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Thillai Arunachalam NS, N S, Priyathersini N, M A, Kajamohideen S. Thyromegaly: Not The Usual Cause. Cureus 2023; 15:e37750. [PMID: 37214041 PMCID: PMC10193190 DOI: 10.7759/cureus.37750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Non-Hodgkin lymphoma (NHL) of the thyroid is a very rare condition. Swelling of the neck is the usual presentation among patients. Of all thyroid malignancies, only a very small portion accounts for NHL of the thyroid. Here, we present two cases of diffuse large B-cell NHL of the thyroid. Preoperative diagnosis helps in the management of patients with chemotherapy, but in rare cases, surgical removal of the thyroid is done to reduce obstructive symptoms. The diagnosis is usually made based on fine-needle aspiration cytology and biopsy with immunohistochemistry. In these two cases, the patients presented with a history of a rapidly growing mass in the neck for three to four months, but the treatment modalities differed. In one of the cases, the patient received six cycles of chemotherapy, and in the other case, the patient underwent a total thyroidectomy, followed by six cycles of chemotherapy, though chemotherapy is the standard treatment option over surgical removal of the thyroid.
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Affiliation(s)
| | - Saranya N
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | | | - Arthi M
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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The Risk of Developing Lymphoma among Autoimmune Thyroid Disorder Patients: A Cross-Section Study. DISEASE MARKERS 2022; 2022:4354595. [PMID: 35692889 PMCID: PMC9187447 DOI: 10.1155/2022/4354595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/06/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022]
Abstract
Background Graves' disease (GD) and Hashimoto's thyroiditis (HT) are the most common types of autoimmune thyroid diseases (AITD), and both are characterized by the infiltration of lymphocytes into the thyroid gland. Moreover, autoimmune diseases like HT have a higher risk of developing lymphoma. This study is aimed at assessing the prevalence and association of lymphoma in patients with AITD. Methods This cross-sectional study was conducted in King Abdulaziz Medical City, Jeddah, Saudi Arabia. Data were gathered from the medical records of patients aged 18 years or older who developed AITD. A total number of 140 medical records were collected, and 72 patients were included after applying in exclusion criteria. Data on the subtype, clinical-stage, treatment modality, patient status, remission, and relapse were collected for patients who developed lymphoma. Results Among 72 patients who developed AITD, HT was diagnosed in 58 (80.6%) patients and GD in 14 (19.4%). Five (7%) patients were diagnosed with lymphoma all of whom had a history of HT. The subtypes of lymphoma were diffuse large B-cell lymphoma (DLBCL 3; 4.2%), follicular lymphoma 1 (1.4%), and Hodgkin's lymphoma 1 (1.4%). Conclusion The prevalence of PTL in patients with AITD, specifically HT, was 7%. Most patients developed NHL, with DLBCL being the most common subtype. The onset of lymphoma in this study was lower than reported in the literature. All patients with PTL had HT in their backgrounds. Further national studies are warranted to explore the relationship between the two diseases to provide more insight into the comprehension of this association.
