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Mishra P, Banerjee D, Gujral S. T-cell Lymphoma of Thyroid Gland with Lennert Type of Morphology: A Case Report and Review of the Literature. Head Neck Pathol 2016; 10:321-6. [PMID: 26984124 PMCID: PMC4972765 DOI: 10.1007/s12105-016-0711-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/10/2016] [Indexed: 11/25/2022]
Abstract
The rare entity of primary T-cell lymphoma of thyroid gland may pose great diagnostic and therapeutic challenges to the pathologist and clinician. There are very few case and short series reports of these tumors describing their varied clinicopathologic features in English literature. We report a case of mature T-cell lymphoma of thyroid in a 26 year old male, with unique pseudogranulomatous and lymphohistiocytic Lennert type of morphology, on a background of autoimmune thyroiditis. This man, diagnosed with Hashimoto's thyroiditis for the previous 2 years, underwent thyroidectomy for sudden onset of pressure symptoms. The diagnosis of T-cell lymphoma was made on the thyroid tissue based on histopathologic and immunophenotypic findings, in concert with the results of T-cell receptor gene rearrangement studies by polymerase chain reaction. Later, after about 3 months, similar findings were confirmed in an excision biopsy from a left cervical lymph node in the patient. The patient has been started on chemotherapy with gemcitabine, dexamethasone, and cisplatin along with involved field radiotherapy; however, he has shown a rapid upstaging of disease from stage IE to IIIE in a short period of 3 months with relatively well preserved clinical parameters until the latest follow up.
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Affiliation(s)
| | - Devmalya Banerjee
- Department of Pathology, Tata Memorial Centre, Parel, Mumbai, 400012, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Centre, Parel, Mumbai, 400012, India
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Fujiwara K, Fukuhara T, Kitano H, Okazaki T. Infiltration of the thyroid gland by T-cell prolymphocytic leukemia. Thyroid 2014; 24:1314-8. [PMID: 24762052 DOI: 10.1089/thy.2013.0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND T-cell prolymphocytic leukemia (T-PLL) is rare, accounting for only 0.06% of all malignant lymphomas, and is classified as a T-cell mature lymphoma. The disease affects mainly elderly patients and is characterized by splenomegaly, lymphadenopathy, skin infiltration, and a high leukocyte count, but thyroid filtration has never been detected as far as we could determine. We report here a case of infiltration of the thyroid gland by T-PLL. PATIENT FINDINGS An 89-year-old woman who had been treated for Hashimoto's thyroiditis for 20 years presented with a progressively enlarging thyroid mass accompanied by dyspnea and dysphasia. Atypical lymphocytes with irregular nuclei were observed in the peripheral blood. An open biopsy of the thyroid provided pathological evidence of T-PLL, and bone marrow examination showed infiltration by T-PLL. The diagnosis was therefore infiltration of the thyroid gland by T-PLL. Chemotherapy was initiated, but six months after termination, recurrence of neck swelling was observed. The patient was then treated with radiotherapy, but she died of a major stroke 15 months after onset. SUMMARY AND CONCLUSION This is the first report of T-PLL infiltration of the thyroid gland, reminding physicians to keep in mind a broad differential diagnosis when encountering a patient with diffuse thyroid lesions and abnormal lymphocytes in the peripheral blood.
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Affiliation(s)
- Kazunori Fujiwara
- 1 Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University , Yonago, Japan
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Yoshida N, Nishikori M, Izumi T, Imaizumi Y, Sawayama Y, Niino D, Tashima M, Hoshi S, Ohshima K, Shimoyama M, Seto M, Tsukasaki K. Primary peripheral T-cell lymphoma, not otherwise specified of the thyroid with autoimmune thyroiditis. Br J Haematol 2013; 161:214-23. [PMID: 23432459 DOI: 10.1111/bjh.12255] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 01/11/2013] [Indexed: 01/08/2023]
Abstract
Primary peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) of the thyroid is an extremely rare neoplasm. Six cases of primary PTCL-NOS of the thyroid were analysed for clinicopathological features and genomic alteration patterns using oligo-array comparative genomic hybridization. All patients had a diffusely enlarged thyroid and three cases showed leukaemic manifestation. Five of the six cases had anti-thyroid antibodies and the remaining case showed hypothyroidism, suggesting that all cases had autoimmune thyroiditis. Except for one early relapsed case, the remaining five patients are alive and three of these five individuals have survived for 70 months or more. Interestingly, two cases showed spontaneous regressions after partial thyroid biopsy without any therapy. Leukaemic manifestation disappeared after irradiation of the thyroid mass in another two cases. The tumour cells were positive for CD3, CD4 and CXCR3 in all cases, suggesting that the tumour cells are of a type 1 helper T-cell origin. All six cases showed genomic alterations that were different from those previously reported for PTCL-NOS. The loss of 6q24·2 was characteristic and was detected in four of the six cases. These results suggest that primary PTCL-NOS of the thyroid arising from autoimmune thyroiditis is a distinct disease entity among heterogeneous PTCL-NOS.
