Clinical Aspects of Primary Thyroid Lymphoma: Diagnosis and Treatment Based on Our Experience of 119 Cases

Abstract

We describe the clinical aspects of primary thyroid lymphoma, particularly diagnostic procedures and successful therapy based on our observation of 119 patients with primary thyroid lymphoma. Thyroid lymphoma occurred exclusively in the thyroid gland of patients with Hashimoto's thyroiditis as a rapidly growing mass in the thyroid gland. Therefore, progressively enlarging goiter and compression symptoms were the most common clinical manifestations. A significant number of patients in our series had subclinical hypothyroidism (14%) or overt hypothyroidism (27%) because of the coexistence of Hashimoto's thyroiditis. Whenever thyroid lymphoma is suspected, we recommend an ultrasound scan of the thyroid gland and fine needle aspiration biopsy as initial diagnostic procedures. Thyroid ultrasound showed characteristic asymmetrical pseudocystic pattern in 43 of the 46 patients (93%), and thyroid cytologic examination showed abundant monomorphic infiltration of lymphoid cells. Among 83 patients who underwent fine needle aspiration biopsy, 65 patients (78.3%) were diagnosed correctly and 10 patients (12%) had borderline cytologic results. Thus, 90% of patients with thyroid lymphoma were diagnosed or the diagnosis suspected based on fine needle aspiration biopsy. To confirm the diagnosis of lymphoma histologically and to determine the degree of malignancy, open biopsy taking 2-3 g tissue should be done for all cases. Treatment of thyroid lymphoma does not require resection of all lymphoma tissue or total thyroidectomy. Our successful treatment is radiation therapy combined with six courses of CHOP chemotherapy (cyclophosphamide, adriamycin, vincristine, prednisolone). This mode of therapy improved the 8-year survival rate to nearly 100% regardless of the histological type of malignancy.

Hodgkin's lymphoma of the thyroid: a clinicopathologic study of five cases and review of the literature

“…26 However, thyroid Hodgkin's lymphoma patients tended to present at a younger age (median age 42 years for our cases combined with the reported cases) than thyroid non-Hodgkin's lymphoma patients, who tend to present between the ages of 50 and 80 years with a peak incidence in the sixth decade. 26,27 Among our series and the cases reported in the literature, patients with Hodgkin's lymphoma commonly presented with a rapidly enlarging thyroid gland or a thyroid mass, similar to the presentation of non-Hodgkin's lymphoma of the thyroid. 5 The mass may cause symptoms related to compression or infiltration of the surrounding neck organs.…”

Hashimoto’s Thyroiditis And Cancer: A Review

“…Women are more commonly affected than men (2-8:1) [47,49,50]. Patients typically present in the sixth or seventh decade of life, with men often presenting at a younger age than women [49][50][51][52]. Most thyroid lymphomas are nonHodgkin's lymphomas (NHLs) of B-cell origin.…”

Non-Hodgkin's Lymphoma Presenting as Thyroid and Adrenal Gland Involvement.

“…Primary NHL of the thyroid accounts for less than 3% of ENL with most of the cases occurring in the gland of Hashimoto's thyroiditis [12,13,15]. Secondary involvement of the gland as a part of disseminated disease was reported in 0.29-0.7% of NHL cases.…”

“…The ultrasonographic appearence of thyroid lymphoma was defined as hypoechoic patterns [15,16]. Nodular enlargement is the most frequent pattern but diffuse goiter can also be seen [16].…”

“…Immunohistochemical staining of aspirates increases the diagnostic value of FNAB [15,31]. We performed FNAB on both adrenal-US-guidedand thyroid glands.…”