Thyroid Lymphoma: Recent Advances in Diagnosis and Optimal Management Strategies

Abstract

Learning Objectives Explain the diagnostic modalities used to diagnose primary thyroid lymphoma. Describe the role of the endocrine surgeon in the diagnosis and treatment of thyroid lymphoma. Cite the recent advances in the treatment of primary thyroid lymphoma.

Primary Thyroid Lymphoma : An Uncommon Etiology of Compressive Goiter

“…Links among auto-immune disease, chronic antigenic stimulation, and PTL have been demonstrated, and Hashimoto's thyroiditis represents the major risk factor (1,12,14) especially in a delay of 20-30 years after initial diagnosis (5,7,10,12) . Commonly, Hashimoto's thyroiditis is considering as a causal factor of primary thyroid MALT lymphoma, which itself may evolve into aggressive lymphoma (6,12,14,15) , by activating B-cells to secrete antibodies, conducting to hyperplasia or malignant transformation of lymphoid tissue (4) . Concerning our patients, we didn't notice any antecedent of Hashimot's thyroiditis, but we suggest a pre-existing chronic thyroiditis within 3 patients having a biologic hypothyroidism.…”

“…Concerning our patients, we didn't notice any antecedent of Hashimot's thyroiditis, but we suggest a pre-existing chronic thyroiditis within 3 patients having a biologic hypothyroidism. The most common clinical presentation is an enlarging painless neck mass, growing rapidly between 1 and 3 months at about 70% of cases (5,7,15) and causing an obstruction of the upper airway tract in an approximately 30% of cases (12) , most often we notice a dysphagia, dyspnea, rarely it's about stridor, hoarseness, dysphonia, or vena cava obstruction (11,12,13,14,16) . In our cases, the prevalent clinical presentation was a rapid enlarging goiter causing an obstruction of the upper airway revealing by dysphonia (paralysis of vocal cord) in one case of DLBCL, and dyspnea in another two cases ; first one was about a women aged 81 years consulting with dyspnea requiring an urgent intervention of desobstruction by tracheotomy, it was a DLBCL ; and for the second case we practice a CT that objective a huge goiter associated to a bilateral lymph nodes, there were a resolution of dyspnea after treatment by corticoids and chemotherapie, it was a rare case of MCL (mantle cell lymphoma).…”

“…This clinical presentation can also occur with other pathologies realizing a differential diagnosis with primary lymphoma, which are an anaplastic carcinoma, squamous cell carcinoma, metastasis of unknown primary and thyroiditis (3) . The diagnosis of lymphoma is often delayed because systemic symptoms, such as fever, night sweat, and weight loss are often missing (13,15) , and reported for only 20% of cases (12) , and if present, a secondary thyroid infiltration by lymphoma of another organ seems to be most likely (13) . None of our population study reported B-symptoms.…”

“…None of our population study reported B-symptoms. On clinical examination, we can objective a diffuse or nodular thyroid enlargement (7) , regional lymph node is often achieved and has a particular presentation compared to those related to other thyroid malignancies, so they appear larger and numerous (12) . Often patients are in clinical and biological euthyroid, contrary to what we conclude with our study population, in whom 3 cases wherein hypothyroid situation.…”

“…Conversely, MALT lymphoma and small lymphocytic lymphoma (SLL) are characterized by an indolent clinical course (2,5,6,9,15,17) , with early stage disease confined to the thyroid. However, transformation to higher grade lymphoma is possible (12) . Patients in our study having MALT lymphoma showed a long period of evolution and localized disease.…”