Primary Burkitt’s lymphoma of the thyroid without Epstein-Barr virus infection: A case report and literature review

Abstract

Primary thyroid lymphomas are rare, and the majority are B-cell lymphoma. Primary Burkitt’s lymphoma (BL) of the thyroid is much less common than the other types of lymphoma. The current study presents the case of an eight-year-old male with a mass in the right lobe of the thyroid, which was detected by B-ultrasound. The patient was diagnosed with BL by immunohistochemistry, fluorescence in situ hybridization analysis of MYC (8q24) and immunoglobulin rearrangement assays. Furthermore, subsequent positron emission tomography-computed tomography scans revealed no abnormal metabolites in the left lobe of the thyroid or in other parts of the body following surgery. The patient underwent alternate R-B-NHL-BFM-90-A and R-B-NHL-BFM-90-B treatment for four cycles each following the thyroidectomy. The patient is well and remains free of disease recurrence following almost four years follow-up. The present study discusses this rare case of primary BL of the thyroid and presents a review of the literature. This case report provides evidence that the immediate diagnosis and treatment of primary Burkitt’s lymphoma of the thyroid is likely to improve patient outcome.

Primary Burkitt lymphoma of the thyroid gland: case report of an exceptional type of thyroid neoplasm and review of the literature

“…The patient also received a single dose of intrathecal methotrexate 27 Patient free of disease after end of treatment Kandil et al [2012] [ 10 ] 60 F Rapidly expanding thyroid mass with airway compression and difficulty in swallowing 8.7 Burkitt-like lymphoma (B-cell lymphoma, unclassifiable) Rituximab, Cyclophosphamide, Mensa, Vincristine and Doxorubicin Successfully treated with 1 cycle of appropriate therapeutic chemotherapy Cooper et al [2014] [ 14 ] 14 M Large predominantly left-sided firm thyroid swelling, with a 3-month history of malaise, lethargy, and weight loss 6.7 Burkitt lymphoma t (8; 14) COP and prednisolone followed by 2 courses of COPADM, prednisolone and two courses of CYM chemotherapy. This was accompanied by intrathecal chemotherapy 36 Disease free 3 years after end of treatment Yildiz et al [2012] [ 22 ] 31 M Rapidly enlarging mass on the fore neck 4 Burkitt lymphoma R-Hyper-CVAD therapy 6 PET-CT scans performed after chemotherapy and at the 6-month follow-up were normal Mweempwa et al [2013] [ 24 ] 58 F Background of benign goiter presented with a rapidly enlarging thyroid mass, causing dysphagia and dyspnea 8 Burkitt lymphoma t (8; 14) Modified Magrath protocol for Burkitt’s lymphoma, low risk disease, which involved having 3 cycles of R-CODOX-M 4 Complete resolution of the tumour mass, 4 weeks after end of treatment Liying et al [2014] [ 30 ] 8 M Mass in the right anterior neck with difficulty in swallowing 4 Burkitt lymphoma t (8; 14) Right lobe thyroidectomy. After diagnosis, the patient underwent alternate R-B-NHL-BFM-90-A and R-B-NHL-BFM-90-B treatment, for 4 cycles each 48 After 4 years of follow-up, the patient appears well and remains free of disease …”

“…Nearly 100 % of the cells are positive for Ki67. There are very few admixed T-cells [ 12 , 28 – 30 ]. In the present case, the immunophenotype of the atypical lymphoid cells was consistent with these features.…”

“…However, the EBV detection rates in different subtypes of BL also vary [ 32 ]. EBV infection is detected in the vast majority of endemic BL and ~30 % of sporadic BL [ 12 , 30 , 32 ].…”

Lymphomas and thyroid: Bridging the gap

“…In the context of DLBCL, 2 histological subtypes can be distinguished: the MALT lymphoma secondarily transformed into an aggressive DLBCL, and the DLBCL without associated marginal zone lymphoma lesions, with a same clinical behavior. Rarer subtypes of PTL include follicular (10%), small lymphocytic (3%), and Hodgkin's lymphoma (2%); along with Burkitt's, T‐cell, mantle cell, and lymphoblastic lymphoma, each accounting for <1% of cases …”

Clinicopathological features of primary thyroid Burkitt’s lymphoma: a systematic review and meta-analysis

“…This neoplasm is characterized by intermediate-sized lymphoid cells with a "starry sky" appearance and exhibits chromosomal translocations that activate the MYC oncogene [2,3]. To our knowledge, only 20 patients with primary thyroid BL have been described in the English-language literature [4][5][6][7][8][9][10][11][12][13][14][15][16]. Because of its extremely low prevalence, little is known about the pathogenesis and clinicopathological features of this disease, or about the differences between it and its systemic counterpart.…”