Search

The value of aspiration cytology in the management of Hodgkin's disease is shown in this study of 228 patients and 403 aspirations; 385 from lymph nodes and 18 from extranodal masses. In all patients the initial diagnosis was established on surgical biopsy. Aspirates were helpful in staging, defining extension of unusual radiation fields, and in recognizing residual disease and relapses after therapy. Adequate material was obtained in 80% of aspirations. The diagnosis of Hodgkin's disease could not be established in the adequate cytologic sample in 9.9% of cases. In 5.5%, the diagnosis was that of benign reactive hyperplasia and in 4.4%, non-Hodgkin's lymphoma. Unsatisfactory material was usually obtained from nodes less than 1 cm in diameter or from residual lesions following radiation or chemotherapy. Only 14 of 93 such lesions proved to have active disease during follow up. There were no significant complications. Characteristics of the varied aspects of aspirated tumor cells found in Hodgkin's disease are described.

This is a case report of a patient who had received radiation therapy for Hodgkin's disease and 48 years later developed adenosquamous carcinoma of the thyroid gland. Radiation associated thyroid carcinoma is usually of differentiated variety and carried no different prognosis than one not related to radiation. Coexisting adenocarcinoma and squamous cell carcinoma is a very rare event, but makes the prognosis of patients with thyroid carcinoma much poorer. As a result, this kind of patient requires early recognition and aggressive therapy.

Post-irradiation carcinoma of the thyroid is usually histologically well-differentiated. In general, those subjects who developed carcinoma had been exposed to low-to-moderate doses of irradiation for benign conditions. We reviewed the charts of 520 patients with Hodgkin's disease seen at Roswell Park Memorial Institute, and found 2 cases of anaplastic carcinoma amongst other thyroidal abnormalities. The existing reports of post-irradiation carcinoma are reviewed and suggestions are made for the management of heavily irradiated, potentially cured patients with Hodgkin's disease.

The effects on the thyroid of radiation therapy to the neck and/or chemotherapy were investigated in 54 Hodgkin's and 72 non-Hodgkin's lymphoma patients. These patients had received radiation therapy with doses ranging from 2000 to 4000 rad (median 3600 rad) to the cervical or mantle fields and/or multiple-agent chemotherapy following usual staging procedures. Palpable abnormalities of the thyroid were found in 15 patients. The patients with irradiation to the neck had a higher incidence of hypothyroidism than those patients treated with chemotherapy alone (31/74 vs. 8/52, P less than 0.001 for TSH and 10/74 vs. 1/52, P less than 0.025 for T4). A higher frequency of elevated serum TSH levels and antithyroid antibodies were also observed in patients receiving radiation therapy alone to the neck than in those receiving both radiation therapy and chemotherapy (19/33 vs. 12/41, P less than 0.025 for TSH and 16/33 vs. 7/41, p less than 0.01 for antibodies), suggesting that chemotherapy agents may reduce the thyroid dysfunction induced by irradiation. There was no difference in prevalence of elevated TSH levels following irradiation to the neck between patients in whom lymphangiogram was or was not performed (21/51 vs. 10/23).

Two patients with anaplastic carcinoma of the thyroid following irradiation for Hodgkin's disease are presented, and the previously reported cases briefly reviewed. The risk of late development of thyroid carcinoma is life-long and high-dose irradiation in patients with prolonged life expectancy may result in anaplastic carcinoma as well as less malignant histological forms.