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Zhu Y, Yang S, He X. Prognostic evaluation models for primary thyroid lymphoma, based on the SEER database and an external validation cohort. J Endocrinol Invest 2022; 45:815-824. [PMID: 34865184 PMCID: PMC8918170 DOI: 10.1007/s40618-021-01712-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/19/2021] [Indexed: 10/28/2022]
Abstract
PURPOSE Primary thyroid lymphoma (PTL) is a rare malignancy, and the literature is limited to small case series and case reports. This study aimed to assess the epidemiologic characteristics, survival, and prognostic factors of patients with PTL. METHODS We analyzed 2215 PTL patients from the Surveillance, Epidemiology, and End Results database medical records, between 1983 and 2015, as the training cohort. We enrolled 105 patients from the Cancer Hospital, Chinese Academy of Medical Sciences, for the external validation cohort. The nomograms for predicting the 1-, 5-, and 10-year overall survival (OS) and lymphoma-specific survival (LSS) were constructed. RESULTS PTL incidence steadily increased from 1977 to 1994, with an annual percentage change of 3.2% (95% confidence interval [CI]: 1.2-5.2, P < 0.05). The 1-, 5-, and 10-year OS and LSS rates were 84.66%, 71.61%, and 55.95%; and 90.5%, 85.7%, and 82.2%, respectively. Multivariate Cox regression analysis revealed that shorter OS association with age ≥ 60 years (hazard ratio [HR], 3.94; 95% CI 3.31-4.69; P < 0.001), unmarried status (HR, 1.55; 95% CI 1.37-1.75; P < 0.001), Ann Arbor stage III-IV (HR, 1.55; 95% CI 1.37-1.75; P = 0.020), diffuse large B-cell lymphoma (HR, 2.60; 95% CI 1.15-5.87; P = 0.022), and T cell non-Hodgkin lymphoma (HR, 3.53; 95% CI 1.12-11.10; P = 0.031). In the multivariate competing-risk analyzes, age, stages III-IV, year of diagnosis, surgery, radiation, chemotherapy, and histology were strongly predictive of PTL-specific risk of death. To estimate the 1-, 5-, and 10-year LSS and OS rates, respectively, nomograms were built. In the validation cohort, the results also confirmed the utility. CONCLUSIONS This study presents the first prognostic model with an external validation that could help clinicians identify patients with high-risk PTL to improve their prognosis.
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Affiliation(s)
- Yunshu Zhu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Sheng Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiaohui He
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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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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Chen E, Wu Q, Jin Y, Jin W, Cai Y, Wang Q, Zhang X, Wang O, Li Q, Zheng Z. Clinicopathological characteristics and prognostic factors for primary thyroid lymphoma: report on 28 Chinese patients and results of a population-based study. Cancer Manag Res 2018; 10:4411-4419. [PMID: 30349374 PMCID: PMC6188115 DOI: 10.2147/cmar.s155170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives Few studies on prognostic indicators for primary thyroid lymphoma (PTL) have been presented due to the uncommon nature of the tumor. This is the first study to explore the independent prognostic factors in the 2 PTL subtypes. Methods We retrospectively reviewed 1,653 cases of PTL. The cases comprised 28 Chinese patients from a local cohort and 1,625 patients from the Surveillance, Epidemiology, and End Results database from 1973 to 2013. Statistical analysis was performed to determine the demographics and prognostic factors of PTL patients. Results The disease-specific survival (DSS) and prognostic indicators were significantly different between patients with extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) and patients with diffuse large B-cell lymphoma (DLBCL). Patients with MALT lymphoma were younger (P=0.011) and had lower clinical stage (P=0.014) compared to patients with DLBCL. Cox regression analysis revealed that age, treatment modalities employed, clinical stage, and number of other types of cancer were independent prognostic factors for DLBCL patients. Conclusion PTL demonstrates specific clinical features and is associated with a relatively good prognosis. Older age is associated with poor DSS in both MALT patients and DLBCL patients. Additionally, combination of different treatment modalities is associated with improved DSS in DLBCL patients.
