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Mahmoud EM, Howard E, Ahsan H, Cousins JP, Nada A. Cross-sectional imaging evaluation of atypical and uncommon extra-nodal head and neck Non-Hodgkin lymphoma: Case series. J Clin Imaging Sci 2023; 13:6. [PMID: 36751565 PMCID: PMC9899482 DOI: 10.25259/jcis_134_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/14/2023] [Indexed: 01/26/2023] Open
Abstract
Extra-nodal Non-Hodgkin lymphoma (ENHL) of the head and neck is not uncommon and has variable clinical and imaging presentations. It represents about 25% of extra-nodal lymphomas. In addition, lymphoma is the third most common malignancy of the head and neck just after squamous cell carcinoma (SCC) and salivary gland neoplasms. Unlike SCC, ENHL usually presents as a well-defined mass in the oral cavity, along the pharyngeal mucosa, sinonasal cavity, orbit, and other different neck spaces. One of the common presentations of ENHL is the glandular type which can arise within the salivary or thyroid glands as marginal zone non-Hodgkin lymphoma. ENHL can infiltrate the bone resembling high grade osseous malignancies. Rarely, ENHL can present as perineural spread without definitive mass and manifest clinically with several neuropathies. In this case series, we presented different imaging features and presentation of ENHL of the head and neck. The knowledge of various presentations of ENHL of the head and neck can help early diagnosis and prompt management of these patients' population.
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Affiliation(s)
- Esmat M. Mahmoud
- Department of Diagnostic and Interventional Radiology, National Cancer Institute, Cairo, Egypt
| | - Emily Howard
- Department of Radiology, University of Missouri, Columbia, Missouri, United States
| | - Humera Ahsan
- Department of Radiology, University of Missouri, Columbia, Missouri, United States
| | - Joseph P. Cousins
- Department of Radiology, University of Missouri, Columbia, Missouri, United States
| | - Ayman Nada
- Department of Radiology, University of Missouri, Columbia, Missouri, United States.,Corresponding author: Ayman Nada, Department of Radiology, University of Missouri, Columbia, Missouri, United States.
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2
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Peng C, Yi D, Zhou Y, Yao J, Chen B, Yang C, Xu D. Differential diagnosis of non-diffuse primary thyroid lymphoma and papillary thyroid carcinoma by ultrasound combined with computed tomography. BMC Cancer 2022; 22:938. [PMID: 36042430 PMCID: PMC9429725 DOI: 10.1186/s12885-022-10035-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background Primary thyroid lymphoma (PTL) and papillary thyroid carcinoma (PTC) are both thyroid malignancies, but their therapeutic methods and prognosis are different. This study aims to explore their sonographic and computed tomography(CT)features, and to improve the early diagnosis rate. Methods The clinical and imaging data of 50 patients with non-diffuse PTL and 100 patients with PTC confirmed by pathology were retrospectively analysed. Results Of the 150 patients, from the perspective of clinical data, between non-diffuse PTL and PTC patients existed significant difference in age, maximum diameter of nodule, asymmetric enlargement and Hashimoto’s thyroiditis (P < 0.001), but not in gender ratio, echo texture, cystic change and anteroposterior-to-transverse ratio (P > 0.05). With respect to sonographic feature, non-diffuse PTL patients had a higher proportion than PTC patients in markedly hypoechoic, internal linear echogenic strands, posterior echo enhancement, rich vascularity, lack of calcification and homogeneous enhancement, with statistically significant difference (P < 0.05), while PTC patients had a higher proportion than non-diffuse PTL patients in irregular border, circumscribed margin, capsular invasion and significant enhancement, with statistically significant difference (P < 0.001). With respect to CT feature, non-diffuse PTL patients were significantly different from PTC patients in the non-contrast CT value mean, venous phase CT value mean, enhanced intensity and homogeneity of nodules (P < 0.05). Multivariate logistic regression analysis showed that age (OR = 1.226, 95%CI:1.056 ~ 1.423, P = 0.007), posterior echo enhancement (OR = 51.152, 95%CI: 2.934 ~ 891.738, P = 0.007), lack of calcification (OR = 0.013, 95%CI: 0.000 ~ 0.400, P = 0.013) and homogeneous enhancement (OR = 0.020, 95%CI: 0.001 ~ 0.507, P = 0.018) were independent risk factors. Conclusions Sonographic and CT features of the presence of posterior echo enhancement, lack of calcification and homogeneous enhancement were valuable to distinguishing non-diffuse PTL from PTC.
