Advertisement

Primary Thyroid Lymphoma

  • Stephanie Aleskow Stein
Chapter

Abstract

Primary thyroid lymphoma is a rare cause of both thyroid malignancy and extranodal lymphoma. It should be suspected in patients with a rapidly enlarging neck mass, especially in women with Hashimoto’s thyroiditis. Certain ultrasound features such as enhanced posterior echoes and hypoechogenicity can suggest the diagnosis, but biopsy for confirmation is ultimately needed. With advances in immunophenotypic analysis, fine needle aspiration can be used for diagnosis in the hands of experienced physicians, but open biopsy may be needed for confirmation. The most common type of primary thyroid lymphoma is diffuse large B-cell lymphoma which behaves in a more aggressive manner than mucosa-associated lymphoid tissue (MALT) lymphoma. Radiation therapy can be employed for localized MALT lymphoma, but combination therapy with chemotherapy and radiation is needed for disseminated disease or aggressive histologic subtypes. More recently, addition of the anti-CD20 antibody rituximab to chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone has been successful for treatment of extranodal non-Hodgkin’s lymphomas and provides hope for the treatment of primary thyroid lymphoma.

Keywords

Thyroid Lymphoma Diffuse large B-cell lymphoma Mucosa-associated lymphoid tissue lymphoma 