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Affiliation(s)
- Endong Chen
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China,
| | - Qiaolin Wu
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yixiang Jin
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China,
| | - Wenxu Jin
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China,
| | - Yefeng Cai
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China,
| | - Qingxuan Wang
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China,
| | - Xiaohua Zhang
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China,
| | - Ouchen Wang
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China,
| | - Quan Li
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China,
| | - Zhouci Zheng
- Department of Head and Neck Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China,
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Avenia N, Ragusa M, Cirocchi R, Puxeddu E, Cavaliere A, De Feo P, Sidoni A, Roila F, Sanguinetti A, Puma F. Surgical Treatment of Primitive Thyroid Lymphoma. TUMORI JOURNAL 2018; 95:712-9. [DOI: 10.1177/030089160909500613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background Primitive thyroid lymphoma, although rare, is becoming more frequent. Its incidence is increasing, from 0.5% in the sixties to 1-5% of all thyroid neoplasms today. The diagnosis of such neoplasms is not always straightforward. In fact, it is often the result of pathologic findings on a gland resected for an apparently benign disease. Surgical dissection may prove more complicated than in standard cases of thyroidectomy for the possible tight adhesions existing between the gland's capsule and the surrounding structures. In cases of capsular infiltration, postoperative external local radiotherapy is indicated. Methods A retrospective observational analysis was performed to establish whether patients with incidental thyroid lymphomas who underwent total thyroidectomy for another pathology had major surgical complications and worse prognostic results than patients with an accurate preoperative diagnosis. Results Six cases of thyroid lymphoma were retrospectively reviewed: 4 diffuse large B-cell lymphomas and 2 MALT lymphomas. Of these, 2 were correctly preoperatively identified by fine-needle aspiration biopsy and 4 were an unexpected finding at histology: 3 cases of total thyroidectomy carried out for huge hypothyroid goiter in patients affected by Hashimoto's thyroiditis and in 1 case of total thyroidectomy carried out for anaplastic carcinoma in a patient affected by Hashimoto's thyroiditis. Conclusions In our experience, a correct preoperative diagnosis was extremely difficult (33%). In patients who underwent fine-needle aspiration, a correct diagnosis was made in 66% of cases. All patients with stage IE lymphoma who underwent total thyroidectomy had equivalent surgical complications and prognosis.
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Affiliation(s)
- Nicola Avenia
- Endocrine Surgical Unit, University of Perugia, Perugia
| | - Mark Ragusa
- Thoracic Surgical Unit, University of Perugia, Perugia
| | | | - Efisio Puxeddu
- Department of Internal Medicine, University of Perugia, Perugia
| | | | | | - Angelo Sidoni
- General Surgical Unit, University of Perugia, Perugia
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BOSTANCI H, DİKMEN K, AKYÜREK N, BÜYÜKKASAP AÇ, YAVUZ A, YALÇIN MM, AKIN M. Eleven patients with primary thyroid lymphoma: a single center experience. Turk J Med Sci 2017; 47:1322-1327. [DOI: 10.3906/sag-1611-91] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Wu SY, Chu CH, Duh QY, Hsieh CB, Yu JC, Shih ML. Management for primary thyroid lymphoma: Experience from a single tertiary care centre in Taiwan. FORMOSAN JOURNAL OF SURGERY 2016. [DOI: 10.1016/j.fjs.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Khaw B, Sivalingam S, Pathamanathan SS, Tan TS, Naicker M. Simultaneous non-Hodgkin lymphoma of the external auditory canal and thyroid gland: A case report. EAR, NOSE & THROAT JOURNAL 2015; 93:508-11. [PMID: 25531844 DOI: 10.1177/014556131409301206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Approximately 25% of all cases of extranodal non-Hodgkin lymphoma (NHL) occur in the head and neck region; NHL of the external auditory canal (EAC) and thyroid gland are rare. Specific immunohistochemical staining of the excised tissue is required to confirm the final pathologic diagnosis. We report the case of a 53-year-old woman with underlying systemic lupus erythematosus and autoimmune hemolytic anemia that were in remission. She presented with chronic left ear pain, a mass in the left EAC, and rapid growth of an anterior neck swelling that had led to left vocal fold palsy. High-resolution computed tomography (CT) of the temporal bone and CT of the neck detected a mass lateral to the left tympanic membrane and another mass in the anterior neck that had infiltrated the thyroid gland. The patient was diagnosed with simultaneous B-cell lymphoma of the left EAC and thyroid gland. She was treated with chemotherapy. She responded well to treatment and was lost to follow-up after 1 year. To the best of our knowledge, the simultaneous occurrence of a lymphoma in the EAC and the thyroid has not been previously described in the literature.
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Affiliation(s)
- BeeLian Khaw
- Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia.