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Affiliation(s)
- Chanjuan Peng
- Department of Ultrasound, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Banshan 7 Road, Gongshu District, Hangzhou, 310022, China.,Institute of Basic Medicine and Cancer (IBMC), Chinese Academy Of Sciences, Hangzhou, 310022, China
| | - Dan Yi
- Department of Ultrasound, Shaoxing People's Hospital, Hangzhou, 312000, China
| | - Ying Zhou
- Department of Surgery, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, 050000, China
| | - Jincao Yao
- Department of Ultrasound, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Banshan 7 Road, Gongshu District, Hangzhou, 310022, China.,Institute of Basic Medicine and Cancer (IBMC), Chinese Academy Of Sciences, Hangzhou, 310022, China
| | - Bo Chen
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Chen Yang
- Department of Ultrasound, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Banshan 7 Road, Gongshu District, Hangzhou, 310022, China. .,Institute of Basic Medicine and Cancer (IBMC), Chinese Academy Of Sciences, Hangzhou, 310022, China.
| | - Dong Xu
- Department of Ultrasound, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 East Banshan 7 Road, Gongshu District, Hangzhou, 310022, China. .,Institute of Basic Medicine and Cancer (IBMC), Chinese Academy Of Sciences, Hangzhou, 310022, China. .,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, 310022, China. .,Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China.
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3
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Multimodality imaging of extra-nodal lymphoma in the head and neck. Clin Radiol 2022; 77:e549-e559. [DOI: 10.1016/j.crad.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/22/2022] [Indexed: 11/19/2022]
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4
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Ando T, Kato H, Matsuo M. Different CT imaging findings between histological subtypes in patients with primary thyroid lymphoma. Radiol Med 2022; 127:191-198. [PMID: 35031960 DOI: 10.1007/s11547-022-01447-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 12/31/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE This study evaluates the differences in CT imaging findings between diffuse large B cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma of the thyroid gland. METHODS This study included 18 patients with histopathologically confirmed primary thyroid lymphoma (nine with DLBCL and nine with MALT lymphoma). All patients underwent pretreatment CT imaging. We retrospectively reviewed all images and compared the imaging findings between the two pathologies. RESULTS The maximum diameter was significantly greater in DLBCL than in MALT lymphoma (67.7 ± 17.0 mm vs. 41.0 ± 27.2 mm, p < 0.01). Diffuse type (78% vs. 11%, p < 0.01), thickening of the isthmus (78% vs. 22%, p < 0.05), invasion of surrounding tissues (78% vs. 0%, p < 0.01), and regional lymphadenopathy (44% vs. 0%, p < 0.05) were more frequent in DLBCL than in MALT lymphoma. However, preserved peripheral thyroid tissue was more frequent in MALT lymphoma than in DLBCL (78% vs. 22%, p < 0.05). CONCLUSIONS The maximum diameter, morphological patterns (diffuse or nodular type), thickening of the isthmus, invasion of surrounding tissues, regional lymphadenopathy, and preserved peripheral thyroid tissue were useful CT imaging features in differentiating DLBCL from MALT lymphoma of the thyroid gland.
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Affiliation(s)
- Tomohiro Ando
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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5
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Oueslati I, Chatti H, Yazidi M, Chaker F, Chihaoui M. A diffuse large B-cell thyroid lymphoma presented as a compressive goiter in a young woman with no evidence of Hashimoto's thyroiditis. Clin Case Rep 2021; 9:e04436. [PMID: 34267915 PMCID: PMC8271253 DOI: 10.1002/ccr3.4436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 04/25/2021] [Accepted: 05/18/2021] [Indexed: 01/08/2023] Open
Abstract
Thyroid lymphoma should be suspected in case of rapid enlargement of the thyroid gland even in a young patient with no history of Hashimoto thyroiditis. The confirmation is based on histopathology and immunohistochemistry.
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Affiliation(s)
- Ibtissem Oueslati
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Hiba‐Allah Chatti
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Meriem Yazidi
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Fatma Chaker
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Melika Chihaoui
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
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6
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Perez AR, Perez MEC, Arcilla CE. Radical surgery for primary thyroid lymphoma in a Filipino female: Report of a case and review of literature. Int J Surg Case Rep 2020; 75:302-306. [PMID: 32979830 PMCID: PMC7519239 DOI: 10.1016/j.ijscr.2020.09.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 12/04/2022] Open
Abstract
Primary Thyroid Lymphomas are rare tumors that must be suspected in progressively enlarging thyroid masses in the background of Hashimoto’s thyroidits. Tissue diagnosis combined with appropriate radiologic imaging may lead to an accurate diagnosis. Preoperative diagnosis is ideal to avoid unnecessary surgery due to the availability of effective multimodal treatment with chemoradiotherapy. Surgery may be appropriate and effective in a select group of patients but must be combined with adjuvant chemoradiotherapy to achieve favorable outcomes.
