Preoperative diagnostic algorithm of primary thyroid lymphoma using ultrasound, aspiration cytology, and flow cytometry

Hirokawa, Mitsuyoshi; Kudo, Takumi; Ota, Hisashi; Suzuki, Ayana; Kobayashi, Kaoru; Miyauchi, Akira

doi:10.1507/endocrj.ej17-0111

Cited by 33 publications

(28 citation statements)

References 21 publications

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“…Even if the excluded patients were added, the order of MALTL and DLBCL would not be reversed. Hirokawa et al suggested that earlier sonographic detection and more accurate cytological diagnosis increased the proportion of MALTL [19] because DLBCLs could be transformed from pre-existing MALTL [11]. The incidence of CD10positive DLBCLs, indicating a germinal center phenotype, was low (5.6%) in our study, suggesting a transformation from MALTL to DLBCL.…”

Section: Discussioncontrasting

confidence: 46%

“…In 99 patients who underwent fine needle aspiration cytology (FNAC), flow cytometry analysis using aspirated materials was performed. The presence of light chain restriction was assumed in cases with kappa lambda ratios of less than 0.33 or more than 3.0 [19]. For tissues surgically resected from 104 patients, flow cytometry based on CD45 and side scatter-based gating, karyotypic analysis (G-banding chromosomal examination), and IgH rearrangement analysis using southern blotting were performed.…”

Section: Study Methodsmentioning

confidence: 99%

“…PTL can usually be diagnosed by histological and immunohistochemical examination. In addition, ancillary studies including flow cytometry, immunoglobulin heavy chain (IgH) rearrangement, and karyotypic analyses, can provide important information for determination of the classification and biological behaviors of lymphomas [15][16][17][18][19]. Such analyses for primary nodal lymphomas have been well documented [15][16][17][18].…”

mentioning

confidence: 99%

“…Such analyses for primary nodal lymphomas have been well documented [15][16][17][18]. For PTL, however, a few sporadic reports have been published [19][20][21][22][23].…”

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confidence: 99%

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Flow cytometric, gene rearrangement, and karyotypic analyses of 110 cases of primary thyroid lymphoma: a single-institutional experience in Japan

et al. 2019

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Ancillary studies for primary nodal lymphomas have been well documented; however, studies of primary thyroid lymphoma (PTL) are limited. Here, we aimed to clarify the clinicopathological, flow cytometric, gene rearrangement, and karyotypic characteristics of PTL by investigation of a large series at a single institute. We performed flow cytometric, IgH rearrangement, and karyotypic analyses of 110 PTL tissues surgically resected at Kuma Hospital between January 2012 and April 2017. All PTLs were of B-cell origin, including mucosa-associated lymphoid tissue lymphoma (MALTL; 89 patients, 80.9%), diffuse large B-cell lymphoma (DLBCL; 18 patients, 16.4%), and follicular lymphoma (FL; three patients, 2.7%). In 96 (87.3%) patients, anti-thyroid antibodies were positive. For flow cytometry using aspirated and resected materials, light chain restriction was observed in 73.7% and 69.2% of examined cases, respectively. Heavy chain JH DNA rearrangement was observed in 65.4% of PTLs (58.1% of MALTL cases, 100% of DLBCL cases, and 100% of FL cases). Chromosomal abnormalities were detected in 49.0% of PTLs, and translocation was most frequently detected (24.0%), followed by addition (20.8%) and trisomy (18.8%). The most frequent (9.4%) karyotype was t(3;14)(q27;q32). Both FLs harbored t(14;18) (q32;q21), and the karyotype was not detected in patients with MALTL and DLBCL. The negative rate for all three examinations was 3.8%. We concluded that thyroid MALTL was cytogenetically different from that in other organs. Our results suggested that pre-operative flow cytometry analysis using aspirated materials was as reliable as that using resected materials.