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Mane M, O'Neill AC, Tirumani SH, Shi M, Shinagare AB, Fisher DC. Thyroid lymphoma on a background of Hashimoto's thyroiditis: PET/CT appearances. Clin Imaging 2014; 38:864-7. [PMID: 24679651 DOI: 10.1016/j.clinimag.2014.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 02/27/2014] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
Abstract
Primary thyroid lymphoma is a rare thyroid tumor accounting for only 5% of all thyroid malignancies. It is more common in patients with a background history of chronic thyroiditis. PET/CT is helpful in the initial staging and for follow up to assess treatment response.
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Affiliation(s)
- Mayuresh Mane
- Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215
| | - Ailbhe C O'Neill
- Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215.
| | - Sree Harsha Tirumani
- Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215
| | - Min Shi
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Atul B Shinagare
- Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215
| | - David C Fisher
- Department of Medical Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215
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12
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Tan AH, Low SY, Al Jajeh I. An elderly woman with stridor. Chest 2012; 141:809-813. [PMID: 22396568 DOI: 10.1378/chest.11-0537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Aik Hau Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
| | - Su-Ying Low
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Issam Al Jajeh
- Department of Pathology, Singapore General Hospital, Singapore
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Abstract
BACKGROUND Thyroid lymphomas are relatively uncommon. This study aimed to analyse our experience of thyroid lymphoma management and outcome. MATERIALS AND METHODS A retrospective case note analysis of 63 patients treated in the previous 13 years was conducted. RESULTS The five-year survival rate was 68 per cent, with most patients dying of their lymphoma. This is at odds with the British Thyroid Association statement that the prognosis of this condition is 'generally excellent'. The only presenting symptom found to be significantly associated with prognosis was dysphagia (p = 0.001). Dual modality treatment provided a significantly better outcome than single modality treatment (p = 0.014). Thyroid lymphoma can present to the head and neck surgeon 'in extremis'; however, it can respond rapidly to appropriate treatment. CONCLUSION The outcome of thyroid lymphoma seems unrelated to the acuteness of its presentation. Thyroid surgery has no role other than for diagnosis. However, 51 per cent of the study patients underwent some form of thyroidectomy, indicating the need to implement better diagnostic pathways.
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Mian M, Gaidano G, Conconi A, Tsang R, Gospodarowicz MK, Rambaldi A, Rossi A, Oldani E, Federico M, Luminari S, Bellei M, Pogliani EM, Rossini F, Cabrera ME, Martelli M, Lopez-Guillermo A, Busetto M, Cavalli F, Zucca E, Cortelazzo S. High response rate and improvement of long-term survival with combined treatment modalities in patients with poor-risk primary thyroid diffuse large B-cell lymphoma: an International Extranodal Lymphoma Study Group and Intergruppo Italiano Linfomi study. Leuk Lymphoma 2011; 52:823-32. [PMID: 21338283 DOI: 10.3109/10428194.2011.555888] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The impact of different treatment modalities and prognostic factors on the clinical course of primary thyroid diffuse large B-cell lymphoma (PTDLBCL) is still the subject of research. This study was conducted to clarify these clinical aspects of this disorder. The clinical parameters of 48 patients with PTDLBCL at time of diagnosis were comparable to those of previous studies. Patients underwent either radiotherapy (RT) ± surgery (SX), chemotherapy (CHT) alone or in combination with local treatments (RT or SX), or SX followed by CHT and RT. A 90% complete remission (CR) rate was observed among patients who underwent combined treatment modalities (CTM), compared to 76% among the others. The 5-year progression-free survival differed significantly between both groups (p = 0.028). Poor performance status and advanced age correlated with decreased survival. PTDLBCL is a curable disease prevalent in elderly patients. Combined treatment modalities were able to induce an elevated rate of CR, improving long-term survival in younger patients. However, the outcome in elderly patients still remains unsatisfactory.
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Affiliation(s)
- Michael Mian
- Division of Hematology, Azienda Ospedaliera S. Maurizio, Bolzano/Bozen, Italy.
