Primary thyroid lymphoma: The 40 year experience of a UK lymphoma treatment centre

Abstract

Abstract. We report the 40-year unselected experience of a UK lymphoma treatment centre. Between 1970 and 2010, 3363 cases of non-Hodgkin lymphoma were managed by the Sheffield Lymphoma Team. Seventy cases of primary thyroid lymphoma were identified during this time. This retrospective review of the clinical and pathological features of patients with thyroid lymphoma comprises one of the largest series conducted in the UK. The series included 57 females and 13 males with a median age at diagnosis of 69.5. The pathological subtypes were diffuse large B-cell lymphoma (DLBCL) in 50 patients, MALT lymphoma in 13, indolent B-cell lymphoma not otherwise specified (NOS) in 6 and T cell lymphoma in one patient. Of the 64 patients fully staged, 53 had Stage IE and 11 Stage IIE disease. Management modalities included surgery, chemotherapy, radiotherapy or combination treatment. Fiveyear survival rates for DLBCL, MALT lymphoma and indolent B-cell lymphoma NOS were 45%, 62% and 75%, respectively, with a median overall survival of all histological subtypes of 68 months (range 0-148) or 5.7 years. The outcomes of this series confirm previous experience. If treatment is needed after surgery radiotherapy alone is sufficient for Stage I and II low grade thyroid lymphoma. Combination chemotherapy or adequate chemotherapy followed by radiotherapy is warranted in high grade thyroid lymphoma. IntroductionPrimary thyroid lymphoma is a rare disease, representing only 2-8% of all thyroid malignancies and 1-2% of all newly diagnosed extranodal lymphomas (1-5). The majority of thyroid lymphomas are B-cell lymphoma, although there have been rare cases of Hodgkin and T cell lymphoma.The most common lymphoma of the thyroid is diffuse large B-cell lymphoma (DLBCL) accounting for 50-70% of all cases (6). Mucosa-associated lymphoid tissue (MALT) lymphoma is a distinct lymphoma originating from parafollicular B cells, developing as a result of chronic inflammation and lymphoplasmacytic infiltration as seen in Hashimoto's thyroiditis, hence the close correlation between the two diseases. MALT lymphomas are thought to account for 25-30% of all thyroid lymphomas (6). Histological evidence of mixed MALT lymphoma and DLBCL support the theory of transformation of DLBCL from a MALT lymphoma. This mixed subtype appears to have the same clinical behaviour as DLBCL (6). Primary thyroid lymphoma is often diagnosed and managed as two distinct clinical entities. High grade lymphomas with a more aggressive clinical course include DLBCL and T cell lymphoma, whereas MALT and follicular lymphomas are considered low grade with a more indolent natural history. Differentiation between the two clinical entities is important as it determines appropriate treatment options.As with Hashimoto's disease, thyroid lymphomas occur more commonly in females than in males with a ratio of 2:1, though in some series this has been reported to be as high as 14:1 (7).Patients usually present with an enlarging neck mass, more rapidly growing in DLBCL than MALT lymphoma, often causin...

Early cytological diagnosis of extranodal stage I, primary thyroid Non-Hodgkin lymphoma in elderly patients. Report of two cases and review of the literature

“…Treatment and prognosis depend on the specific subtype and staging; surgical treatment of localized tumors, radio and chemotherapy for low-grade and high-grade histotypes respectively is generally utilized [6]. A 5-year survival of 90% has been reported in correctly diagnosed and treated PTL patients [7]; therefore a timely and accurate diagnosis of PTL is mandatory for treatment and prognosis. Palpable neck masses are not a rare occurrence, some time representing a challenging diagnostic dilemma with unusual extrathyroidal masses [8,9].…”

Burkitt Lymphoma of Thyroid Gland in an Adolescent

“…The common histological subtypes are diffuse large B-cell lymphoma or mucosa-associated lymphoid tissue (MALT) lymphoma or a mixture of both [4–6]. Primary BL of the thyroid is very rare with a few isolated case reports in adult patients [7–10].…”

Impact of Flow Cytometry in Thyroid Cytopathology

“…In contrast to the distinction between low-grade lymphoma and Hashimoto thyroiditis, the diagnosis of large cell lymphoma is often straightforward morphologically, with practising cytopathologists keenly aware of the morphological features as it is the most common lymphoma [6] of the thyroid. Given that large cell lymphoma is most commonly treated with chemotherapy rather than excision, noninvasive diagnosis is most desirable.…”

“…Lymphoma rarely involves the thyroid; 0.3% of all malignancies in the thyroid are lymphoma [5]. Conversely, 0.2% of all non-Hodgkin lymphomas involve the thyroid [6]. Thus, the observation that cytomorphology alone is a poor diagnostic modality for lymphoma in the thyroid [7] is not surprising.…”