Introduction Primary thyroid lymphomas are rare. They constitute only 2% of all thyroid malignancies. It is important to distinguish it from other tumors of the thyroid due to the marked difference in approach to management. Preoperative diagnostic confirmation is ideal to allow for appropriate therapeutic management, which consists of chemotherapy with or without radiotherapy and to avoid unnecessary surgery. In a select group of patients, surgery may be of benefit to relieve obstructive symptoms and establish diagnosis. Case presentation Presented herein is a 48 year old female with a progressively enlarging neck mass previously being treated for Hashimoto’s thyroiditis. Obstructive symptoms and a preoperative diagnosis of anaplastic carcinoma prompted surgical intervention. The patient underwent resection of the tumor with a total thyroidectomy and bilateral neck dissection. Post -operative diagnosis of non Hodgkins diffuse large B cell type of lymphoma was made. Discussion Primary thyroid lymphomas are rare tumors that may present similarly with some types of thyroid malignancies. An accurate diagnosis is important because non-surgical treatment options like combination chemotherapy and radiotherapy may be effective while sparing the patient from unnecessary radical surgery. Conclusion Primary thyroid lymphoma must be a differential diagnosis in patients presenting with large thyroid tumors in the background of Hashimoto’s thyroiditis. Although chemoradiotherapy is the preferred treatment approach, there is a role for surgery in cases of tumor obstruction and uncertain diagnosis.
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Affiliation(s)
- Anthony R Perez
- University of the Philippines College of Medicine and Philippine General Hospital, Philippines.
| | - Mary Ellen Chiong Perez
- University of the Philippines College of Medicine and Philippine General Hospital, Philippines
| | - Crisostomo E Arcilla
- University of the Philippines College of Medicine and Philippine General Hospital, Philippines
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Reginelli A, Urraro F, Sangiovanni A, Russo GM, Russo C, Grassi R, Agostini A, Belfiore MP, Cellina M, Floridi C, Giovagnoni A, Sica A, Cappabianca S. Extranodal Lymphomas: a pictorial review for CT and MRI classification. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:34-42. [PMID: 32945277 PMCID: PMC7944666 DOI: 10.23750/abm.v91i8-s.9971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022]
Abstract
Extranodal lymphomas represent an extranodal location of both non-Hodgkin and Hodgkin lymphomas. This study aims to evaluate the role of CT and MRI in the assessment of relationships of extranodal lymphomas with surrounding tissues and in the characterization of the lesion. We selected and reviewed ten recent studies among the most recent ones present in literature exclusively about CT and MRI imaging of extranodal lymphomas. Contrast-enhanced computed tomography (CT) is usually the first-line imaging modality in the evaluation of extranodal lymphomas, according to Lugano classification. However, MRI has a crucial role thanks to the superior soft-tissue contrast resolution, particularly in the anatomical region as head and neck. (www.actabiomedica.it)
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Angelo Sangiovanni
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Gaetano Maria Russo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Carolina Russo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Andrea Agostini
- Radiology Department, Università Politecnica delle Marche, Ancona, Italy.
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Michaela Cellina
- Department of Radiology, Ospedale Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Chiara Floridi
- Radiology Department, Università Politecnica delle Marche, Ancona, Italy.
| | - Andrea Giovagnoni
- Radiology Department, Università Politecnica delle Marche, Ancona, Italy.
| | - Antonello Sica
- Oncology and Hematology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
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8
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Travaglino A, Pace M, Varricchio S, Insabato L, Picardi M, Severino A, Pane F, Staibano S, Mascolo M. Clinical features associated with high pathological grade in primary thyroid lymphoma. Pathol Res Pract 2020; 216:152819. [PMID: 31974002 DOI: 10.1016/j.prp.2020.152819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/04/2020] [Accepted: 01/09/2020] [Indexed: 12/17/2022]
Abstract
This study aimed to identify clinical features associated with high pathological grade (HG) in primary thyroid lymphoma (PTL), through a systematic review and meta-analysis. Electronic databases were searched for studies assessing PTL. Extracted data were age, sex, lymph node involvement, symptoms, lymphocytic thyroiditis, serum tumor markers; the association with HG was assessed by using odds ratio (OR), with a significant p-value<0.05. Twenty-four studies with 1916 PTLs were included. HG was significantly associated with age≤55 (OR = 0.54; p < 0.0001); female sex (OR = 1.31; p = 0.02), lymph node involvement (OR = 2.23; p < 0.00001), compressive symptoms (OR = 2.61; p < 0.0001), absence of lymphocytic thyroiditis (OR = 0.45; p = 0.0002), and increased LDH levels (OR = 4.90; p < 0.00001), but not with age>60 (OR = 0.74; p = 0.24), age>70 (OR = 1.16; p = 0.66), and B symptoms (OR = 1.30; p = 0.54). In conclusion, Age≤55, female sex, lymph node involvement, compressive symptoms and absence of lymphocytic thyroiditis may be predictive factors for HG in PTL. On the other hand, B symptoms does not seem to be associated with pathological grade.
