T-cell lymphoma of the thyroid.

Abstract

Surface marker studies on lymphocytes have shown that many nonHodgkin's lymphomas, especially the nodular variety, are of B-cell type, while only a small proportion-mainly those occurring in young people-are of T-cell type.1 2 We believe that this is the first account of a primary T-cell lymphoma of the thyroid. Case reportA 73-year-old woman was referred to hospital with a two-month history of a painless swelling in the neck. She was clinically euthyroid and had a nodular non-tender swelling in the left lobe of the thyroid. The results of antithyroglobulin tanned red cell and antimicrosomal fluorescent antibody tests were negative. A full blood count was normal. Surgical exploration showed that the left lobe of the thyroid was replaced by a fleshy mass, but the isthmus, right lobe, and adjacent cervical lymph nodes appeared normal. After examination of a frozen section the left lobe of the thyroid was removed. The specimen, which was received unfixed, measured 80xw 70 x 4-5 cm. It had a slightly nodular outer surface and a uniform white cut surface. Sections showed almost complete replacement of the thyroid parenchyma by a malignant lymphoma with a varied appearance. In places, the cells had slightly irregular nuclei a little larger than mature lymphocytes, but elsewhere the cells had larger nuclei which were often irregular showing numerous mitotic figures and surrounded by a moderate amount of pyroninophilic cytoplasm. A few non-neoplastic histiocytes with abundant pink cytoplasm were also present.Lymphocyte surface marker studies were carried out on a cell suspension prepared from the fresh surgical specimen.3 99 % of the viable tumour cells (80°o viability) formed E-rosettes with sheep red blood cells, while only 1 % showed surface immunoglobulin. A rosette cell pellet was also processed for electron microscopy (see figure). Postoperative radiotherapy was given to the thyroid region, and the patient is alive and free from evidence of disease two years after operation.Lymphoid cell with an irregular nucleus surrounded by sheep red cells. (x 10 890.) Comment Primary lymphomas of the thyroid are uncommon and may be difficult to distinguish from anaplastic small cell carcinoma In this case, the histological and electron microscopical appearance of the tumour cells indicated a lymphoid rather than an epithelial neoplasm. The absence of any sign of disease two years after operation is also more in keeping with lymphoma than anaplastic carcinoma. Difficulty may also arise in distinguishing the lymphoid infiltrate in Hashimoto's thyroiditis from lymphomaa In this case there was no serological evidence of thyroiditis and the appearance of the infiltrating cells left no doubt that they were malignant. Most of the viable tumour cells formed E-rosettes, indicating a lymphoma of T-cell type.' 5 While a few T-cell lymphomas have been reported in adults, most have been found in young people in whom a mediastinal mass has often been present and who have tended to develop a leukaemic blood picture.2 Our patient is older a...

T-cell Lymphoma of Thyroid Gland with Lennert Type of Morphology: A Case Report and Review of the Literature

“…Thyroid function tests and the clinical thyroid status of patients are found to be either euthyroid or hypothyroid goiter in all case reports [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Our patient was a case of sub-clinical goiter with a sudden onset of pressure symptoms.…”

“…B-cell lymphomas overwhelmingly outnumber their T-cell counterparts in thyroid gland, with only about twenty cases of TCL having been reported in the literature [2][3][4][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The first case of TCL of thyroid was reported in an English lady in 1977 [12].…”

“…Surgery alone or in combination with loco-regional radiotherapy is the choice of treatment in early stage cases [3,4,6]. The most common choice of drugs for chemotherapy used in index cases has included cyclophosphamide, daunorubicin, vincristine, and prednisolone (CHOP) based regimen [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. This case is being treated with 6 cycles of gemcitabine, dexamethasone, and cisplatin followed by involved field radiotherapy.…”

“…Almost all primary thyroid lymphomas turn out to be a non-Hodgkin lymphoma (NHL) of B-cell origin of either marginal zone lymphoma of mucosa associated lymphoid tissue (MALT) or diffuse large B-cell lymphoma (DLBCL) type [2][3][4][5]. T-cell lymphoma (TCL) in the thyroid gland is distinctly rare with about 20 cases having been reported so far in the literature [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Age range of these cases was between 34 and 86 years with a male to female ratio of 1.15:1.…”

“…Most of the reported cases showed a low grade behavior on follow up unlike the aggressive behavior seen in conventional TCL [3,9]. Microscopic morphology, in these cases, is variable showing most commonly a small lymphocytic infiltrate invading the thyroid follicles, also forming lymphoepithelial bodies in some cases [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Immunohistochemistry (IHC) of tumors in these cases has often revealed a predominant T-cell population with positivity for CD2, CD3 & CD5, with one case also reporting loss for CD7 [6].…”