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Affiliation(s)
- Noriaki Yoshida
- Division of Molecular Medicine, Aichi Cancer Centre Research Institute, Nagoya, Japan
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Yokoyama J, Ito S, Ohba S, Fujimaki M, Sato E, Komatsu N, Ikeda K, Hanaguri M. Problems of primary T-cell lymphoma of the thyroid gland--a case report. World J Surg Oncol 2012; 10:58. [PMID: 22515161 PMCID: PMC3414802 DOI: 10.1186/1477-7819-10-58] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 04/19/2012] [Indexed: 11/29/2022] Open
Abstract
In the following report we discuss a very rare case of malignant T-cell lymphoma of the thyroid gland that developed in a 70-year-old woman with a past history of hypothyroidism due to chronic thyroiditis. The chief complaint was a rapidly growing neck mass. CT and ultrasonographic examination revealed a diffuse large thyroid gland without a nodule extending up to 13 cm. Although presence of abnormal lymphoid cells in the peripheral blood was not found, the sIL-2 Receptor antibody and thyroglobulin measured as high as 970 U/ml and 600 ng/mL respectively. Fine needle aspiration cytology diagnosed chronic thyroiditis. A preoperative diagnosis of suspicious malignant lymphoma of the thyroid gland accompanied by Hashimoto’s thyroiditis was made, and a right hemithyroidectomy was performed to definite diagnosis. Histological examination revealed diffuse small lymphocytic infiltration in the thyroid gland associated with Hashimoto’s thyroiditis. Immunohistochemical examination showed that the small lymphocytes were positive for T-cell markers with CD3 and CD45RO. The pathological diagnosis was chronic thyroiditis with atypical lymphocytes infiltration. However, Southern blot analysis of tumor specimens revealed only a monoclonal T-cell receptor gene rearrangement. Finally, peripheral T cell lymphoma was diagnosed. Therefore, the left hemithyroidectomy was also performed one month later. No adjuvant therapy was performed due to the tumor stage and its subtype. The patient is well with no recurrence or metastasis 22 months after the surgical removal of the thyroid. As malignant T-cell lymphoma of the thyroid gland with Hashimoto’s thyroiditis was difficult to diagnose, gene rearrangement examination needed to be performed concurrently.
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Affiliation(s)
- Junkichi Yokoyama
- Department of Otolaryngology, Head and Neck Surgery, Juntendo University School of Medicine, Tokyo, Japan.
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Abstract
Malignant lymphomas represent approximately 5% of all malignant neoplasms of the head and neck area. They are classically divided into two subgroups, Hodgkin's lymphomas (HLs) and non-Hodgkin's lymphomas (NHLs). We describe the clinical characteristics of head and neck lymphomas and the methods to establish the diagnosis. The World Health Organization classification of lymphoid tissues describes more than 50 different histological types, and we analyse the most common staging system for lymphomas, the Ann Arbor staging system. Finally, the different therapeutic approaches are discussed.
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Affiliation(s)
- E Zapater
- ENT Department, University General Hospital, Valencia Medical School, Valencia, Spain.
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Kim NR, Ko YH, Lee YD. Primary T-cell lymphoma of the thyroid associated with Hashimoto's thyroiditis, histologically mimicking MALT-lymphoma. J Korean Med Sci 2010; 25:481-4. [PMID: 20191052 PMCID: PMC2826735 DOI: 10.3346/jkms.2010.25.3.481] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 12/24/2008] [Indexed: 11/20/2022] Open
Abstract
Most of thyroid lymphomas are B-lineage, and T-cell lymphomas are rare. Here, we report a case of primary thyroid T-cell lymphoma associated with Hashimoto's thyroiditis. A 48-yr-old woman presented with incidentally found neck mass. Histologically, the resected right lobe of the thyroid was replaced by monomorphic small atypical lymphoid cells with lymphoepithelial lesion-like change, most of which were immunoreactive for CD3, CD8, betaF-1, and TIA-1. Peripheral T-cell lymphoma, unspecified, was finally diagnosed after molecular study for TCR-gamma gene rearrangement. This is the second case of cytotoxic T-cell lymphoma reported in the thyroid gland so far. Unique association between thyroid follicles and neoplastic lymphocytes may be characteristic feature of this type of T-cell lymphoma.