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Affiliation(s)
- Antonio Travaglino
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", Naples, Italy
| | - Mirella Pace
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", Naples, Italy
| | - Silvia Varricchio
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", Naples, Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", Naples, Italy
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples "Federico II", Naples, Italy
| | - Alessandro Severino
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples "Federico II", Naples, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples "Federico II", Naples, Italy
| | - Stefania Staibano
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", Naples, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", Naples, Italy.
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9
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Travaglino A, Pace M, Varricchio S, Insabato L, Giordano C, Picardi M, Pane F, Staibano S, Mascolo M. Hashimoto Thyroiditis in Primary Thyroid Non-Hodgkin Lymphoma. Am J Clin Pathol 2020; 153:156-164. [PMID: 31584614 DOI: 10.1093/ajcp/aqz145] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To assess the prevalence of Hashimoto thyroiditis (HT) in primary thyroid lymphoma (PTL) and whether it differs between mucosa-associated lymphoid tissue (MALT) lymphoma and diffuse large B-cell lymphoma (DLBCL). METHODS Electronic databases were searched for studies assessing HT prevalence in PTL, based on antithyroid antibodies, clinical history, or pathology. Pooled prevalence of HT and its association with histotype (MALT or DLBCL) were calculated. RESULTS Thirty-eight studies with 1,346 PTLs were included. Pooled prevalence results were 78.9% (any HT evidence), 65.3% (antithyroid antibodies), 41.7% (clinical history), and 64% (pathology). HT prevalence was significantly higher in MALT lymphoma than in DLBCL (P = .007) and in mixed DLBCL/MALT than in pure DLBCL (P = .002). CONCLUSIONS Overall, 78.9% of patients with PTL have any HT evidence, but only half of these had been clinically followed. The difference in HT prevalence suggests that a subset of DLBCL may not derive from MALT lymphoma.
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Affiliation(s)
- Antonio Travaglino
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples “Federico II”, Naples, Italy
| | - Mirella Pace
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples “Federico II”, Naples, Italy
| | - Silvia Varricchio
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples “Federico II”, Naples, Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples “Federico II”, Naples, Italy
| | - Claudia Giordano
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Naples, Italy
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Naples, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Naples, Italy
| | - Stefania Staibano
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples “Federico II”, Naples, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples “Federico II”, Naples, Italy
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Abstract
Primary extranodal lymphoma is defined as a lymphoma at a solitary extranodal
site, with or without involvement of the lymph nodes. The clinical and
radiological features of extranodal lymphoma have been documented in recent
studies. In this pictorial essay, we reviewed imaging findings of extranodal
lymphoma in the head and neck region.
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Affiliation(s)
- Pinar Gulmez Cakmak
- Department of Radiology, Pamukkale University Medical Center, Denizli, Turkey
| | | | - Furkan Ufuk
- Department of Radiology, Pamukkale University Medical Center, Denizli, Turkey
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Mancuso S, Carlisi M, Napolitano M, Siragusa S. Lymphomas and thyroid: Bridging the gap. Hematol Oncol 2018; 36:519-524. [PMID: 29484690 DOI: 10.1002/hon.2504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 12/27/2017] [Accepted: 01/24/2018] [Indexed: 01/08/2023]
Abstract
The thyroid gland is often involved in the development of neoplastic diseases, including lymphoproliferative disorders. The aim of this paper is to provide a comprehensive overview of the multiple interactions between lymphoma and thyroid. Through an extensive research among the literature, the relationship between lymphomas and thyroid can be established at various levels, and the possible interconnections are here summarized in 5 points: (1) the greater risk of lymphoma development in some thyroid diseases; (2) the primary thyroid lymphoma, with focus on issues related to the diagnosis, differential diagnosis, and treatment; (3) the incidence of thyroid involvement in primitive nodal lymphomas or in extranodal lymphomas of the other sites; (4) thyroid changes after treatment of lymphoma, in relation to the effects of radiation therapy and immuno-chemotherapy; (5) the incidental findings of thyroid changes, on imaging, in patients with lymphoma, without a direct involvement of the gland in malignant disease. In conclusion, issues that until now have been dealt with separately will therefore be analyzed in a unique paper, allowing a global view of the topic and emphasizing the need of a multidisciplinary approach. Future learning areas in this topic mainly relate to rapidly increasing the knowledge of imaging studies together with expanding the armamentarium of novel biological and targeting agents in lymphoma patients.
