Conducting prospective randomized trials is difficult due to

Conducting prospective, randomized trials is difficult due to the limited number of cases. Therefore, a single standard treatment is not available for thyroid lymphoma. Common treatment regimens are derived from the treatment of extranodal lymphomas. Thyroidectomy and radiotherapy are effective for local tumor control; however, chemotherapy is necessary in aggressive, disseminated disease. In both retrospective studies of thyroid lymphoma and prospective studies of extranodal lymphoma, more favorable survival was achieved through combined radiotherapy than through a single treatment. However, a limitation of these studies is the lack of differentiation among histological subtypes of thyroid lymphoma. DLBCL usually presents as a more aggressive and disseminated disease, whereas MALT lymphoma tends to be localized. Localized treatment through surgery or radiotherapy produces satisfactory results for early-stage MALT lymphoma. Radiotherapy alone can deliver excellent long-term relapse-free survival in stage I and II thyroid MALT lymphoma. Moreover, no clear survival benefit is yielded when chemotherapy is used for MALT lymphoma. The outcomes of large sirtuin 1 or high-grade malignant cells admixed with MALT lymphoma are similar to or poorer than those of pure diffuse large-cell-subtype lymphoma. In such cases, a more aggressive treatment should be used. The complete surgical resection of the thyroid can exclude this possibility. In Patient 5, total thyroidectomy was performed despite a previous pathological diagnosis of MALT lymphoma. The reasons for removing the remaining thyroid tissue were both to establish a definitive diagnosis and to cure the localized lymphoma. Because high-grade malignancies were excluded by pathology, the patient underwent adjuvant radiotherapy instead of chemotherapy. No recurrence was observed after 107 months of follow-up, consistent with favorable outcomes expected from surgical treatments of MALT lymphoma. The airway obstruction caused by thyroid lymphomas requires urgent treatment. Endotracheal-tube insertion or tracheostomy is the first step to securing the airway in an emergency situation, followed by definite treatment. Radiotherapy alone with pulse-steroid therapy can induce tumor necrosis and shrinkage. Once DLBCL is confirmed through biopsy, airway compression can be further relieved using a combination of steroid, chemotherapy, and radiotherapy. Thyroidectomy may also have an immediate relieving effect on the airway obstruction; however, complete resection is usually impossible due to the infiltrating tumor or extensive growth, posing a high risk of injury to the recurrent laryngeal nerve or parathyroid glands.
Introduction Excessive production of proinflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-8 by immunocompetent cells can induce systemic inflammatory response syndrome (SIRS). Among these proinflammatory cytokines, IL-6 has a longer half-life than TNF-α and IL-1β do, and blood IL-6 levels remain consistently elevated in people with various diseases. IL-6 has been implicated as being responsible for increased gut mucosal permeability in mice with a condition associated with systemic inflammation, namely, polymicrobial peritonitis induced by cecal ligation and perforation. IL-6 is a pleiotropic cytokine involved in both proinflammatory and anti-inflammatory responses by regulating leukocyte function and apoptosis. It is a crucial cytokine associated with inflammatory bowel disease as well as other chronic inflammatory diseases and cancer. However, the correlation of IL-6 with gut barrier failure and bacterial translocation in critically ill patients has not been well characterized. The intestinal tract acts as a major physical barrier between the microflora and internal host tissue, and it responds to the mucosal innate system through commensal microflora. The mucosal barrier is composed of epithelial apical junction complexes, consisting of tight junctions and adherence junctions. Gut barrier function failure due to a major stress insult permits bacterial and endotoxin translocation, which triggers systemic cytokines and exacerbates a systemic immunoinflammatory response that results in organ failure. Intestinal barrier failure is a crucial issue in the treatment of critically ill patients. Bacterial translocation from the intestinal tract is a major cause of thermal injury-induced sepsis and mortality. Providing enteral nutrients shortly after injury alters the gut flora and protects the immunocompromised, stressed, or thermally injured patients through an unknown mechanism. However, small intestine dysfunction is frequently underdiagnosed and associated with poor prognosis in critically ill patients.