gastrectomy. One patient developed recurrent pseudolymphoma in the proximal gastric remnant 39 months after a distal subtotal gastrectomy for pseudolymphoma. Another patient subsequently developed Hodgkin's disease of the gastric remnant, with regional lymph node and liver involvement, and died 35 months after the earlier subtotal gastrectomy for pseudolymphoma. Our clinical experience with this confusing and uncommon entity is compared with that previously reported in the medical literature.

Extranodal malignant lymphoma arising from mucosa-associated lymphoid tissue

Four cases of extranodal malignant lymphoma, one each arising in the stomach, salivary gland, lung, and thyroid, are described. These cases have many clinical, histopathologic, and immunohistochemical features in common, and it is proposed that this is because they share a common pattern of histogenesis from mucosa-associated lymphoid tissue (MALT). Clinical features of MALT-derived lymphomas include a tendency to remain localized for prolonged periods, and, thus, to be responsive to locally directed therapy. Histologically, this group of tumors is characterized by a noninvasive lymphoplasmacytic infiltrate within which foci of follicle center cells (FCC) can be seen invading epithelial structures, forming lymphoplasmacytic infiltrate lesions. Immunohistochemistry reveals monotypic cytoplasmic immunoglobulin (CIg) in the plasma cells serving to highlight the CIg-negative lymphoepithelial lesions. The clinical and histopathologic features of these lymphomas can be understood in the context of the behavioral characteristics and morphology of MALT.

Thyroid lymphoma in a patient with hyperthyroidism

A patient presenting with hyperthyroidism had a rapidly enlarging thyroid mass that histopathologically was a diffuse histiocytic lymphoma arising in a gland with Hashimoto's thyroiditis. The concurrent development of both hyperthyroidism and lymphoma may have resulted from similar immunologic abnormalities. Appreciation of the relationship between thyroid lymphoma and Hashimoto's thyroiditis, and their presentation with either hypothyroidism or hyperthyroidism should lead to an earlier diagnosis of lymphoma and improved survival.

Undifferentiated thyroid tumors of diffuse small cell type. Histological and immunohistochemical evidence for their lymphomatous nature

A histological review of 72 undifferentiated thyroid tumors was performed in order to discover small cell anaplastic carcinomas and Non-Hodgkin lymphomas. Cases suspected to be lymphoma were examined for the presence of Ig and keratin and lectins with a PAP-procedure. Among the 72 cases, 68 (94,5%) were anaplastic carcinomas of various types. Four cases (5,5%) were diffuse small cell tumors, which had previously been regarded as anaplastic carcinomas. All four could be identified as Non-Hodgkin lymphomas by histology, immunohistochemistry, repeat biopsy or autopsy. The findings suggest that the majority of small cell anaplastic thyroid tumors are lymphomas and that true anaplastic small cell carcinoma of the thyroid must be extremely rare. Its diagnosis requires electronmicroscopy and/or immunohistochemistry to demonstrate the epithelial nature of tumor cells.

Anaplastic small cell neoplasms of the thyroid: an immunoperoxidase study

The cell origins of ten anaplastic small cell neoplasms of the thyroid gland were investigated using the immunoperoxidase technique. Sections of the neoplasms were examined for immunostaining for the tissue markers of B lymphocytes, thyroid follicular cells, and C cells by incubation with antisera to the lambda and kappa light chains, human thyroxine and human calcitonin, respectively. Six neoplasms were identified as malignant lymphomas, and two were identified as anaplastic small cell follicular carcinomas. The cell origins of the remaining two neoplasms could not be determined. The prognosis for patients with malignant lymphoma was favorable compared with the prognoses for patients in the other two groups. The prognosis for patients with anaplastic small cell follicular carcinomas was better than for those with small cell malignancies of undetermined cell origins. These findings suggest an important role for the immunoperoxidase technique in the precise classification of anaplastic small cell neoplasms of the thyroid.