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Affiliation(s)
- Salvatrice Mancuso
- Department of Oncology, Haematology Unit, University of Palermo School of Medicine, Palermo, Italy
| | - Melania Carlisi
- Department of Oncology, Haematology Unit, University of Palermo School of Medicine, Palermo, Italy
| | - Mariasanta Napolitano
- Department of Oncology, Haematology Unit, University of Palermo School of Medicine, Palermo, Italy
| | - Sergio Siragusa
- Department of Oncology, Haematology Unit, University of Palermo School of Medicine, Palermo, Italy
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12
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Watal P, Bathla G, Thaker S, Sato TS, Moritani T, Smoker WRK. Multimodality Imaging Spectrum of the Extranodal Lymphomas in the Head and Neck-A Pictorial Review. Curr Probl Diagn Radiol 2017; 47:340-352. [PMID: 29174137 DOI: 10.1067/j.cpradiol.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/14/2017] [Accepted: 07/26/2017] [Indexed: 02/06/2023]
Abstract
Lymphoma is the second most common malignant neoplasm of the head and neck region, involving the nodal and/or extranodal sites or both in a variable fashion. Lymphoma may mimic a variety of tumors in this region depending on the subsite involved. The usual presentation of lymphomatous disease is presence of multiple enlarged, often conglomerate, lymph nodes without significant necrosis. Extranodal lymphomas demonstrate more complex radiologic features, but careful evaluation can identify distinct imaging patterns to suggest extranodal lymphomatous disease from other more common lesions. Knowledge of these imaging features can help raise suspicion for lymphoma as a differential consideration. This can be of critical importance since further work-up and management can be vastly different between lymphomatous disease and other disease entities. The authors present a pictorial review of the spectrum of imaging findings in extranodal head and neck lymphomas.
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Affiliation(s)
- Pankaj Watal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA.
| | - Girish Bathla
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Siddharth Thaker
- Department of Radiology, M P Shah Government Medical College & Government General Hospital, Jamnagar, Gujarat, India
| | - T Shawn Sato
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Toshio Moritani
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Wendy R K Smoker
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
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13
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Ruggiero FP, Frauenhoffer E, Stack BC. Thyroid Lymphoma: A Single Institution's Experience. Otolaryngol Head Neck Surg 2016; 133:888-96. [PMID: 16360509 DOI: 10.1016/j.otohns.2005.07.040] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Accepted: 07/12/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND: Primary lymphoma of the thyroid gland is uncommon. METHODS: The tumor registry at the Penn State Milton S. Hershey Medical Center was searched for all patients carrying a diagnosis of thyroid lymphoma. All available records for these patients were examined and information regarding patient and tumor characteristics, clinical presentation, interventions, and survival were tabulated. RESULTS: The average age of patient in our series was 67.5 years. There was a 2.7:1 female to male preponderance. Thirteen (60%) patients presented with thyroid nodule(s). Eleven (50%) presented with aerodigestive tract obstructive symptoms. Sixteen (73%) patients had no pre-existing history of thyroid disease; none had known pre-existing Hashimoto's thyroiditis. CONCLUSIONS: The typical thyroid lymphoma patient is female and elderly with painless thyroid enlargement. Compressive symptoms of the aerodigestive tract are common at presentation and may require urgent intervention. Treatment modalities (XRT, CHOP chemotherapy) and outcomes are distinct from other thyroid malignancies. EBM RATING: C
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Affiliation(s)
- Francis P Ruggiero
- Division of Otolaryngology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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14
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Li XB, Ye ZX. Primary Thyroid Lymphoma: Multi-Slice Computed Tomography Findings. Asian Pac J Cancer Prev 2015; 16:1135-8. [DOI: 10.7314/apjcp.2015.16.3.1135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wang JH, Chen L, Ren K. Identification of primary thyroid lymphoma with medical imaging: A case report and review of the literature. Oncol Lett 2014; 8:2505-2508. [PMID: 25364417 PMCID: PMC4214466 DOI: 10.3892/ol.2014.2542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 04/03/2014] [Indexed: 12/31/2022] Open
Abstract
Primary thyroid lymphoma (PTL) is a rare thyroid malignancy. Clinical diagnosis of PTL may not be easily established based on imaging studies, as the imaging features of PTL are similar to those of lymphocytic thyroiditis and primary thyroid cancer. The present study describes the case of a patient who was confirmed to have PTL by intra-operative pathological diagnosis. On color Doppler ultrasound, the PTL was shown as a significantly enlarged thyroid with reduced gland echoes. Color Doppler flow imaging showed increased blood flow. By computed tomography, the thyroid was revealed to be enlarged with reduced tissue density, particularly in the left lobe and the isthmus. In addition, calcified spots and swollen lymph nodes were evident. The clinical history of the patient was obtained and the imaging results were retrospectively analyzed. The imaging features of PTL were investigated through reviewing the literature. PTL exhibits specific features on medical imaging that aid in distinguishing it from other thyroid diseases. PTL exhibits specific features on medical imaging that aid in distinguishing PTL from other thyroid diseases, which may aid the support for clinical diagnosis and improve the clinical accuracy.
