1993 Volume 30 Issue 11 Pages 985-989
An 87-year-old woman, who had been suffering from hypothyroidism and had been treated as an outpatient at our department since 1982, noticed left cervical swelling toward the end of November 1992. Because ultrasonic examination revealed a mass in her thyroid gland, she was admitted for a closer examination and additional treatment. Biopsy of thyroid gland revealed non-Hodgkin's lymphoma (NHL; the diffuse small cell type, B-cell origin). A part from the swelling of thyroid gland and the left cervial lymph node, performance of various examinations did not detected any other NHL lesions. Therefore, it was classified as stage II NHL according to the Ann Arbor classification. Laboratory data on admission were as follows; WBC 4, 400/μl, Hb 13.6g/dl, platelet count 10.1×104/μl, GOT 51 IU/l, GPT 31 IU/l, TSH 1.17, free-T4 1.03, free-T3 2.04, and microsome test 1, 600x. Those data indicated marked hypothyroidism. In addition, stage IIa and IIc gastric cancers were detected by the examination with gastric endoscopy performed for stage classification. Both were adenocarcinomas. Because polyps were found in her sigmoid colon with colonoscopy, polypectomy was performed. The polyps were diagnose histologically as moderately differentiated adenocarcinoma. On July 20, COP-BLAM therapy was started (CPM 600mg div, VCR 1.2mg iv, ADR 30mg iv on day 1, PDN 40mg p.o and PCZ 100mg p.o. on days 1-10, BLM 7.5mg div on day 14). Subsequently, the left cervical lymph node swelling disappeard, and shrinkage of the mass in the thyroid gland was observed. During the second cycle of the chemotherapy, which was started on Feburary 15, she complained dyspnea on February 25 and she was found to have heart failure and fungal pneumonia, which was successfully treated by administration of oxygen, diuretics, and antifungal agents. Consequently, because the continuation of strong chemotherapy was considered impossible, she was treated with sustained oral administration of VP-16 (25mg/body) and entered into complete remission (CR), She was discharged on April 10 and is now receiving a continued maintenance therapy with a small dose of VP-16 on an outpatient basis. We reported a case of primary NHL of the thyroid, which was detected during the course of Hashimoto's disease and associated with the simultaneous occurrence of gastric cancer and colon cancer, and with chemotherapy.