Lymphomas or leukemia presenting as ovarian tumors. An analysis of 42 cases

Forty cases of ovarian lymphoma and two of extramedullary leukemia were examined with emphasis on histologic types correlated with age, modes of presentation, operative findings, including frequency of bilaterality and omental spread, clinical course following therapy, and problems in differential diagnosis. Although most cases were referred with diagnoses other than lymphoma (granulosa cell tumor or dysgerminoma, occasionally anaplastic tumor, Krukenberg tumor, or metastatic breast carcinoma), utilization of sections cut at 4 mu and stained with hematoxylin and eosin, or sections stained by the methyl green pyronine (MGP), naphthol-ASD esterase (NASD) or periodic acid-Schiff (PAS) methods helped bring out the lymphoid or hematopoietic nature of the cells. Sixteen patients were under 20 years of age. They had small noncleaved cell lymphoma (undifferentiated Burkitt's and non-Burkitt's, 10 cases), diffuse immunoblastic large cell lymphoma (4 cases), or acute granulocytic leukemia (2 cases). Twenty-six patients were 29 to 74 years of age and had diffuse large cell lymphoma (10 cases), diffuse immunoblastic large cell lymphoma (9 cases), follicular (nodular) lymphoma (6 cases) or small noncleaved cell lymphoma (1 case). Pain with an abdominal or pelvic mass was the most common presentation. Nine tumors were discovered during investigation of other gynecologic complaints. At laparotomy, the tumors in 55% of cases involved both ovaries, and in 64% also involved extragonadal sites (usually omentum, fallopian tubes, or lymph nodes). Seventeen patients had tumor affecting one ovary, seven of these without any evidence of extragonadal spread. Forty-two percent (15) of 37 patients with follow-up were alive after 2 years. Only nine patients survived more than 5 years; two subsequently died of lymphoma. Favorable prognostic features included: (1) FIGO stage IA; (2) unilateral ovarian involvement; (3) focal involvement of one ovary; and (4) follicular (nodular) lymphoma.

Immunoblastic sarcoma of the bladder

We describe the first case of immunoblastic sarcoma of the bladder. Urologists should be aware of this entity arising in organs that are prone to chronic antigenic stimulation. Treatment consists of radiotherapy for localized lesions and combination chemotherapy for more advanced disease.

The immunologic characterization of 40 extranodal lymphoid infiltrates: usefulness in distinguishing between benign pseudolymphoma and malignant lymphoma

In the studies described here, 40 extranodal lymphoid tumors obtained from 38 patients were evaluated by cell-marker analysis and the results correlated with the light microscopic features. These infiltrates were investigated for the present composition of cells expressing Ia antigens, surface immunoglobulin (SIg), including kappa and lambda light chains, sheep erythrocyte (E) rosette formation, and acid a-naphthyl acetate esterase (ANAE) activity. Fifteen biopsy specimens consisted of variable proportions of benign T and polyclonal B cells; these 15 lesions had the histopathologic features of benign pseudolymphomas. The remaining biopsy specimens consisted almost entirely of B cells bearing monoclonal SIg (18 cases) or a great preponderance of T cells (five cases) or non-B, non-T (null) cells (two cases); these 25 lesions were classified histopathologically as malignant lymphomas. Thus, the extranodal lymphoid infiltrates were divisible, according to their cell-marker characteristics, into two categories: lesions that are immunologically polyclonal and lesions that are immunologically monoclonal B-cell proliferations or consist of a great preponderance of T or null cells. In each case, polyclonality correlated with benign cytomorphologic features and monoclonality correlated with malignant histopathology. Cell-marker analysis appears to represent an important adjunct to light microscopy in distinguishing histologically problematic benign pseudolymphomas from malignant lymphomas that arise in the extranodal tissues. Cell marker analysis will undoubtedly provide insights into the histogenesis, natural history, and biologic behavior of the extranodal lymphoid neoplasms not attainable using light microscopy alone.

Malignant lymphoma of the thyroid gland: a clinicopathologic study

This study reviews 21 cases of thyroid lymphoma diagnosed between 1969 and 1980. The thyroid gland was the primary site in all but two cases. The 20 patients with non-Hodgkin lymphoma had a mean age of 66 years, 75% were women, and all were Caucasian. A rapidly growing thyroid mass with hoarseness, dysphagia, and difficulty in breathing was the initial finding. Most patients had diffuse histiocytic lymphomas. Associated Hashimoto thyroiditis was found histologically in 57% of the cases. Using the immunoperoxidase stain method on tissue sections, intracytoplasmic monoclonal immunoglobulin was demonstrated in 5 of 15 cases. All but two patients received radiation therapy, and 13 received chemotherapy. The median survival was 8 months; 20% died of unrelated causes and 32% are alive (average duration: 27 months). Dissemination, after local control by radiation therapy, was the leading cause of death. The prognosis was better in men, in patients under the age of 65 years, and in those patients who, on biopsy, did not have involvement of the extrathyroid soft tissue or regional lymph nodes.

