An Unwonted Clinicopathological Subtype of Thyroid Primary Lymphoma

Abstract

Primary thyroid lymphomas account for less than 5% of all thyroid malignancies and the majority of cases concern non- Hodgkin's lymphoma of B and T-cell origin as well as Hodgkin's lymphoma. Mucosa-associated lymphoid tissue (MALT) lymphoma are a relatively recently described subset of low grade B-cell non-Hodgkin's lymphoma representing between 6 and 27% of the patients with thyroid lymphomas. These cases occur usually in patients with Hashimoto's thyroiditis having a long indolent course and delayed diagnosis, actually benefit from several therapeutic opportunities among them even surgery and a favorable prognostic. Herein we present a 42-year-old female admitted in our unit for a right firm sensitive thyroid swelling, nonhomogeneous on ultrasound images. FNAB showed cellular smears of mixed follicular cells on a background of mature lymphocytes displaying some nuclear atypia and scanty cytoplasm but no definite malignant elements. Intraoperatively, in addition to the "banal" goiter that was found, some subcentimeter cervical lymph nodes were evidenced. Frozen section showed no evidence of malignant or even suspected cellular elements. However a total right lobectomy and lymph node excision was performed. Microscopy revealed a diffuse lymphoproliferative infiltrate in a background of lymphocytic thyroiditis suggesting a diagnosis of B-cell lymphoma of MALT type and the patient was referred to chemotherapy. She was currently under follow-up without recurrences or metastases after two years from surgery.

Parathyroid Carcinoma in a Patient With Secondary Hyperparathyroidism and Thyroid Hemiagenesis: A Case Report and Review of the Literature

“…5 In the English-language literature, there have been 34 reports to our knowledge (Table 1). 16 -27 Typically, each of the 4 parathyroid glands shows different pathological findings. 1 6 Bilateral PC has been reported.…”

Splenic Cysts: A Strong Indication for a Minimally Invasive Partial Splenectomy. Could the Splenic Hilar Vasculature Type Hold a Defining Role?

“…In case of large cysts and splenomegaly or perisplenic adhesions, the laparoscopic dissection can be very difficult. In these particular cases, the robotic system is more efficient due to a better visualization and motion control, allowing more precise intracorporeal maneuvers [18]. The robotic technology is useful for better dissection of the hilar splenic vessels, especially in the case of a distributed supply.…”

Clinicopathological analysis of primary thyroid non-Hodgkin lymphoma: a single-center study

“…The preoperative diagnosis of PTL is quite difficult, and PTL has been previously categorized as undifferentiated thyroid carcinoma. The most common clinical presentation of PTL is rapid enlargement of a mass in the neck which, in about 30% of patients, may cause compression symptoms such as dysphasia, dyspnea, coughing, and hoarseness (17), thus resembling anaplastic thyroid cancer (ATC). B-cell lymphoma symptoms, such as fever, night sweats, and weight loss, occur in 10-20% of patients (1,9), hyperthyroidism is present in 7-36% of patients, and HT occurs in 27-80.6% of patients (2,8,9,11,12), which is in accordance with our study.…”

“…B-cell lymphoma symptoms, such as fever, night sweats, and weight loss, occur in 10-20% of patients (1,9), hyperthyroidism is present in 7-36% of patients, and HT occurs in 27-80.6% of patients (2,8,9,11,12), which is in accordance with our study. Most commonly, ultrasound (US) of PTL shows a hypoechoic mass, with the echogenicity less than that of the adjacent neck musculature, combined with hypervascularity and a characteristically undifferentiated outline (17). Computed tomography (CT) and magnetic resonance imaging (MRI) show a homogenous mass with a lack of calcification, cystic degeneration, and necrosis.…”

“…There has been a reduction in surgery since the development of new diagnostic modalities, as surgery may lead to surgical complications and the incomplete removal of residual tissue. Indolent subtype therapy involves local treatment with either surgery alone and/or local radiotherapy, while thyroidectomy alone or radiotherapy alone is only adequate for stage 1E MALT (6,17). A high-grade or progressive subtype usually requires a combination of chemotherapy and radiotherapy, referred to as CMT.…”