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Affiliation(s)
- Na Rae Kim
- Department of Pathology, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea
| | - Young-Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Don Lee
- Department of Surgery, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea
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Sarinah B, Hisham AN. Primary Lymphoma of the Thyroid: Diagnostic and Therapeutic Considerations. Asian J Surg 2010; 33:20-4. [DOI: 10.1016/s1015-9584(10)60004-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2009] [Indexed: 11/29/2022] Open
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8
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Primary T-cell lymphoma of the thyroid: case report and review of the literature. Med Oncol 2008; 25:462-6. [DOI: 10.1007/s12032-008-9059-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 03/07/2008] [Indexed: 10/22/2022]
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Green LD, Mack L, Pasieka JL. Anaplastic thyroid cancer and primary thyroid lymphoma: a review of these rare thyroid malignancies. J Surg Oncol 2006; 94:725-36. [PMID: 17131397 DOI: 10.1002/jso.20691] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND To review the current literature on the treatment of anaplastic thyroid cancer (ATC) and thyroid lymphoma (TL). RESULTS Both anaplastic carcinoma (ATC) and TL represent rare forms of thyroid cancer. ATC behaves in a highly aggressive manner, resulting in significant morbidity and mortality. Multimodality therapy consisting of both radiotherapy (RT) and chemotherapy is essential in obtaining local/regional control. Although ATC has been relatively chemo resistant, newer agents such like taxotere show promise. The role of surgery in the treatment of ATC continues to evolve, presently it should be reserved for patients who have shown an initial response to multimodality therapy and in patients in whom a complete macroscopic resection can be achieved with minimal morbidity. The successful treatment of TL currently lies in accurately diagnosing the histological subtype. Both large B-cell and mixed lymphomas are best treated with multimodality therapy consisting of CHOP combined with hyper-fractioned RT. MALT lymphomas with there more indolent course may be amenable to single modality RT or total thyroidectomy if diagnosed at an early stage IE. DISCUSSION Although both ATC and TL are rare, it is important for surgeons to be aware of the need for multimodality therapy when treating these patients and to understand the limited role surgery plays in diagnosis and treatment.
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Affiliation(s)
- Lawrence D Green
- Department of Surgery, Division of General Surgery and Surgical Oncology, University of Calgary, Calgary Alberta, Canada
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Chetty R. Thyroid lymphomas. Cancer Treat Res 2005; 122:69-84. [PMID: 16209038 DOI: 10.1007/1-4020-8107-3_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Runjan Chetty
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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Abstract
Reported herein is a rare case of malignant T-cell lymphoma of the thyroid gland that developed in a 71-year-old woman with a past history of chronic thyroiditis. The chief complaints were rapidly growing neck mass, weight loss and hoarseness. Presence of abnormal lymphoid cells in the peripheral blood, and an increase in anti-microsome antibodies and anti-thyroglobulin antibodies were found on preoperative laboratory tests. A diagnosis of suspicious malignant lymphoma of the thyroid gland accompanied by Hashimoto's thyroiditis was made, and a total thyroidectomy was performed. Histological examination revealed diffuse small lymphocytic infiltration in the thyroid gland associated with Hashimoto's thyroiditis. Immunohistochemical examination showed that the small lymphocytes were positive for T-cell markers with CD4 predominance. Southern blot analysis of tumor specimens revealed a monoclonal T-cell receptor gene rearrangement. Peripheral T-cell lymphoma was diagnosed. No adjuvant therapy was performed because of the tumor stage and its subtype. The patient is well with no recurrence or metastasis 25 months after the surgical removal of the thyroid. The present case suggests that Hashimoto's thyroiditis might play an important role in the carcinogenesis of thyroid lymphoma not only of B-cell lineage but also of T-cell lineage.