Ocular adnexal lymphoid neoplasms: clinical, histopathologic, electron microscopic, and immunologic characteristics

Clinicopathologic analysis of 400 ocular adnexal lymphoid neoplasms has demonstrated that the orbital lymphoid neoplasms occur primarily in the sixth and seventh decades of life; that their benignancy or malignancy is generally indistinguishable clinically; that the orbital malignant lymphomas are most commonly small cell lymphomas; that the orbital "histiocytic" lymphomas almost always represent an anomalous deposit of disseminated lymphoma; and that the percentage of patients with orbital lymphoma who develop systemic disease varies with the histopathology: two thirds of cases of poorly differentiated lymphocytic lymphomas, as defined cytomorphologically, have associated systemic disease. Prospective correlative clinicopathologic and immunologic analysis of 25 cases has shown that cell marker analysis divides the ocular adnexal lymphoid infiltrates into immunologically polyclonal proliferations, which show diverse but benign histopathologic features, and immunologically monoclonal B cell proliferations, which have the histologic features of malignant lymphomas. The benign, polyclonal ocular pseudolymphomas recapitulate the cell marker profile of a benign reactive lymph node with similar variations in the T cell:B cell ratio. The ocular adnexal and nodal B cell lymphomas are analogous in that they most commonly express surface IgM heavy chains and kappa light chains, express Ia antigens in parallel with SIg, and occasionally contain neoplastic B cells at various developmental stages--i.e., Ia+SIg+ and Ia+SIg-. Correlative immunologic and ultrastructural studies have demonstrated that electron microscopy is a reliable and reproducible technique for indirectly assessing the mono- or polyclonality of an ocular adnexal lymphoid neoplasm. This study is focused on the use of hybridoma-derived monoclonal antibodies, which are capable of detecting maturational stages of B and T cell differentiation and functionally distinct T cell subsets, in order to investigate the interactional and immunoregulatory defects that participate in the generation of the ocular adnexal lymphoid proliferations.

Non-Hodgkin's lymphoma presenting as thyroid enlargement

From 1969 to 1978, 11 patients with non-Hodgkin's lymphoma presenting as thyroid enlargement were evaluated and treated in the Division of Radiation Therapy at Stanford University Hospital. All patients were staged with lymphangiogram and bone marrow biopsy. Eight patients had Stage I-II disease and three patients had Stage III-IV disease. The histologic pattern of the biopsies was diffuse in nine cases, and eight cases were classified as histiocytic lymphoma. All eight patients with Stage I or II disease were treated with irradiation. There is an 83.3% survival at three years and a 75% relapse-free survival at two years. No instance of local recurrence was observed in this group of patients. The three patients with Stage III or IV disease were treated by either irradiation or chemotherapy. Two relapsed within one year and died with disease; the third remained free of disease for nine years before relapse and died with disease six months later. High dose regional irradiation is the recommended treatment for patients with Stage I-II lymphoma of the thyroid.

Non-Hodgkin's lymphoma of the nose and paranasal sinuses: a study of 17 cases

Non-Hodgkin's lymphoma of the nose and paranasal sinuses occurred in 14 men and 3 women with a mean age of 61 years. Nasal obstruction, unilateral facial swelling, and nasal discharge were frequent initial manifestations. The maxillary sinus and nose were the commonest primary sites. Using Rappaport's classification, there were 9 histiocytic, 5 poorly differentiated lymphocytic, and 3 mixed histiocytic-lymphocytic lymphomas. Sixteen patients had radiation therapy to the primary site, and 9 patients later received chemotherapy. Eleven patients (69%) are dead, with a median survival time of 11 months after diagnosis. Dissemination of lymphoma was the most common cause of death. Five patients (29%) are alive up to 40 months after diagnosis. Patients with poorly differentiated lymphocytic lymphoma survived longer than those with histiocytic or mixed histiocytic-lymphocytic lymphomas (medium survival times 35, 9, and 12 months, respectively). Poor response to radiation therapy and dissemination of lymphoma were poor prognostic indicators.