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Onal C, Li Y, Miller R, Poortmans P, Constantinou N, Weber D, Atasoy B, Igdem S, Ozsahin M, Ozyar E. Treatment results and prognostic factors in primary thyroid lymphoma patients: a Rare Cancer Network study. Ann Oncol 2011; 22:156-164. [DOI: 10.1093/annonc/mdq310] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Sun TQ, Zhu XL, Wang ZY, Wang CF, Zhou XY, Ji QH, Wu Y. Characteristics and prognosis of primary thyroid non-Hodgkin's lymphoma in Chinese patients. J Surg Oncol 2010; 101:545-50. [DOI: 10.1002/jso.21543] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Primary thyroid lymphoma: a review of recent developments in diagnosis and histology-driven treatment. Curr Opin Oncol 2010; 22:17-22. [PMID: 19844180 DOI: 10.1097/cco.0b013e3283330848] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Primary thyroid lymphoma (PTL) is a rare but clinically important malignancy of the thyroid. This article reviews the diagnosis, histologic subtypes, pathogenesis, and treatment of PTL, with the objective of optimizing diagnosis and management of the disease. RECENT FINDINGS Recent studies have shed light on the clinicopathologic features of the histologic subtypes of PTL. Analysis of the pathogenesis of PTL indicates that both antigenic stimulation in the setting of Hashimoto's thyroiditis and aberrant somatic hypermutation may play a role. The first large, population-based study of PTL indicated that age, stage, histologic subtype, and treatment modality have prognostic implications. The U.S. Food and Drug Administration approval of rituximab for non-Hodgkin's lymphoma has improved standard chemotherapeutic options, as data on efficacy in nodal and other extranodal lymphomas have been extrapolated to PTL. SUMMARY Advances in the understanding of the histologic subtypes of PTL have led to more accurate diagnosis and tailored treatments. The introduction of a new chemotherapeutic agent has expanded the treatment paradigm for PTL. Important prognostic indicators of survival for patients with PTL have been confirmed in the first population-based study. This article emphasizes current diagnostic and treatment approaches and discusses the potential for future developments.
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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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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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Hwang YC, Kim TY, Kim WB, Shong YK, Yi KH, Shong M, Jo YS, Kim WS, Chung JH. Clinical characteristics of primary thyroid lymphoma in Koreans. Endocr J 2009; 56:399-405. [PMID: 19225216 DOI: 10.1507/endocrj.k08e-355] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Primary thyroid lymphoma is a very rare tumor and its prevalence is approximately 0.1% of all thyroid cancers in Korea. Its clinical experience is limited and not familiar to physicians. Therefore, we performed this study to investigate the clinical characteristics of primary thyroid lymphoma in Koreans. We retrospectively analyzed the medical records of the 44 patients with primary thyroid lymphoma from 1991 to 2006 at four major referral hospitals in Korea. Out of 44 patients, eight patients were male and 36 patients were female and their average age was 57 years. Fifty-six percent of patients had underlying Hashimoto's thyroiditis. All but two patients had non-Hodgkin's lymphoma with B cell origin, and eighty percent of patients presented with stage IE or IIE. Twenty-one of 44 patients (48%) had diffuse large B cell lymphoma (DLBCL) and 17 (39%) had MALT lymphoma. Malignancies originating from lymphoid cells were suspected in 10 of eighteen patients with DLBCL (56%) by using fine-needle aspiration cytology (FNAC), and no difference was noted compared with MALT lymphoma (64%). Compared with DLBCL, the patients with MALT lymphoma were more frequently presented with stage I disease (DLBCL vs. MALT lymphoma: 32% vs. 65%, P=0.04). Moreover, in contrast to DLBCL, most of the patients with MALT lymphoma achieved complete response with treatments (DLBCL vs. MALT lymphoma: 53% vs. 94%, P<0.01). Because of the low diagnostic accuracy of FNAC, thyroid biopsy should be considered for the diagnosis of thyroid lymphomas in suspicious cases. The patients with MALT lymphoma were more frequently presented with early stage diseases and this might lead to the favorable outcome to treatments than those with DLBCL.
