Primary Mucosa-Associated Lymphoid Tissue Lymphoma of Thyroid with the Serial Ultrasound Findings

Abstract

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) of the thyroid gland is uncommon. Even though its natural history is not well defined, it is known to be indolent course. We present a case of primary MALT thyroid lymphoma with the serial sonographic findings in the patient presenting as the focal nodule. A 45-year-old woman visited our hospital for neck examination. Initially, fine-needle aspiration cytology in the focal hypoechoic lesion in the left thyroid lobe on ultrasound sonography was performed and consistent with Hashimoto's thyroiditis. However, the results of serial ultrasounds and core-needle biopsy revealed an extranodal marginal zone lymphoma of MALT on 4-year follow-up. Patients with a focal hypoechoic nodule with linear echogenic strands and segmental pattern in the background of Hashimoto's thyroiditis on ultrasonography should undergo careful surveillance for malignancy. Serial sonographic features in this case are meaningful in the understanding of the natural history of the extranodal marginal zone lymphoma of MALT of the thyroid.

Coexistence of Primary Mucosa-Associated Lymphoid Tissue Lymphoma of Thyroid and Papillary Thyroid Microcarcinoma in a Background of Hashimoto’s Thyroiditis

“…The study also stated that the incidence of Hashimoto's thyroiditis differed significantly among the four lymphoma groups: MALT, DLBL, MALT + DLBL, and small lymphocytic lymphoma (P=0.014) (11). Although most cases have Hashimoto's thyroiditis in the background, it has been reported that MALT lymphoma can also develop as de novo without the presence of the former (12).…”

“…The diagnosis of extranodal marginal zone lymphoma may be delayed due to poor systemic symptoms. The occurrence of B symptoms and cytopenia is very rare in this disease (11,12). Hematological tests along with few additional tests are required for patients with MALT lymphoma that are standard for patients with NHL required at the time of diagnosis.…”

“…The prognosis of the extranodal marginal zone lymphoma of MALT localized to the thyroid is excellent and the 5-year disease-specific survival rates for it are more than 95%; however, it is known that patients with extrathyroidal invasion or transformation to high-grade lymphoma have a poor prognosis. In addition, current guidelines do not have the optimal treatment and standardized follow-up protocol (12). As a result, extranodal marginal zone lymphoma of the thyroid gland is rare and its pathogenesis is not fully understood.…”

Primary mucosal-associated lymphoid tissue extranodal marginal zone lymphoma of the bladder from an imaging perspective: A case report

“…The general imaging manifestations of MALT lymphoma are solitary or multiple solid homogeneous masses without cysts, necrosis or calcification[ 15 , 16 ]. The ultrasound features of MALT lymphoma could be described as interspersed linear echogenic strand patterns or segmental patterns, according to the thicknesses of the septa[ 17 ]. The pathological basis for the formation of linear echo may be the expansion of lymphoma cells bordered by fibrous bands.…”

Fine needle aspiration of hematolymphoid lesions of the thyroid: Onsite adequacy and ancillary testing

“…[ 3 - 5 ] It is postulated to occur as a response to autoimmune processes, such as in patients with Hashimoto thyroiditis and patients with Helicobacter pylori infection. [ 6 ] FNA would show thyroid follicular atrophy with Hurthle cell changes and follicular cells with lymphocytic infiltration as lymphoepithelial structures [ 7 ] which were not detected in the current case (option C). Primary squamous cell carcinoma, typically common in elderly patients, is a rare entity which carries poor prognosis (may be a component of anaplastic thyroid carcinoma).…”