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Affiliation(s)
- Jia-Huan Wang
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China ; Department of Radiology, Jilin Central Hospital, Jilin City, Jilin 132000, P.R. China
| | - Liang Chen
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ke Ren
- Department of Radiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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16
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Kim EH, Kim JY, Kim TJ. Aggressive primary thyroid lymphoma: imaging features of two elderly patients. Ultrasonography 2014; 33:298-302. [PMID: 25060184 PMCID: PMC4176117 DOI: 10.14366/usg.14025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 12/26/2022] Open
Abstract
We report two cases of aggressive thyroid lymphoma in elderly patients that presented as large infiltrative thyroid masses with extensive invasion to adjacent structures including trachea, esophagus, and common carotid artery. Ultrasonography displayed irregular shaped, heterogeneous hypoechoic mass, mimicking anaplastic carcinoma. Computed tomography showed heterogeneously enhancing mass compared to surrounding muscles without calcification and hemorrhage. After biopsy, the masses were histopathologically diagnosed as lymphoma. Aggressive primary thyroid lymphoma is rare; therefore, here we report its image features, with emphasis on ultrasonographic findings, and discuss its differential diagnosis.
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Affiliation(s)
- Eu Hyun Kim
- Department of Radiology, Yeouido St. Mary's hospital, The Catholic University College of Medicine, Seoul, Korea
| | - Jee Young Kim
- Department of Radiology, Yeouido St. Mary's hospital, The Catholic University College of Medicine, Seoul, Korea
| | - Tae-Jung Kim
- Department of Pathology, Yeouido St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Korea
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17
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What is the Role of Diffusion Weigh Magnetic Resonance Imaging in Evaluation of Thyroid Nodules? Indian J Otolaryngol Head Neck Surg 2014; 66:336-40. [PMID: 25032125 DOI: 10.1007/s12070-014-0731-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/03/2014] [Indexed: 10/25/2022] Open
Abstract
This study aimed to compare ultrasonography (US), contrast-enhanced computed tomography (CCT) of the neck, and diffusion-weigh magnetic resonance imaging (DW-MRI) in differentiating between benign and malignant nodules while approaching to thyroid nodules, and to estimate sensitivity and specificity of these methods. On thyroid US, echogenicity, calcification, presence/absence of halo, nodule size being larger/smaller than 20 mm, and nodule nature (cystic/solid nature) were evaluated. Findings on CCT of the neck were grouped according to the heterogeneity/homogeneity, presence/absence of enhancement, and intensity. On DW-MRI, diffusion restriction was evaluated. The findings of these tests were compared with postoperative histopathological findings, and specificity and sensitivity of the tests in differentiating malignant and benign nodules were assessed. The study included 38 patients (34 females, 4 males). The sensitivity and specificity of DW-MRI were 20 and 75 %, respectively. Presence of a >20 mm nodule in thyroid US had the highest sensitivity, whereas thyroid fine-needle aspiration biopsy (FNAB) had the highest specificity in detecting malignancy. The sensitivities and specificities of CCT of the neck and DW-MRI appeared relatively low. Evaluation of thyroid US findings together with thyroid FNAB findings provided high specificity and sensitivity and yielded better results than findings of CCT of the neck and DW-MRI.
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18
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Walsh S, Lowery AJ, Evoy D, McDermott EW, Prichard RS. Thyroid lymphoma: recent advances in diagnosis and optimal management strategies. Oncologist 2013; 18:994-1003. [PMID: 23881987 DOI: 10.1634/theoncologist.2013-0036] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Primary thyroid lymphoma is rare, composing approximately 5% of all thyroid malignancies and less than 3% of all extranodal lymphomas. It typically presents as a rapidly enlarging goiter with associated compressive symptoms. Thyroid ultrasound and fine needle aspiration cytology, using flow cytometry and immunohistochemistry, remain the main modalities used to confirm the presence of lymphoma. The increasing use of an ultrasound-guided core biopsy to achieve an accurate diagnosis has further limited the role of surgery. An open surgical biopsy may still be required not only for definitive diagnosis but also to confirm the subtype of lymphoma. There are limited numbers of randomized or prospective trials to guide management, and controversy remains over optimal treatment. Treatment and prognosis of this disease can be dichotomized into two separate groups: pure mucosa-associated lymphoid tissue (MALT) lymphoma and diffuse large B-cell lymphoma (DLBCL) or mixed subtypes. Early stage (stage IE) intrathyroidal MALT lymphomas typically have an indolent course and may be treated with single-modality surgery, radiotherapy, or a combination of both. DLBCLs are more aggressive, and survival outcomes are highest with multimodal therapy incorporating monoclonal antibodies, chemotherapy, and radiotherapy. The prognosis is generally excellent but can be varied because of the heterogeneous nature of thyroid lymphomas. The aim of this paper is to discuss the changes in diagnostic modalities and to focus on the recent alterations in the management of this rare disease, including targeted therapies as well as the more limited role of the endocrine surgeon.