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Affiliation(s)
- Noriko Motoi
- Department of Pathology, Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
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Weber AL, Rahemtullah A, Ferry JA. Hodgkin and non-Hodgkin lymphoma of the head and neck: clinical, pathologic, and imaging evaluation. Neuroimaging Clin N Am 2004; 13:371-92. [PMID: 14631680 DOI: 10.1016/s1052-5149(03)00039-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lymphomas are subdivided into HL and NHL and are more specifically classified into subtypes of HL or NHL according to the WHO classification. HLs involve the lymph nodes predominantly and only approximately 5% arise in extranodal sites, whereas 30% of NHLs present in extranodal sites. Imaging studies, including CT and MR imaging, cannot distinguish [figure: see text] HL from NHL, and cannot differentiate their various subtypes, necessitating a pathologic diagnosis. Clinical parameters, however, can be helpful in differentiating the two broad categories of lymphomas, and subtypes of lymphomas have predilections for different sites within the head and neck. HL is most commonly located in the lymph nodes of the neck and mediastinum. Marginal-zone lymphoma has an affinity for the ocular adnexa, salivary glands, larynx, and the thyroid gland. Diffuse large B-cell lymphoma is commonly encountered in the paranasal sinuses, mandible, maxilla, and Waldeyer ring. Burkitt lymphoma occurs more frequently in children and young adults and frequently affects the maxilla and mandible, with a greater distribution of involvement at a lower frequency. On imaging studies, the lymph nodes of HL and NHL are homogeneous and variable in size, with an average diameter from 2 to 10 cm. They may enhance slightly to moderately, display necrosis before and after treatment, and display calcification post-treatment. NHL in extranodal sites in the head and neck (nasopharynx, Waldeyer ring, oral cavity, and larynx) manifests frequently as a submucosal mass accompanied [figure: see text] by polypoid, bulky masses with a smooth mucosal surface. Clinically aggressive lymphomas, such as Burkitt lymphoma, diffuse large B-cell lymphoma, and NK-/T-cell lymphomas are characterized by destruction of the maxilla, mandible, and bones around the paranasal sinuses, which is indistinguishable from bony destruction in other malignant tumors, such as SCC. Contrast CT is indicated for evaluation of cervical lymph nodes; the chest, including the mediastinum; the pelvic cavity; paranasal sinuses; and orbits. CT is also useful for detection of bone destruction involving the base of the skull, paranasal sinuses, and the mandible or maxilla. MR imaging is preferred for the assessment of extension of lymphomas to different fascial spaces (parapharyngeal, masticator, infratemporal fossa, tongue, and nasopharynx) and for intracranial extension. Lymphomas are isodense to muscle on CT and circumscribed with distinct margins that occasionally display extranodal extension with less-well-defined margins and areas of necrosis within the tumor matrix. Lymphomas appear low in signal intensity on T1-weighted images and low to high in signal intensity on T2-weighted images, with variable, but usually low, enhancement following introduction of Gadolinium-DTPA (Gd-DTPA) contrast material.
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Affiliation(s)
- Alfred L Weber
- Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
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Abstract
Although the vast majority of thyroid cancers are well-differentiated and carry an excellent prognosis, several rare tumors occasionally involve the thyroid gland and require unique treatment paradigms. Anaplastic carcinoma of the thyroid is an extremely aggressive neoplasm that is generally best managed with surgery followed by a multimodality regimen of radiotherapy and chemotherapy. Squamous cell carcinoma of the thyroid often mimics the clinical course of anaplastic carcinoma and is best treated with aggressive surgery followed by postoperative radiotherapy. Treatment and prognosis of lymphoma of the thyroid varies depending upon the specific pathological subtype, with combination chemotherapy and radiation therapy used primarily. Sarcomas of the thyroid are primarily managed with surgery, although radiation and chemotherapy are indicated in some cases.
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Affiliation(s)
- Joseph C Sniezek
- Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859-5000, USA.
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Raftopoulos I, Vanuno D, Kouraklis G. Two unusual sites of colon cancer metastases and a rare thyroid lymphoma. Case 3. Primary T-cell lymphoma of the thyroid arising in a background of Hashimoto's thyroiditis. J Clin Oncol 2001; 19:3576-80. [PMID: 11481367 DOI: 10.1200/jco.2001.19.15.3576] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- I Raftopoulos
- St Francis Hospital, Evanston, and Metropolitan Group Hospitals General Surgery Residency at Chicago, University of Illinois, Chicago, IL, USA
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Haciyanli M, Erkan N, Yorukoglu K, Sagol O, Harmancioğlu O. Primary non-Hodgkin's T-cell lymphoma of the thyroid gland complicating Hashimoto's thyroiditis: case report. Thyroid 2000; 10:717-20. [PMID: 11014319 DOI: 10.1089/10507250050137824] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This case report presents an extremely rare case of primary non-Hodgkin's T-cell lymphoma of the thyroid gland complicating Hashimoto's thyroiditis and discusses the clinical history, findings, treatment, and prognosis. Although the place of surgery in the treatment of thyroid lymphoma is controversial, in this case, surgery followed by three rounds of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone, and radiation therapy to neck and mediastinum were a very effective treatment for the disease so that no relapse has been detected during 3-year follow-up.
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Affiliation(s)
- M Haciyanli
- Department of General Surgery, Dokuzeylül University Hospital, Izmir, Turkey.
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