References

  1. 1.
    Sangalli G, Serio G, Zampatti C, Lomuscio G, Colombo L. Fine needle aspiration cytology of primary lymphoma of the thyroid: a report of 17 cases. Cytopathology. 2001;12(4):257–63.PubMedGoogle Scholar
  2. 2.
    Freeman C, Berg JW, Cutler SJ. Occurrence and prognosis of extranodal lymphomas. Cancer. 1972;29(1):252–60.PubMedGoogle Scholar
  3. 3.
    Thieblemont C, Mayer A, Dumontet C, Barbier Y, Callet-Bauchu E, Felman P, et al. Primary thyroid lymphoma is a heterogeneous disease. J Clin Endocrinol Metab. 2002;87(1):105–11.PubMedGoogle Scholar
  4. 4.
    Pedersen RK, Pedersen NT. Primary non-Hodgkin’s lymphoma of the thyroid gland: a population based study. Histopathology. 1996;28(1):25–32.PubMedGoogle Scholar
  5. 5.
    Derringer GA, Thompson LD, Frommelt RA, Bijwaard KE, Heffess CS, Abbondanzo SL. Malignant lymphoma of the thyroid gland: a clinicopathologic study of 108 cases. Am J Surg Pathol. 2000;24(5):623–39.PubMedGoogle Scholar
  6. 6.
    Sarinah B, Hisham AN. Primary lymphoma of the thyroid: diagnostic and therapeutic considerations. Asian J Surg. 2010;33(1):20–4.PubMedGoogle Scholar
  7. 7.
    Graff-Baker A, Roman SA, Thomas DC, Udelsman R, Sosa JA. Prognosis of primary thyroid lymphoma: demographic, clinical, and pathologic predictors of survival in 1,408 cases. Surgery. 2009;146(6):1105–15.PubMedGoogle Scholar
  8. 8.
    Matsuzuka F, Miyauchi A, Katayama S, Narabayashi I, Ikeda H, Kuma K, et al. Clinical aspects of primary thyroid lymphoma: diagnosis and treatment based on our experience of 119 cases. Thyroid. 1993;3(2):93–9.PubMedGoogle Scholar
  9. 9.
    Holm LE, Blomgren H, Lowhagen T. Cancer risks in patients with chronic lymphocytic thyroiditis. N Engl J Med. 1985;312(10):601–4.PubMedGoogle Scholar
  10. 10.
    Jaffe ES. The 2008 WHO classification of lymphomas: implications for clinical practice and translational research. Hematology Am Soc Hematol Educ Program. 2009:523–31.Google Scholar
  11. 11.
    Alzouebi M, Goepel JR, Horsman JM, Hancock BW. Primary thyroid lymphoma: the 40 year experience of a UK lymphoma treatment centre. Int J Oncol. 2012;40(6):2075–80.PubMedGoogle Scholar
  12. 12.
    Onal C, Li YX, Miller RC, Poortmans P, Constantinou N, Weber DC, et al. Treatment results and prognostic factors in primary thyroid lymphoma patients: a rare cancer network study. Ann Oncol. 2011;22(1):156–64.PubMedGoogle Scholar
  13. 13.
    Hyjek E, Isaacson PG. Primary B cell lymphoma of the thyroid and its relationship to Hashimoto’s thyroiditis. Hum Pathol. 1988;19(11):1315–26.PubMedGoogle Scholar
  14. 14.
    Moshynska OV, Saxena A. Clonal relationship between Hashimoto thyroiditis and thyroid lymphoma. J Clin Pathol. 2008;61(4):438–44.PubMedGoogle Scholar
  15. 15.
    Watanabe N, Noh JY, Narimatsu H, Takeuchi K, Yamaguchi T, Kameyama K, et al. Clinicopathological features of 171 cases of primary thyroid lymphoma: a long-term study involving 24553 patients with Hashimoto’s disease. Br J Haematol. 2011;153(2):236–43.PubMedGoogle Scholar
  16. 16.
    Kossev P, Livolsi V. Lymphoid lesions of the thyroid: review in light of the revised European-American lymphoma classification and upcoming World Health Organization classification. Thyroid. 1999;9(12):1273–80.PubMedGoogle Scholar
  17. 17.
    Ota H, Ito Y, Matsuzuka F, Kuma S, Fukata S, Morita S, et al. Usefulness of ultrasonography for diagnosis of malignant lymphoma of the thyroid. Thyroid. 2006;16(10):983–7.PubMedGoogle Scholar
  18. 18.
    Ma B, Jia Y, Wang Q, Li X. Ultrasound of primary thyroid non-Hodgkin’s lymphoma. Clin Imaging. 2014;38(5):621–6.PubMedGoogle Scholar
  19. 19.