Management of thyroid nodules. II: Scanning techniques, thyroid suppressive therapy, and fine needle aspiration

For the differentiation of benign from malignant thyroidal disease, ultrasound displays anatomic but not histologic features. Other visualization techniques can be used including isotope scanning (radioiodine, 99m technetium, 241 americium fluorescence, 131 cesium, 67 gallium, 75 selenomethionine, 201 thallium, 32 phosphorus, 99m Tc-bleomycin, 197 mercury, 133 xenon), thermography, x-ray techniques (plain films, computed tomographic scan, xeroradiography, chest x-ray barium swallow, lymphography, angiography), and thyroid hormone suppression. Needle biopsy can be done by core biopsy (Vim-Silverman and drill biopsy), large needle biopsy for histologic processing and fine needle aspiration for cytologic interpretation. The latter is the safest, most reliable, and most cost-effective technique currently available to differentiate between benign and malignant thyroidal disease and has great promise for the future.

Electron microscopy in surgical pathology: a selective review

The high resolution provided by electron microscopy can contribute to histomorphological diagnosis by allowing the detection of structures which are invisible to the light microscope. These structures include characteristic nuclear or cytoplasmic contours, intercellular attachments and intracellular components. The recognition of such features may allow specific diagnosis in lesions which cannot be precisely categorized by light microscopy. Electron microscopy is particularly useful for the diagnosis of neoplasms. This review describes some of the characteristic morphological features which can be demonstrated in neoplastic cells by electron microscopy and briefly considers several areas where the technique is of special value. Electron microscopy is now an integral part of the diagnostic process in surgical pathology and can be regarded as a routine technique rather than a special procedure to be delegated to others.

Malignant lymphoma of the thyroid gland with plasma cell differentiation (plasmacytoma)

An unusual case of malignant lymphoma of the thyroid is reported. The predominant appearance of the neoplasm was that of a large cell ("histiocytic") lymphoma, but a discrete portion of the tumor showed features typical of plasmacytoma. Electron microscopy revealed a wide spectrum of cell types, ranging from very immature lymphoid cells to relatively well-developed plasma cells. The findings support the concept that the neoplastic process represents an immunoblastic sarcoma composed of proliferating transformed B lymphocytes (immunoblasts) and their progeny (plasma cells) rather than two distinct lymphoid neoplasms occurring simultaneously.

Sinusoidal large cell ("histiocytic") lymphoma

A sinusoidal pattern of involvement by large cell ("histiocytic") lymphoma was present focally or throughout the initial lymph node biopsies of 18 patients. Clinical, ultrastructural, histochemical, and immunopathologic studies confirm that this is lymphoma. The recognition of this variant of large cell lymphoma is important in avoiding the common misdiagnoses, which were metastatic carcinoma, metastatic malignant melanoma, and malignant histiocytosis. The number of patients is too small for comment on whether the pattern has prognostic implications.

Orbital lymphoid neoplasms: a clinicopathologic study of 60 patients

Sixty cases of orbital lymphoid neoplasms originally accessioned as malignant lymphomas were analyzed histopathologically and the follow-up data evaluated separately for each category as follows: inflammatory pseudo-tumor, 5; reactive lymphoid hyperplasia, 8; atypical lymphoid hyperplasia, 7; and malignant lymphocytic lymphoma (classified according to Rappaport), 40. Significant clinical differences were not observed among these patients, suggesting that the lesions must be distinguished by histologic rather than clinical criteria. Systematic application of the histologic criteria discussed here improved diagnostic accuracy and our ability to predict clinical outcome as substantiated by follow-up data. Two of 13 patients (15%) with benign pseudo-lymphomas, 2 of 7 patients (29%) with atypical lymphoid hyperplasia, 2 of 8 patients (25%) with well differentiated lymphocytic lymphomas, and 22 of 32 patients (68%) with less differentiated lymphocytic lymphomas either had or later developed systemic lymphomas. Thus, the degree of cytologic differentiation appears to be the single most important factor for determining the prognosis of patients with orbital lymphoid neoplasms.

The natural history of malignant thyroid lymphomas

Twelve patients with malignant thyroid lymphomas seen over a 12-year period were reviewed. Two of these patients developed intra-abdominal lymphoma and a third, adult coeliac disease. Treatment by radiotherapy and thyroxine was effective, with thyroid excision mainly reserved for obstructing lesions. Prognosis was not affected by local metastases. A plea is made for open thyroid biopsy and accurate clinical staging of patients with this disease.

