A Current Analysis of Primary Lymphoma of the Thyroid

Abstract

Over a 9-year period ending in May 1990, 27 patients with histologically proved thyroid lymphoma were assessed and treated. There were 24 female and three male patients with a median age of 67 years at the time of diagnosis (age range, 39 to 85 years). The usual presentation was that of a rapidly enlarging neck mass. Incisional biopsy was the diagnostic procedure of choice; however, nine of 27 patients underwent diagnostic partial or total thyroidectomy based on a preoperative impression of thyroid carcinoma. All 27 patients had non-Hodgkin's lymphomas of intermediate (77%) or high (23%) grade. Detailed staging was carried out in 25 patients; seven patients (28%) had disease confined to the thyroid gland (stage I), while 18 (73%) had accompanying disease in cervical lymph nodes or the mediastinum (stage II). Combined multiagent chemotherapy and irradiation was given to 19 of 25 staged patients (76%). Actuarial, overall 5-year survival for all patients was 70% with 48 months being the median follow-up for living patients (follow-up range, 3 to 102 months). Of a number of factors evaluated using log-rank survival tests, only the absence of dysphagia at the time of hospital admission, a primary tumor mass not greater than 10 cm, restriction of disease to the thyroid gland, and the absence of mediastinal lymph node involvement were statistically significant predictors of improved survival. Surgery should usually be restricted to diagnostic biopsy, as there is infrequently a role for resection in the management of thyroid lymphoma, given the effectiveness of combined multiagent chemotherapy and radiotherapy.

Non-Hodgkin's Lymphoma of the Thyroid: A clinical study of twenty-two cases

“…Although some investigators question any special relationship between thyroid and gastrointestinal lymphoma (19), others have reported that relapse after treatment of thyroid lymphomas is frequently located in the gastrointestinal tract (12,20,21), as was also observed in our study. Most relapses seem to occur within the first 2 years after diagnosis (6,7,9,10,22).…”

“…Most relapses seem to occur within the first 2 years after diagnosis (6,7,9,10,22). Late relapses have, however, also been reported (11,12). Lymphomas arising from MALT tend to remain localized until late in the course of the disease (1 5 , 16).…”

Non-Hodgkin's Lymphomas (NHL)

“…5-year survival of 70% to 80% (132,134,135). In one study, nonrandomized comparisons showed longer relapse-free survival for combination therapy than for radiotherapy (134), but another study found no difference between these two forms of treatment (132).…”

“…that stages 11-IV should be treated by primary chemotherapy, and if complete remission is not achieved or if the disease is bulky, it should be followed by radiotherapy (128,135) or combination therapy if the patient's condition permits (131,133,134);…”

Primary thyroid lymphoma: report of two cases

“…Almost all patients with these forms of thyroid lymphoma have a history of Hashimoto's thyroiditis. The five year survival rate for patients with thyroid lymphoma ranges from 10-35% in cases with unfavourable histology to 70% in those with favourable histology (4,5). Mediastinal involvement and performance status are important prognostic factors influencing relapse free survival and overall survival(6).…”