Thyroid Lymphoma: A Single Institution's Experience

Abstract

The typical thyroid lymphoma patient is female and elderly with painless thyroid enlargement. Compressive symptoms of the aerodigestive tract are common at presentation and may require urgent intervention. Treatment modalities (XRT, CHOP chemotherapy) and outcomes are distinct from other thyroid malignancies.

Primary thyroid lymphoma: a rare but challenging diagnosis

“…The latter is associated with long -lasting autoimmune thyroiditis. 6 Hashimoto disease cannot be confirmed in all cases, as some patients do not present symptoms of hypothyroidism, and, in some cases, there are no signs of lymphocytic thyroiditis in histological specimen. Development of MALT lymphoma in the organs that physiologically do not contain lymphoid tissue has to be preceded by lymphocytic proliferation of the inflammatory origin.…”

“…[1][2][3][4][5][6][7] The lymphoma usually presents as rapidly growing thyroid mass, with increasing dyspnea due to tracheal compression, sometimes accompanied by enlargement of regional lymph nodes. 8,9 Consequent respiratory disturbances and decreased venous reflow from the head and neck (superior vena cava syndrome) require early diagnosis and immediate treatment.…”

“…The definite treatment is based on chemotherapy with radiation therapy; only in selected cases of mucosa -associated lymphoid tissue (MALT) lymphoma at an early stage, radical surgery may be sufficient. 1,3,6,11,12 Surgery plays an important role in sampling the specimen and when conservative treatment of tracheal stenosis fails.…”

“…7 DLBCL usually extends widely to the adjacent structures, making the radical resection impossible, while debulking surgery does not improve the results of treatment but increases the risk of local complications. 6 The first--line diagnostic technique is neck ultrasound to visualize the thyroid gland and cervical lymph nodes. Scintigraphy is useless because lymphomas are not capable of iodine uptake.…”

“…Radical resection is rarely possible for technical reasons and additionally exposes the patient to complications. 3,5,6 Surgery may be curative only in rare cases of thyroid -limited MALT lymphoma (stage IE); in more advanced cases of MALT lymphoma and in all other histological types of lymphoma, of the patient is a poor prognostic factor. There is some strong evidence for lymphoma development from chronic lymphocytic thyroiditis, although this has not been clearly confirmed in our experience.…”