Medicine:Thyroid lymphoma

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Thyroid lymphoma
SpecialtyENT surgery, endocrinology, oncology

Thyroid lymphoma is a rare cancer constituting 1% to 2% of all thyroid cancers and less than 2% of lymphomas. Thyroid lymphomas are classified as non–Hodgkin's B-cell lymphomas in a majority of cases, although Hodgkin's lymphoma of the thyroid has also been identified.[1]

Signs and symptoms

As with other thyroid lesions, thyroid lymphoma affects predominantly females over 70 years of age with a history of Hashimoto's thyroiditis.[2] Thus, Hashimoto's thyroiditis is considered a risk factor for thyroid lymphoma development.[3] Thyroid lymphoma manifests as a rapidly enlarging neck mass which may compress the nearby trachea thereby causing narrowing or obstruction of the airway resulting in breathing difficulties or even respiratory failure.[4] On physical examination, affected people typically exhibit a firm thyroid gland and enlarged lymph nodes.[4]

  • Painless neck mass
  • Hoarseness
  • Difficulty swallowing
  • Signs of tracheal compression

Diagnosis

Thyroid lymphoma poses a diagnostic and therapeutic challenge. This is because several manifestation patterns are similar to those of anaplastic thyroid cancer (ATC). Fine-needle aspiration (FNA) helps distinguish the two entities preoperatively.[5][6]

Histopathology

The majority of thyroid lymphomas are non–Hodgkin's B-cell lymphomas; a minority exhibit properties of T-cell lymphomas.[7]

  • Diffuse large B-cell lymphoma with marginal zone
  • Diffuse large B-cell lymphoma without marginal zone
  • Marginal zone В-cell lymphoma of mucosa-associated lymphoid tissue (MALT)
  • Follicular lymphoma

Staging

Staging of thyroid lymphoma is shown in the table below[8]

Stage Characteristics
1Е Lymphoma is located within the thyroid
2Е Lymphoma is located within the thyroid and regional lymph-nodes
3Е Lymphoma is located at both sides of diaphragm
4Е Dissemination of lymphoma

Treatment

Combined modality therapy is the most common approach for the initial treatment of thyroid lymphomas. The CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisone) has been shown to be highly effective for many types of thyroid lymphoma.[9] However, it is suggested to perform radiation therapy only for MALT resulting a 96% complete response, with only a 30% relapse rate. Surgical treatment might be performed for patients with thyroid lymphoma in addition to chemotherapy and radiation, particularly for MALT lymphomas.[10][11][9]

Prognosis

The factors of poor prognosis for people with thyroid lymphoma are advanced stage of the tumor,[12] large size (>10 cm) as well as spreading to mediastinum.[13][14] The overall survival for primary thyroid lymphoma is 50% to 70%, ranging from 80% in stage IE to less than 36% in stage IIE and IVE in 5 years.[15][9]