Radiation therapy treatment of stage I and II extranodal non-Hodgkin's lymphoma of the head and neck

We have reviewed the records of 76 patients with Stage I or II extranodal non-Hodgkin's lymphoma who were referred to the Division of Radiation Oncology, Mallinckrodt Institute of Radiology, during the years 1964 through 1974. The histologic slides were reviewed in the 67 cases in which they were available. Forty-three percent of Ann Arbor Stage I and II patients relapsed after primary radiation treatment.Seventy-three percent of these failed in sites distant from the irradiated volume. Failures in the treated volume were infrequent (7%) except in those patients presenting with primary lesions of the brain (4/5). Those patients presenting with lesions of Waldeyer's ring experienced a decrease in survival with increasing tumor size. Because of the high rate of failure in distant sites with tumors in the lingual and palatine tonsils, we are recommending the study of adjuvant chemotherapy in these cases, after primary radiation treatment.

Benign and malignant lymphoid lesions of the stomach. A histological reappraisal in the light of the Kiel classification for non-Hodgkin's lymphomas

Twenty-two cases of lymphoid tumours of the stomach were reviewed by application of the Kiel classification for non-Hodgkin's malignant lymphomas. Four cases of pseudolymphomas were found, one of which had been previously misdiagnosed as malignant lymphoma. The remaining cases were all malignant tumours with B-cell lymphoma features. These were divided into seven low grade lymphomas (three immunocytomas and four centroblastic/centrocytic) and II high grade lymphomas (six centroblastic and five immunoblastic lymphomas). No cases of Hodgkin's disease or lymphoblastic lymphoma were observed. The Kiel nomenclature was not only easy to apply, but also helped to differentiate pseudolymphoma from malignant lymphoma. Both the pseudolymphomas and the malignant lymphomas were consistently associated with follicular gastritis. This lesion, while intrinsically non specific, was sometimes accompanied by suggestions of transition between itself and the lymphoma, a fact which at least raises the possibility of a transformation of the former into the latter.

Immunoblastic sarcoma: a clinical description

We reviewed the clinical records of 33 patients with Immunoblastic Sarcoma in order to further describe this disease clinically. Several common features were found. Thirty percent of the patients had a history of a prior immune disease or lymphoproliferative malignancy. Forty-four percent of the patients tested had a diffuse hypergammaglobulinemia. Lymphopenia (less than 1,000/mm3) was found in 45%, and anemia occurred in 73%. At initial presentation, 30% of the cases were clinically staged as either stage I or II, whereas 70% were found to be stage III or IV. Forty-nine percent of the patients had systemic symptoms at presentation. The median survival was 14 months. Advanced stage of disease, lymphopenia, and presence of systemic symptomatology were associated with significantly decreased survival times (p less than .05). We conclude that IBS is a clinical entity often associated with prior immune disease and/or diffuse hypergammaglobulinemia.

Immunoblastic lymphosarcoma: a light, immunofluorescence, and electron microscopic study

Immunoblastic lymphosarcoma (ILS) is a newly recognized malignant lymphoreticular neoplasm and is included in the recent W.H.O. classification of lymphomas. This report concerns six cases of ILS studied by light, immunofluorescence (IF), and electron microscopy (EM). Four patients were female and all except one were over 50 years of age. Four patients had some immunological abnormality. Light microscopy showed a monomorphic population of immunoblasts with pyroninophilic cytoplasm and variable plasmacytoid differentiation. Intracytoplasmic IgG was demonstrated by IF in four cases, and IgA in one. Large lymphoid cells with varying proportions of polysomes, rough endoplasmic reticulum, and Golgi apparatus were seen by EM in four cases. Mean survival was 4.8 months in five cases; death in four was due to disseminated ILS. We concluded that our cases of ILS are of B cell origin, are often associated with immunological abnormalities, and carry a poor prognosis. Immunofluorescence and EM are helpful in its diagnosis.

