Eleven patients with primary thyroid lymphoma: a single center experience

Abstract

IntroductionPrimary thyroid lymphoma (PTL) is quite a rare malignancy, constituting 1%-5% of all thyroid malignancies, and 2% of all extranodal lymphomas (1). It is seen more frequently in females with chronic Hashimoto's thyroiditis, with 3-4fold higher incidence than in male patients. PTL incidence peaks in the mid-sixties; hence, half of PTL patients are between the age of 60 and 79 years (2,3).The most frequent complaint is a large palpable swelling in the neck that resembles anaplastic thyroid cancers. Diagnosis must be performed rapidly due to differences in treatment. A large neck mass triggered by PTL also causes symptoms such as dysphagia, dyspnea, and hoarseness due to mass effect, which is typically associated with the disease. In addition to these symptoms, some patients may show B symptoms such as fever, night sweats, and weight loss of 10% and higher in the last 6 months.Histopathologically, PTLs appear in the form of B-cell and T-cell type non-Hodgkin's lymphomas (4). B-cell non-Hodgkin lymphoma, which is the most Background/aim: Primary thyroid lymphoma (PTL) is a very rare thyroid malignancy. It should be diagnosed and treated immediately and accurately. Our aim was to evaluate the diagnostic methods and treatment results for patients with PTL. Materials and methods: We retrospectively evaluated the records of 11 patients with PTL from 2009 to 2015, diagnosed at our institute. Age, sex, stage, histopathologic type, presence of Hashimoto's thyroiditis, diagnostic methods, treatment types, and recurrence were examined.Results: Six patients were female, 5 were male, and the median age of the patients was 61 years (range: 15-76 years). All patients had a large palpable mass in the neck. Fine needle aspirate (FNA) biopsy was performed in all patients; however, it was useful only in the diagnosis of 7 patients. Excisional and surgical biopsy was performed in 4 patients. All patients had non-Hodgkin B-cell lymphoma, including 9 cases of diffuse large B-cell lymphoma (DLBCL), and 2 patients had mucosa-associated lymphoid tissue (MALT) lymphoma. Recurrence was observed in one patient. Median survival was 34 months. Conclusions:The preferred option for the diagnosis of PTL should be FNA biopsy, and the treatment should be decided on according to whether the disease is limited to the thyroid gland or not, its histological type, and its stage.

Fine-needle aspiration to diagnose primary thyroid lymphomas: a systematic review and meta-analysis

“…Duplicates were excluded by using a specific software, and titles and abstracts of 819 references were screened leading to the exclusion of 655 articles. The remaining 164 were evaluated in full-text, and 32 (20, 22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52) were finally included for the present review ( Fig. 1).…”

“…Other examinations were described alongside to FNA cytology. Among cytological ancillary testing, flow cytometry was the most widely used(22,26,30, 43, 47); Firstly, in the 12 articles published more recently (i.e., we arbitrary selected papers published after 2010)(22,23,28,30,35, 39, 45, 47, 48, 50, 51, 52), we found a sensitivity of 0.39 with heterogeneity and no publication bias(Fig. 3).…”

“…3). Secondly, in the nine papers reporting PTL series enrolled after 2000 (20,22,23,30,32,35, 39, 47,52), the pooled FNA sensitivity was 0.44 with heterogeneity, but there was no publication bias(Fig. 4).…”

Prognostic evaluation models for primary thyroid lymphoma, based on the SEER database and an external validation cohort

“…Fast-growing, painless mass of the neck is the most typical clinical presentation. PTL can also cause obstructive symptoms owing to mass aggregation, such as hoarseness, dyspnea, and dysphagia [ 3 ]. About 10% of patients with PTL present with the B symptoms, such as fever, night sweating, and weight loss ≥ 10% within the past 6 months [ 4 ].…”

The diagnosis of primary thyroid lymphoma by fine‐needle aspiration, cell block, and immunohistochemistry technique

“…Primary thyroid lymphoma (PTL) is a rare malignant disease that accounts for 1% to 5% of all thyroid malignancies and 1% to 7% of all extranodal lymphomas 1,2 . The preoperative diagnosis is mainly based on the examination of the thyroid function, CT scanning, and sonographic appearance, 3‐5 but findings of these measures are only suggestive and may be misdiagnosed as other thyroid tumors.…”