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Section: Discussioncontrasting

confidence: 46%

Section: Study Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

“…Such analyses for primary nodal lymphomas have been well documented [15][16][17][18]. For PTL, however, a few sporadic reports have been published [19][20][21][22][23].…”

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confidence: 99%

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Flow cytometric, gene rearrangement, and karyotypic analyses of 110 cases of primary thyroid lymphoma: a single-institutional experience in Japan

et al. 2019

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“…All of the patients were operated on at the Kuma Hospital from January 2013 to November 2016. The diagnosis of MALT-L was based on the following criteria: (1) diffuse proliferation of medium-sized CD20-positive lymphoid cells, (2) packing or lymphoepithelial lesion composed of CD20-positive lymphoid cells and follicular cells, (3) follicular colonization confirmed by structural alterations in the meshwork of CD23-positive follicular dendritic cells, and (4) at least one of restricted light chain (κ/λ ratio > 3 or < 0.33) by flow cytometry, chromosomal abnormality by G-banding, or immunoglobulin heavy chain gene rearrangements [15]. The diagnosis of DLBCL was based on diffuse proliferation of large CD20-positive lymphoid cells.…”

Section: Methodsmentioning

confidence: 99%

Identification of Cytological Features Distinguishing Mucosa-Associated Lymphoid Tissue Lymphoma from Reactive Lymphoid Proliferation Using Thyroid Liquid-Based Cytology

et al. 2018

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Objective: To identify cytological differences between mucosa-associated lymphoid tissue lymphoma (MALT-L) and nonneoplastic lymphocytes using thyroid liquid-based cytology (LBC). Study Design: We observed LBC and conventional specimens from 35 MALT-L cases, 3 diffuse large B-cell cell lymphoma (DLBCL) cases, and 44 prominent nonneoplastic lymphocytic infiltration cases. Results: In MALT-L cases, the incidence of lymphoglandular bodies in the LBC specimens was lower than that in the conventional specimens (p < 0.001). Moreover, the nuclear sizes in LBC specimens were larger than those in conventional specimens. In 62.9% of the MALT-L and all DLBCL specimens, large nuclei were present in > 10% of the lymphoid cells in LBC specimens. Two cases with prominent nonneoplastic lymphocytic infiltration also exhibited these findings. In LBC specimens, swollen naked nuclei with less punctate chromatin patterns and thin nuclear margins were observed in 92.1% of lymphoma and 20.5% of prominent nonneoplastic lymphocytic infiltration. Elongated nuclei were significantly more apparent in thyroid lymphoma than in prominent nonneoplastic lymphocytic infiltration (p < 0.001), with a significantly higher incidence in LBC specimens than in conventional specimens (p < 0.001). Conclusions: Lymphoglandular bodies are not reliable markers for lymphoma diagnosis using LBC specimens. Large, swollen naked, and elongated nuclei are useful in distinguishing thyroid lymphoma from nonneoplastic lymphocytes in LBC specimens.

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The diagnosis of primary thyroid lymphoma by fine‐needle aspiration, cell block, and immunohistochemistry technique

Huang

Li²,

Wang

et al. 2020

Diagnostic Cytopathology

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Aim: Primary thyroid lymphoma (PTL) is a rare malignant disease. Its prognosis depends on early diagnosis. The role of fine-needle aspiration (FNA), including smear cytology, cell block (CB) techniques, and immunohistochemistry (IHC) sections in the diagnosis of PTL is still unclear. Here we reported 19 cases of PTL and literature review to evaluate the diagnostic accuracy for lymphoma by cytology. Methods: Our study retrospectively reviewed 19 patients diagnosed with PTL at the affiliated hospital of Southwest Medical University in China from June 2011 to May 2019. According to the Bethesda system for reporting thyroid cytopathology, the CB sections were evaluated for the presence of single tumor cells. IHC was performed on CB. Results: The diagnostic accuracy for PTL of FNA, CB with smears, and the joint application of the three methods (FNA + CB + IHC) of our study with 19 cases was 68.4% (13/19), 83.3% (15/18), and 100% (17/17), respectively. Conclusion: The present study demonstrates that FNA has low sensitivity in diagnosing PTL, but the joint application of FNA, CB, and IHC might provide high diagnostic accuracy for lymphoma and should be applied in all cases where the clinical suspicion is high regardless of the FNA findings.

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Preoperative diagnostic algorithm of primary thyroid lymphoma using ultrasound, aspiration cytology, and flow cytometry

Cited by 33 publications

References 21 publications

Flow cytometric, gene rearrangement, and karyotypic analyses of 110 cases of primary thyroid lymphoma: a single-institutional experience in Japan

Flow cytometric, gene rearrangement, and karyotypic analyses of 110 cases of primary thyroid lymphoma: a single-institutional experience in Japan

Identification of Cytological Features Distinguishing Mucosa-Associated Lymphoid Tissue Lymphoma from Reactive Lymphoid Proliferation Using Thyroid Liquid-Based Cytology

The diagnosis of primary thyroid lymphoma by fine‐needle aspiration, cell block, and immunohistochemistry technique

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