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Affiliation(s)
- Siun Walsh
- Department of Endocrine Surgery, St. Vincent's University Hospital, Dublin, Ireland
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19
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Sakorafas GH, Kokkoris P, Farley DR. Primary thyroid lympoma. Surg Oncol 2010; 19:e124-9. [DOI: 10.1016/j.suronc.2010.06.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 06/10/2010] [Accepted: 06/12/2010] [Indexed: 01/08/2023]
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20
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Prognosis of primary thyroid lymphoma: demographic, clinical, and pathologic predictors of survival in 1,408 cases. Surgery 2009; 146:1105-15. [PMID: 19958938 DOI: 10.1016/j.surg.2009.09.020] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 09/22/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is a paucity of data regarding prognosis of primary thyroid lymphoma (PTL), with only case reports and institutional series reported. This is the first population-based study of PTL in the United States. METHODS PTL patients were identified in the SEER database. Bivariate (chi(2), Kaplan-Meier, and log rank) and multivariate (Cox proportional hazards) analyses were used to assess the associations between patient characteristics and survival. RESULTS A total of 1,408 patients were identified over 32 years of follow-up (median, 3.75 years). Mean age was 66 years; 75% were female and 93% white. Overall, 98% had non-Hodgkin's lymphoma; 68% had diffuse large B-cell, 10% follicular, 10% marginal zone, and 3% small lymphocytic. A total of 88% had stage I-II disease. Median survival was 9.3 years. On bivariate analysis, older age, single marital status, stage II-IV disease, histology (large B-cell, follicular, or other non-Hodgkin's), earlier year of diagnosis, lack of prior malignancies, and no radiation/surgery predicted worse survival. Age >or=80 years, advanced stage, no radiation/surgery, and large B-cell or follicular histology predicted worse prognosis in multivariate analysis. CONCLUSION Older age, advanced stage, histologic subtype, and lack of radiation/surgical treatment are associated with worse survival. Thyroid resection offers benefit only for patients with stage I disease. Management of PTL requires multidisciplinary collaboration.
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Cho JH, Park YH, Kim WS, Oh SY, Cho SI, Kang HJ, Na II, Ryoo BY, Yang SH, Kim K, Jung CW, Park K, Ko YH, Lee SS. High incidence of mucosa-associated lymphoid tissue in primary thyroid lymphoma: A clinicopathologic study of 18 casesin the Korean population. Leuk Lymphoma 2009; 47:2128-31. [PMID: 17071486 DOI: 10.1080/10428190600783395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The present study aimed to evaluate the clinicopathologic features and treatment outcomes of patients with primary thyroid lymphoma (PTL). The patients included 14 women and four men with a median age of 50 years (range 31 - 82 years). Thirteen cases involved the thyroid alone (stage IE) and five cases involved the regional lymph nodes (stage IIE). Histopathologic studies revealed marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) in 13 patients and diffuse large B-cell lymphoma (DLBCL) in three patients. The other two patients showed features of both MALT and DLBCL. Surgery and chemotherapy with or without radiotherapy were performed. All patients achieved complete remission. All 18 patients were alive with a median follow-up period of 55 months. The prognosis of patients with primary thyroid lymphoma appears to be favourable.
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Affiliation(s)
- Jang Hyun Cho
- Department of Internal Medicine, Korea Institute of Radiological & Medical Science, Nowon-Ku, Seoul, Korea
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22
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Chua SC, Rozalli FI, O'Connor SR. Imaging features of primary extranodal lymphomas. Clin Radiol 2008; 64:574-88. [PMID: 19414080 DOI: 10.1016/j.crad.2008.11.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 10/18/2008] [Accepted: 11/02/2008] [Indexed: 12/14/2022]
Abstract
Lymphomas are generally considered tumours of lymph nodes, but up to 40% arise extranodally. This group shows distinctive pathological, radiological, and clinical features. Different subtypes of extranodal lymphoma may show sufficiently specific radiological features to be of significant value in both establishing a diagnosis of lymphoma and ascertaining the exact subtype. Rapidly evolving lymphoma classifications and emergence of new entities have, however, hampered the accurate description of these features in the literature. In this review, we discuss the radiological appearances, using a variety of imaging methods, of the full spectrum of primary extranodal lymphomas, categorized according to the current World Health Organisation classification.