    Xia Y, Wang L, Jiang Y, Dai Q, Li X, Li W. Sonographic appearance of primary thyroid lymphoma-preliminary experience. PLoS One. 2014;9(12):e114080.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Li X, Ye Z. Primary thyroid lymphoma: multi-slice computed tomography findings. Asian Pac J Cancer Prev. 2015;16(3):1135–8.PubMedGoogle Scholar
  21. 21.
    Kim H, Han M, Kim K, Jae H, Lee S, Kim S, et al. Primary thyroid lymphoma: CT findings. Eur J Radiol. 2003;46(3):233–9.PubMedGoogle Scholar
  22. 22.
    Young NA, Al-Saleem TI, Ehya H, Smith MR. Utilization of fine-needle aspiration cytology and flow cytometry in the diagnosis and subclassification of primary and recurrent lymphoma. Cancer. 1998;84(4):252–61.PubMedGoogle Scholar
  23. 23.
    Jeffers MD, Milton J, Herriot R, McKean M. Fine needle aspiration cytology in the investigation on non-Hodgkin’s lymphoma. J Clin Pathol. 1998;51(3):189–96.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Sneige N, Dekmezian R, el-Naggar A, Manning J. Cytomorphologic, immunocytochemical, and nucleic acid flow cytometric study of 50 lymph nodes by fine-needle aspiration. Comparison with results obtained by subsequent excisional biopsy. Cancer. 1991;67(4):1003–7.PubMedGoogle Scholar
  25. 25.
    Morgen EK, Geddie W, Boerner S, Bailey D, Santos Gda C. The role of fine-needle aspiration in the diagnosis of thyroid lymphoma: a retrospective study of nine cases and review of published series. J Clin Pathol. 2010;63(2):129–33.PubMedGoogle Scholar
  26. 26.
    Rawal A, Finn WG, Schnitzer B, Valdez R. Site-specific morphologic differences in extranodal marginal zone B-cell lymphomas. Arch Pathol Lab Med. 2007;131(11):1673–8.PubMedGoogle Scholar
  27. 27.
    Kaba S, Hirokawa M, Higuchi M, Suzuki A, Kojima M, Miyauchi A. Cytological findings for the diagnosis of primary thyroid mucosa-associated lymphoid tissue lymphoma by fine needle aspiration. Acta Cytol. 2015;59:26–36.PubMedGoogle Scholar
  28. 28.
    Kumar V, Abbas A, Fausto N, Aster J. Kumar: Robbins and Cotran. Pathologic basis of disease. Philadelphia: Saunders Elsevier; 2010.Google Scholar
  29. 29.
    Vega F, Lin P, Medeiros LJ. Extranodal lymphomas of the head and neck. Ann Diagn Pathol. 2005;9(6):340–50.PubMedGoogle Scholar
  30. 30.
    Yang L, Wang A, Zhang Y, Mu Y. 12 cases of primary thyroid lymphoma in China. J Endocrinol Investig. 2015;38:739–44.Google Scholar
  31. 31.
    Niitsu N, Okamoto M, Nakamura N, Nakamine H, Bessho M, Hirano M. Clinicopathologic correlations of stage IE/IIE primary thyroid diffuse large B-cell lymphoma. Ann Oncol. 2007;18(7):1203–8.PubMedGoogle Scholar
  32. 32.
    Skarsgard ED, Connors JM, Robins RE. A current analysis of primary lymphoma of the thyroid. Arch Surg. 1991;126(10):1199–203. discussion 1203-4.PubMedGoogle Scholar
  33. 33.
    Cha C, Chen H, Westra WH, Udelsman R. Primary thyroid lymphoma: can the diagnosis be made solely by fine-needle aspiration? Ann Surg Oncol. 2002;9(3):298–302.PubMedGoogle Scholar
  34. 34.
    Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M. Report of the committee on Hodgkin’s disease staging classification. Cancer Res. 1971;31(11):1860–1.PubMedGoogle Scholar
  35. 35.
    Takashima S, Morimoto S, Ikezoe J, Arisawa J, Hamada S, Ikeda H, et al. Primary thyroid lymphoma: comparison of CT and US assessment. Radiology. 1989;171(2):439–43.PubMedGoogle Scholar
  36. 36.
    Basu S, Li G, Bural G, Alavi A. Fluorodeoxyglucose positron emission tomography (FDG-PET) and PET/computed tomography imaging characteristics of thyroid lymphoma and their potential clinical utility. Acta Radiol. 2009;50(2):201–4.PubMedGoogle Scholar
  37. 37.
    Arabi M, Dvorak R, Smith LB, Kujawski L, Gross MD. Fluorodeoxyglucose positron emission tomography in primary thyroid lymphoma with coexisting lymphocytic thyroiditis. Thyroid. 2011;21(10):1153–6.PubMedGoogle Scholar
  38. 38.