References

  1. ↑ "Primary thyroid lymphoma (correction of lympoma): diagnostic and therapeutic dilemmas". Surg. Oncol. 19 (4): 124–29. 2010. doi:10.1016/j.suronc.2010.06.002. PMID 20620043. 
  2. ↑ Travaglino, Antonio; Pace, Mirella; Varricchio, Silvia; Insabato, Luigi; Giordano, Claudia; Picardi, Marco; Pane, Fabrizio; Staibano, Stefania et al. (2020-01-02). "Hashimoto Thyroiditis in Primary Thyroid Non-Hodgkin Lymphoma" (in en). American Journal of Clinical Pathology 153 (2): 156–164. doi:10.1093/ajcp/aqz145. ISSN 0002-9173. PMID 31584614. https://academic.oup.com/ajcp/article/153/2/156/5581432. 
  3. ↑ Lai, Yi; Ding, Chenhuan; Shen, Yanying; Zhao, Ling; Li, He (2023-03-31). "Clinicopathological analysis of primary thyroid non-Hodgkin lymphoma: a single-center study" (in en). Translational Cancer Research 12 (3): 515–524. doi:10.21037/tcr-22-2257. ISSN 2219-6803. PMID 37033341. 
  4. ↑ 4.0 4.1 Joshi, A.; Chan, J.; Bruch, G.; Jeannon, J.-P.; Mikhaeel, N. G.; Fields, P. A.; Simo, R. (November 2009). "Thyroid lymphoma and airway obstruction - is there a rationale for surgical management?". International Journal of Clinical Practice 63 (11): 1647–1652. doi:10.1111/j.1742-1241.2009.02050.x. ISSN 1742-1241. PMID 19832821. 
  5. ↑ Vander Poorten, Vincent; Goedseels, Nathan; Triantafyllou, Asterios; Sanabria, Alvaro; Clement, Paul M.; Cohen, Oded; Golusinski, Pawel; Guntinas-Lichius, Orlando et al. (2022-09-20). "Effectiveness of core needle biopsy in the diagnosis of thyroid lymphoma and anaplastic thyroid carcinoma: A systematic review and meta-analysis" (in English). Frontiers in Endocrinology 13. doi:10.3389/fendo.2022.971249. ISSN 1664-2392. PMID 36204100. 
  6. ↑ Jin, Ming; Jakowski, Joseph; Wakely, Paul E. (2016-03-01). "Undifferentiated (anaplastic) thyroid carcinoma and its mimics: a report of 59 cases". Journal of the American Society of Cytopathology 5 (2): 107–115. doi:10.1016/j.jasc.2015.08.001. ISSN 2213-2945. PMID 31042490. https://www.sciencedirect.com/science/article/pii/S2213294515001817. 
  7. ↑ Shinkov, Alexander (2024-01-01), "1.27 - Endocrine Complications of the Hematologic Disorders and of Their Treatment", in Rezaei, Nima, Comprehensive Hematology and Stem Cell Research (First Edition), Oxford: Elsevier, pp. 467–483, doi:10.1016/B978-0-443-15717-2.00040-8, ISBN 978-0-443-15718-9, https://www.sciencedirect.com/science/article/pii/B9780443157172000408, retrieved 2026-07-14 
  8. ↑ "Thyroid Lymphoma - Patient Education - Endocrine Diseases - AAES" (in en-US). 2023-10-19. https://endocrinediseases.org/thyroid/thyroid-lymphoma/. 
  9. ↑ 9.0 9.1 9.2 Pavlidis, Efstathios T; Pavlidis, Theodoros E (March 2019). "A Review of Primary Thyroid Lymphoma: Molecular Factors, Diagnosis and Management". Journal of Investigative Surgery 32 (2): 137–142. doi:10.1080/08941939.2017.1383536. ISSN 1521-0553. PMID 29058491. 
  10. ↑ Saito, Yoshiyuki; Watanabe, Natsuko; Suzuki, Nami; Saito, Naoko; Narimatsu, Hiroto; Takami, Hiroshi; Kameyama, Kaori; Yoshioka, Kana et al. (March 2023). "Role of Surgery in Patients with Stage IE Primary Thyroid MALT Lymphoma Staged by a Modified Classification System: The Tokyo Classification". Cancers 15 (5): 1451. doi:10.3390/cancers15051451. PMID 36900242. 
  11. ↑ Fattahi Masuom, Seyed Hossein; Amirian-far, Azam; Rezaei, Reza (Summer 2022). "Radical Surgery for Primary Thyroid Lymphoma in Elderly Patients: A Short Report". Journal of Cardio-Thoracic Medicine 10 (3): 1044–1047. 
  12. ↑ Tupchong, L.; Hughes, F.; Harmer, C.L. (October 1986). "Primary lymphoma of the thyroid: Clinical features, prognostic factors, and results of treatment". International Journal of Radiation Oncology*Biology*Physics 12 (10): 1813–1821. doi:10.1016/0360-3016(86)90324-X. ISSN 0360-3016. PMID 3759532. https://linkinghub.elsevier.com/retrieve/pii/036030168690324X. 
  13. ↑ "Thyroid Lymphoma". http://shifrinmd.com/thyroid-lymphoma.html. 
  14. ↑ Fatima, Sohaila; Siddiqui, Wajih Ahmed; Alshehri, Abdulrahman (September 2014). "Primary thyroid lymphoma: case series with review of literature". Indian Journal of Hematology & Blood Transfusion: An Official Journal of Indian Society of Hematology and Blood Transfusion 30 (Suppl 1): 346–348. doi:10.1007/s12288-014-0400-6. ISSN 0971-4502. PMID 25332615. 
  15. ↑ Zhimin Bai; Lingyu Li; Tao Guan; Jiangtao Wang; Jin Zhao; Liping Su; Bai, Zhimin; Li, Lingyu et al. (2021-02-12). "Clinical prognosis and bioinformatic analysis of primary thyroid lymphoma". Medicine 100 (6). doi:10.1097/MD.0000000000024598. ISSN 0025-7974. PMID 33578562. 
Classification

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