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Affiliation(s)
- S C Chua
- Department of Nuclear Medicine, PET, and Radiology, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
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23
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The prevalence and significance of incidental thyroid nodules identified on computed tomography. J Comput Assist Tomogr 2008; 32:810-5. [PMID: 18830117 DOI: 10.1097/rct.0b013e318157fd38] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of this study was to assess the prevalence of incidental thyroid nodules (ITN) found on computed tomography (CT) of the neck and to determine whether CT characteristics could distinguish malignant from benign thyroid lesions. MATERIALS AND METHODS We retrospectively reviewed CT scans in 734 patients without known thyroid disease (384 men and 350 women; mean age, 49.8 +/- 13.7 years). The CT findings of ITN such as size, shape (anteroposterior-transverse diameter ratio [AP/T ratio]), margin, peripheral enhancing rim, intralesional calcification, and attenuation characteristics were analyzed and correlated with ultrasonographic (US) findings. RESULTS One hundred sixty ITNs were noted in 123 (16.8%) patients. Of 120 ITNs whose histological diagnoses were available, 15 (12.5%) were malignant. Malignant nodules more frequently showed nodular or rim calcifications (46.7% vs 13.3%; P < 0.0005), AP/T ratio of greater than 1.0 (33.3% vs 9.5%; P < 0.05), and mean attenuation value on contrast-enhanced scan of greater than 130 Hounsfield units (86.7% vs 49.5%; P < 0.05) than benign nodules. CONCLUSIONS We found at least a 9.4% (15/160) prevalence of malignancy among ITN detected on CT. The further evaluation with US or biopsy should be performed, if an ITN shows CT features suggesting malignancy (calcification; AP/T ratio, >1.0; or mean attenuation value, >130 HU).
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Earnest LM, Cooper DS, Sciubba JJ, Tufano RP. Thyroid MALT lymphoma in patients with a compressive goiter. Head Neck 2006; 28:765-70. [PMID: 16628752 DOI: 10.1002/hed.20424] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mucosa-associated lymphoid tissue (MALT) lymphomas account for less than 1% of all primary thyroid malignancies. They typically arise as neoplastic transformations within areas of autoimmune thyroiditis. Although they tend to have an indolent course, these lymphomas present a diagnostic challenge requiring a high level of suspicion in patients at increased risk of development. METHODS We retrospectively reviewed 3 cases of primary MALT thyroid lymphoma discovered in patients with a compressive goiter. This represents the experience at a single institution from 1996 to 2005. Hospital and clinic records were reviewed to identify the workup, treatment, and outcome. RESULTS One of 3 patients underwent preoperative fine-needle aspiration (FNA). All patients underwent total thyroidectomy to relieve compressive symptoms, and the final pathology revealed MALT lymphoma. Two patients subsequently underwent radiation therapy. All patients are alive without evidence of disease recurrence. CONCLUSIONS These cases are notable for the unexpected presentation of MALT lymphoma within a compressive goiter.
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Affiliation(s)
- Lisa M Earnest
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Kim HC, Han MH, Moon MH, Kim JH, Kim IO, Chang KH. CT and MR imaging of the buccal space: normal anatomy and abnormalities. Korean J Radiol 2005; 6:22-30. [PMID: 15782016 PMCID: PMC2684993 DOI: 10.3348/kjr.2005.6.1.22] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The buccal space is an anatomical compartment lying anterior to the masticator space and lateral to the buccinator muscle. Since the major purpose of imaging is to define the likely anatomic origin and also the extent of a given lesion, thorough knowledge of the normal anatomy of the buccal space is essential, and this knowledge can aid the physician in narrowing down the list of possible maladies on the differential diagnosis. We illustrate here in this paper the important anatomic landmarks and typical pathologic conditions of the buccal space such as the developmental lesions and the neoplastic lesions. Knowledge of the expected pathologic conditions is useful for the radiologist when interpreting facial CT and MR images.
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Affiliation(s)
- Hyo-Cheol Kim
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, SNUMRC, and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, SNUMRC, and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Min Hoan Moon
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, SNUMRC, and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Ji Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, SNUMRC, and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - In-One Kim
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, SNUMRC, and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Kee-Hyun Chang
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, SNUMRC, and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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