    Lin EC. FDG PET/CT for assessing therapy response in primary thyroid lymphoma. Clin Nucl Med. 2007;32(2):152–3.PubMedGoogle Scholar
  39. 39.
    Klyachkin ML, Schwartz RW, Cibull M, Munn RK, Regine WF, Kenady DE, et al. Thyroid lymphoma: is there a role for surgery? Am Surg. 1998;64(3):234–8.PubMedGoogle Scholar
  40. 40.
    Blair TJ, Evans RG, Buskirk SJ, Banks PM, Earle JD. Radiotherapeutic management of primary thyroid lymphoma. Int J Radiat Oncol Biol Phys. 1985;11(2):365–70.PubMedGoogle Scholar
  41. 41.
    Pyke CM, Grant CS, Habermann TM, Kurtin PJ, van Heerden JA, Bergstralh EJ, et al. Non-Hodgkin’s lymphoma of the thyroid: is more than biopsy necessary? World J Surg. 1992;16(4):604–9. discussion 609-10.PubMedGoogle Scholar
  42. 42.
    Friedberg MH, Coburn MC, Monchik JM. Role of surgery in stage IE non-Hodgkin’s lymphoma of the thyroid. Surgery. 1994;116(6):1061–6. discussion 1066-7.PubMedGoogle Scholar
  43. 43.
    Doria R, Jekel JF, Cooper DL. Thyroid lymphoma. The case for combined modality therapy. Cancer. 1994;73(1):200–6.PubMedGoogle Scholar
  44. 44.
    Vigliotti A, Kong JS, Fuller LM, Velasquez WS. Thyroid lymphomas stages IE and IIE: comparative results for radiotherapy only, combination chemotherapy only, and multimodality treatment. Int J Radiat Oncol Biol Phys. 1986;12(10):1807–12.PubMedGoogle Scholar
  45. 45.
    Laing RW, Hoskin P, Hudson BV, Hudson GV, Harmer C, Bennett MH, et al. The significance of MALT histology in thyroid lymphoma: a review of patients from the BNLI and royal marsden hospital. Clin Oncol (R Coll Radiol). 1994;6(5):300–4.Google Scholar
  46. 46.
    Tsang RW, Gospodarowicz MK, Pintilie M, Wells W, Hodgson DC, Sun A, et al. Localized mucosa-associated lymphoid tissue lymphoma treated with radiation therapy has excellent clinical outcome. J Clin Oncol. 2003;21(22):4157–64.PubMedGoogle Scholar
  47. 47.
    Miller TP, Dahlberg S, Cassady JR, Adelstein DJ, Spier CM, Grogan TM, et al. Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin’s lymphoma. N Engl J Med. 1998;339(1):21–6.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Ha CS, Shadle KM, Medeiros LJ, Wilder RB, Hess MA, Cabanillas F, et al. Localized non-Hodgkin lymphoma involving the thyroid gland. Cancer. 2001;91(4):629–35.PubMedGoogle Scholar
  49. 49.
    Jonak C, Troch M, Mullauer L, Niederle B, Hoffmann M, Raderer M. Rituximab plus dose-reduced cyclophosphamide, mitoxantrone, vincristine, and prednisolone are effective in elderly patients with diffuse large B-cell lymphoma of the thyroid. Thyroid. 2010;20(4):425–7.PubMedGoogle Scholar
  50. 50.
    Watanabe N, Narimatsu H, Noh JY, Kunii Y, Mukasa K, Matsumoto M, et al. Rituximab-including combined modality treatment for primary thyroid lymphoma: an effective regimen for elderly patients. Thyroid. 2014;24(6):994–9.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Pfreundschuh M, Schubert J, Ziepert M, Schmits R, Mohren M, Lengfelder E, et al. Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas: a randomised controlled trial (RICOVER-60). Lancet Oncol. 2008;9(2):105–16.PubMedGoogle Scholar
  52. 52.
    Sippel RS, Gauger PG, Angelos P, Thompson NW, Mack E, Chen H. Palliative thyroidectomy for malignant lymphoma of the thyroid. Ann Surg Oncol. 2002;9(9):907–11.PubMedGoogle Scholar
  53. 53.
    Hopkins C, Stearns M, Watkinson AF. Palliative tracheal stenting in invasive papillary thyroid carcinoma. J Laryngol Otol. 2001;115(11):935–7.PubMedGoogle Scholar
  54. 54.
    Chai Y, Hong J, Koo D, Yu H, Lee J, Kwon H, et al. Clinicopathological characteristics and treatment outcomes of 38 cases of primary thyroid lymphoma: a multicenter study. Ann Surg Treat Res. 2015;89(6):295–9.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Stephanie Aleskow Stein
    • 1
  1. 1.Washington, DCUSA

Personalised recommendations