Primary Diffuse B-Cell Thyroid Lymphoma: Case Report and Literature Review

Alyami, Hassan; Alsofyani, Talal; Bshait, Mohammed Bu; AL-Osail, Emad M.

doi:10.1159/000490883

Cited by 4 publications

(7 citation statements)

References 11 publications

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“…PTL has a female preponderance, usually developing in the sixth and seventh decades of life (1, 2). Normally, the thyroid gland does not contain native lymphoid tissue, unless there is a pathological condition like autoimmune thyroiditis (5,6). In fact, most of PTLs arise in the setting of Hashimoto's thyroiditis (60%), as in the present clinical case (5).…”

Section: Discussionmentioning

confidence: 64%

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Follicular lymphoma of the thyroid and the role of core needle biopsy

Cunha

Mousinho

Saraiva

et al. 2023

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Primary thyroid lymphoma (PTL) is a rare malignancy, accounting for less than 5% of all thyroid neoplasms. The follicular subtype is even more rare, accounting for approximately 10% of all PTL cases. We report a case of a 64-year-old woman, who presented with a rapidly growing goitre with mass effect and B symptoms. She had a history of Hashimoto’s thyroiditis and her thyroid ultrasound revealed diffuse goitre with a dominant nodule (56 × 63 × 60 mm) within the right thyroid lobe. Ultrasound-guided percutaneous fine-needle aspiration of the right thyroid nodule was classified as benign, according to Bethesda System, with lymphocytic thyroiditis. A CT scan of the neck showed diffuse enlargement of the thyroid gland extending towards the anterior mediastinum with tracheal deviation and lymphadenopathy within levels VII and right II–IV. The core needle biopsy of the right thyroid nodule revealed a follicular non-Hodgkin’s B cell lymphoma with a Ki67 of 60%. According to the Ann Arbor staging system, she was at stage IIIE. She underwent chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) with remarkable clinical improvement and is currently in remission 2 years after the diagnosis. PTL is an extremely rare malignancy that usually arises in a lymphocytic thyroiditis background, presenting as a rapidly enlarging goitre, which can lead to compressive symptoms or airway comprise. Learning points Primary thyroid lymphoma (PTL) is a rare malignancy, accounting for less than 5% of thyroid neoplasms. PTL should be suspected when a patient presents with a rapidly enlarging goitre, especially in the setting of Hashimoto’s thyroiditis. Fine-needle aspiration has a limited capacity for PTL diagnosis due to similar cytomorphological features of lymphoma with thyroiditis. Therefore, in case of clinical suspicion and if fine needle aspiration fails to diagnose PTL, a tissue biopsy should be performed. Treatment is dependent on both the stage and histology of PTL. Chemotherapy and local radiotherapy remain the mainstay treatment for PTL.

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Section: Discussionmentioning

confidence: 64%

“…Diffuse large B-cell lymphoma (>50%) and marginal zone lymphoma are the most frequent subtypes (10-23%). (2,6). Rarer subtypes include follicular (10%), small lymphocytic (3%), Burkitt's lymphoma (<1%) and Hodgkin's lymphoma (2%) (2).…”

Section: Discussionmentioning

confidence: 99%

Follicular lymphoma of the thyroid and the role of core needle biopsy

Cunha

Mousinho

Saraiva

et al. 2023

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…The incidence of thyroid lymphoma ranges from 1%-4.93% according to various studies. 29 , 30 We came across only 1 (1.01%) case of lymphoma in 48 years old female patient with Hashimoto's thyroiditis.…”

Section: Discussionmentioning

confidence: 94%

Histopathological Spectrum of Non-Neoplastic and Neoplastic Lesions of Thyroid: A Descriptive Cross-sectional Study

