What Is the Connection Between Night Sweats and Lymphoma?

Primary thyroid malignant lymphoma (PTML) refers to a lymphoma that originates from the thyroid gland and is a rare malignant tumor of the thyroid gland. It often occurs in middle-aged and elderly people, and there are more women than men. The ratio of male to female is 1: 2.7. May be related to factors such as viral infections and immunodeficiency.

Basic Information

Visiting department: Endocrinology
Multiple groups: Middle-aged and elderly women

Common locations: thyroid
Common symptoms: Compression symptoms of trachea and throat, fever, night sweats, and significant weight loss

Causes of primary malignant thyroid lymphoma

The etiology of PTML has not been fully clarified so far, and may be related to viral infection, immune deficiency and other factors. Whether the infiltration of lymphocytes in thyroid lymphoma leads to the occurrence of chronic lymphocytic thyroiditis, or the long-term chronic stimulation of lymphocytes in thyroiditis, which induces the occurrence of PTML, needs further study.

Clinical manifestations of primary malignant thyroid lymphoma

Patients often show short-term rapid thyroid enlargement, and symptoms of trachea and larynx compression may occur, with fever, night sweats, and significant weight loss. Most patients can see a goiter mass at the time of consultation. The mass varies in size, has a firm texture, is often fixed, and has poor mobility. 40% of cervical lymphadenopathy can occur. Speech insufficiency is associated with 30% of patients. Hoarseness was seen in 20% of patients, dyspnea in 10%, and hypothyroidism in 7%. Distant metastases are more common in the mediastinum, with bone and spleen invasion.

Examination of primary malignant thyroid lymphoma

Blood test

Blood routine suggests anemia and granulocytopenia.

2. Thyroid function test

It is suggested that TGAb and TPOAb are significantly increased.

3. bone marrow aspiration

Eliminate blood diseases.

4. Fine Needle Aspiration Aspiration Cytology (FNAC)

The immunological indicators and DNA flow cytometry can be performed at the same time to further confirm the diagnosis. If immunohistochemical staining shows CD20 positive, suggesting B cell-derived lymphoma. Sometimes it can be seen that the immunoglobulin is elevated, especially the lambda and kappa light chains are over-expressed. The detection of immunoglobulin gene rearrangement indicates clonal aggregation. FNAC meets clinical diagnostic requirements. If HT that is difficult to identify is suspected, it must be supplemented with the above-mentioned immunological indicators and surgical biopsy if necessary.

5.X-ray chest radiograph

It can show the compression of the mediastinum, widen the trachea, etc., and help to understand the presence of thoracic metastasis.

6.CT scan

CT of the chest and abdomen can help to understand the presence of lymphoid tissue lesions in the mediastinum, inside and outside the abdominal cavity.

7.B-ultrasound

Exclude liver and spleen organs.

8. Lymphangiography

If lymphedema occurs, radionuclide lymphangiography is required.

Diagnosis of primary malignant thyroid lymphoma

There are certain difficulties in clinical diagnosis of PTML. The preoperative diagnosis rate was less than 50%. In recent years, with the advancement of imaging technology and diagnostic technology, the preoperative diagnosis rate has increased greatly.

1. The disease should be highly suspected if the following conditions occur: a short-term rapid increase in thyroid mass with cervical lymphadenopathy Hoarseness and difficulty breathing. accompanied by fever and weight loss. The chest X-ray showed that the mediastinum was widened and the trachea was compressed. Have a history of HT. The thyroid function test showed that TGAb and TPOab were significantly increased.

2. Blood routine, bone marrow aspiration, whole body bone scan, etc. can exclude other blood diseases; fine needle aspiration aspiration cytology (FNAC), biopsy pathological examination can confirm the diagnosis, and immunohistochemical examination must be done; X-ray examination, CT Scans, ultrasounds, etc. can help find metastatic lesions.

Differential diagnosis of primary thyroid lymphoma

Before treatment, benign nodules of the thyroid gland, such as adenomas, nodular goiters, thyroid cancer, and thyroiditis, must be ruled out. If necessary, FNAC and related immunohistochemical indicators should be used.

Primary malignant thyroid lymphoma treatment

A more unified understanding of the treatment of PTML has the following aspects:

1. If E, stage

Surgical resection is taken in principle. Complemented by radiotherapy or chemotherapy after surgery.

2. If IIIE, IVE stage

In principle, radiation therapy combined with chemotherapy is adopted. Surgical palliative resection can be used when the thyroid mass is significantly enlarged and there are compression symptoms.

3. When FNAC cannot confirm the diagnosis and must open a biopsy

It can be combined with radiotherapy or combined radiotherapy and chemotherapy according to the stage after surgical resection.

4. Radiation dose

Generally, the area of 30-50Gy radiation mainly adopts regional lymph node area and mediastinal area.

5. Chemotherapy regimen

Generally choose CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) plus bleomycin, or methotrexate, or doxorubicin (doxorubicin). The average period is 6 A course of treatment.