Primary extranodal lymphoma: response to treatment and factors influencing prognosis

The cumulative 10 year lymphoma experience of a teaching hospital and two of its affiliated institutions was reviewed. From this group, a series of 39 cases of regionally localized primary extranodal lymphomas (Ann Arbor Stages IE and IIE) were selected for study. This group of patients was analyzed for response to initial curative treatment and factors influencing prognosis. The disease-free survival rate following initial treatment is 41% and the rate is 51% if those treated for a single relapse are included. Factors which clearly influence prognosis in this group are stage (extent of disease) at presentation and Rappaport histologic subclassification. The relationships of anatomic site and age to prognosis independent of other factors are unclear. There appears to be an association between sites of involvement in Waldeyer's Ring and the gastrointestinal tract seen both initially and in sites of relapse. An analysis of relapse patterns revealed that 33% of relapses occur as solitary extranodal "skip" recurrences that when treated with radical local treatment may result in long disease-free survival. The latter is one of several findings which suggest that a modification of the current Ann Arbor staging system may be necessary to encompass certain unique features of this group of tumors.

Idiopathic pleomorphic midfacial granuloma (Stewart's type)

Idiopathic mid-facial granuloma is an unusual highly destructive disease which was virtually unknown prior to 1955. Great confusion exists, due in large part to the terminology applied to this entity as well as the clinical similarity of the process to other destructive mid-facial lesions. A classical case of idiopathic mid-facial granuloma of Stewart's type is presented, with characteristic lesions limited to the mid-face. Definitive histopathological features consist of pleomorphic inflammatory granulation tissue with patchy necrosis and no system lesions or neoplasia in the autopsy tissues.

The fine structure of human thyroid cancer

This ultrastructural description of human thyroid cancers is based on the available literature and on our own studies of about 150 cases. Electron microscopy is an invaluable diagnostic adjunct to light microscopy, as it may eliminate inaccurate designations such as "small cell malignant tumors of the thyroid," which include tumors of different histogenetic origin with a different prognosis and treatment that share only a similarity in appearance under the light microscope. Ultrastructure is also of diagnostic importance in cases of medullary carcinoma that imitate papillary or follicular patterns or lack amyloid stroma. Its importance in separating follicular adenomas from carcinomas, however, has not been proven. In conjunction with other methods ultrastructural study might throw new light on the controversial classification of papillary and follicular carcinomas and improve our understanding of their different biologic behavior. Immunoelectron microscopy may help in solving the problem of amyloid pathogenesis in endocrine tumors and in charting the subcellular mechanisms involved in the production of multiple polypeptide hormones in a single tumor.

Cell receptor studies on six anaplastic tumours of the thyroid

Cell suspensions from six anaplastic thyroid tumours were studied for expression of lymphocyte and macrophage surface markers, and results were correlated with electron microscopy, clinical extent of disease, and response to radiotherapy. The clinical presentation of the disease was similar in all six patients. In five cases, many of the cells showed surface immunoglobulin. Electron microscopy was available on three of these and showed appearances in keeping with malignant lymphoma. The single case whose cells did not show surface immunoglobulin had an entirely different ultrastructure and was probably a carcinoma. This case was the only one that did not achieve complete remission with radiotherapy and the patient died from extensive local recurrence. It is concluded that receptor techniques are of value in distinguishing between malignant lymphoma and other anaplastic tumours of the thyroid, particularly when the results are correlated with histology.

Malignant lymphomas and undifferentiated small cell carcinoma of the thyroid: a clinicopathological review in the light of the Kiel classification for malignant lymphomas

The paper reports a re-evaluation--based on the Kiel classification for non-Hodgkin lymphomas--of a group of cases initially diagnosed as undifferentiated small cell carcinomas or primary lymphomas of the thyroid. Twelve such cases were found among the 155 cases of primary malignant tumours of the thyroid recorded at the Institut Jules Bordet between 1955 and 1975. The review of the clinical charts and the histology showed that all the cases were in fact malignant lymphomas fitting easily into one of the groups described in the Kiel classification. These findings support the growing opinion that undifferentiated small cell carcinoma of the thyroid does not exist as a distinctive clinicopathological entity. Furthermore, the Kiel classification proved to be an excellent prognostic indicator, since all the cases classified as highly malignant were indeed fatal, whereas the surviving cases--three of which had shown tumoral extension beyond the thyroid capsule--fell into the group of low malignancy. Lastly, this study acknowledges the frequently observed association of malignant lymphoma of the thyroid with stigmata of Hashimoto's disease, and thus supports the concept that the continuous antigenic stimulation observed in the latter could trigger the development of a malignant lymphoma.