Ghartimagar

Ghosh

Shrestha³

et al. 2020

J Nepal Med Assoc

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Introduction: Thyroid gland lesions are the most common endocrine disorders encountered globally. Diseases of the thyroid gland present with either an alteration of hormone secretion or as an enlargement of the thyroid gland. The objective of the study is to find the frequency of different thyroid lesions. Methods: A descriptive cross-sectional study was conducted at Manipal Teaching Hospital, Pokhara from Jan 2005 to Jan 2020. Ethical approval was taken from the Institutional Review Committee (Ref: 330). Patients who had undergone thyroidectomy procedures for both non-neoplastic and neoplastic thyroid lesions were enrolled. Convenient sampling was done. IBM Statistical Package for Social Sciences version 21 and Microsoft Excel were used. Results: Out of 345 thyroidectomy specimens, 246 (71.3%) cases of non-neoplastic lesions, and 99 (28.69%) cases of neoplastic lesions were present. There were 54 males and 291 females with a male to female ratio of 1:5.4. The age ranged from 9 to 76 years with a mean age of 43.67 years. In non-neoplastic lesions, the predominant lesion was the colloid goiter with 205 (83.33%) cases followed by Grave’s disease and lymphocytic thyroiditis with 14 (5.69%) cases each. In neoplastic lesions, papillary carcinoma was the commonest lesion with 56 (56.56%) cases followed by follicular carcinoma with 14 (14.14%) cases and follicular adenoma with 13 (13.13%) cases. There were also 9 (9.09%) cases of anaplastic carcinoma in neoplastic lesions. Conclusions: Colloid goiter and papillary carcinoma was the most commonly encountered non-neoplastic and neoplastic lesion with a female predominance. Rare tumors like anaplastic carcinoma, papillary carcinoma, and follicular carcinoma with anaplastic transformation were also encountered.

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“…5) Of these subtypes, DLBL is the most common variant. 2) As the thyroid gland lacks lymphoid tissues, most thyroid lymphomas arise from pre-existing chronic autoimmune thyroiditis. 6) The incidence of DLBL is approximately 67 times higher in patients with Hashimoto's thyroiditis.…”

Section: A B Cmentioning

confidence: 99%

“…1) According to the current classification system, diffuse large B-cell lymphoma (DLBL) is the most common subtype. 2) One of the important features of thyroid lymphoma is that the tumor can grow rapidly over the course of only a few months, leading to airway obstruction. 3) In such cases, an emergency tracheostomy or early thyroidectomy is usually performed to secure the airway.…”

Section: Introductionmentioning

confidence: 99%

A Case of a Temporary Endotracheal Stent for Airway Management in a Patient with Primary Thyroid Lymphoma

Kim¹,

Yeo²,

Kim³

et al. 2020

Korean J Otorhinolaryngol-Head Neck Surg

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Primary thyroid lymphoma is a rare malignancy that can grow rapidly and compress the airway. In such cases, a tracheostomy or thyroidectomy is generally required. Here, we report a case of a 76-year-old woman diagnosed with primary thyroid diffuse large B-cell lymphoma (DLBL), with dyspnea attributed to tracheal compression by the enlarged thyroid. The patient’s poor general condition meant that thyroidectomy was considered challenging. Therefore, a temporary endotracheal silicone stent was successfully inserted to maintain the airway, as tracheal stenting has been shown to be an effective treatment for both benign and malignant obstructive airway diseases. We conclude that, in patients with primary thyroid DLBL who present with airway compression but are not eligible for surgery, tracheal stent insertion can maintain the airway and allow time for chemotherapy to be administered.

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Primary Diffuse B-Cell Thyroid Lymphoma: Case Report and Literature Review

Cited by 4 publications

References 11 publications

Follicular lymphoma of the thyroid and the role of core needle biopsy

Follicular lymphoma of the thyroid and the role of core needle biopsy

Histopathological Spectrum of Non-Neoplastic and Neoplastic Lesions of Thyroid: A Descriptive Cross-sectional Study

A Case of a Temporary Endotracheal Stent for Airway Management in a Patient with Primary Thyroid Lymphoma

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