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Affiliation(s)
- You-Cheol Hwang
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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21
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Reid-Nicholson M, Moreira A, Ramalingam P. Cytologic features of mixed papillary carcinoma and chronic lymphocytic leukemia/small lymphocytic lymphoma of the thyroid gland. Diagn Cytopathol 2008; 36:813-7. [PMID: 18831028 DOI: 10.1002/dc.20894] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report a case of papillary thyroid carcinoma (PTC) and chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma of the thyroid gland. To the best of our knowledge, this is the first such case to be reported in the cytology literature. An 81-year-old male with known CLL presented for routine physical examination and was found to have a left-sided thyroid nodule. Thyroid ultrasound showed a calcified nodule. Fine-needle aspiration biopsy (FNAB) was performed and revealed PTC and an atypical lymphoid infiltrate that was suspicious for lymphoma. A partial thyroidectomy was performed and confirmed PTC with concurrent gland involvement by chronic lymphocytic leukemia/small lymphocytic lymphoma (SLL).
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22
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Abstract
BACKGROUND Primary thyroid lymphoma is a rare tumor that makes up 1-5% of thyroid malignancies and less than 2% of extranodal lymphomas. The treatment and prognosis of thyroid lymphomas can be divided into two distinct clinicopathologic entities: pure mucosa-associated lymphoid tissue (MALT) lymphomas and diffuse large B-cell or mixed subtypes. METHODS An evidence-based review was performed to determine the role of fine-needle aspiration (FNA) biopsy and adjuncts as the first diagnostic test for thyroid lymphoma, the role of open surgical biopsy, the role of palliative surgery as well as the best treatment (combined chemoradiation versus single modality surgery or radiation) for thyroid lymphoma. The ideal treatment of thyroid lymphoma was further assessed for both diffuse B-cell and MALT histologic subtypes. RESULTS Although an evidence-based review was challenging primarily due to a lack of high-level evidence, several recommendations are possible and presented regarding the optimal diagnostic methods and treatment of thyroid lymphoma. FNA and adjuncts are recommended as the first test to diagnose thyroid lymphoma, but open surgical biopsy may still be required in many cases. Combined chemoradiation therapy is recommended for all diffuse B-cell or mixed lymphomas. Single modality therapy with surgery or radiation alone may be considered for early-stage (IE) intrathyroidal MALT lymphomas. No recommendations could be made regarding the role of palliative surgery. CONCLUSION Evidence-based recommendations can be applied to the individual patient with thyroid lymphoma with the involvement of an experienced multidisciplinary team consisting of an endocrine/oncology surgeon, radiation oncologist, and medical oncologist.
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Affiliation(s)
- Lloyd A Mack
- Tom Baker Cancer Centre and the University of Calgary, Calgary, AB, Canada
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23
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Colović M, Matić S, Kryeziu E, Tomin D, Colović N, Atkinson HDE. Outcomes of primary thyroid non-Hodgkin’s Lymphoma. Med Oncol 2007; 24:203-8. [PMID: PMID: 17848745 DOI: 10.1007/bf02698041] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 11/30/1999] [Accepted: 12/24/2006] [Indexed: 10/22/2022]
Abstract
Primary non-Hodgkin's lymphoma (NHL) of the thyroid gland is a rare disease with an incidence of 0.5 per 100,000 population. Stages IE and IIE thyroid NHL have been traditionally treated by surgical resection; however, modern treatment consists of chemotherapy and local radiotherapy, and surgery is often reserved for tissue diagnosis and relief of airway compression. We retrospectively reviewed the management and outcomes of nine consecutive patients with thyroid NHL, eight females and one male (median age 63 yr, range 34-71 yr) treated between 1994 and 1999. Five patients had disease stage IE and 4 stage IIE. Median follow-up was 72 mo. Pathohistology and immunohistochemistry identified two patients with mucosa-associated lymphoid tissue (MALT), three follicular center cell lymphoma (FCC), two patients large B-cell lymphoma (BLCL), one a marginal zone lymphoma (MZL), and one patient a peripheral T-cell lymphoma (PTCL). Total thyroidectomy was performed in three patients and subtotal thyroidectomy in four. One (MALT) patient underwent surgery alone; three patients surgery, radiotherapy, and chemotherapy (two FCC, one PTCL); three patients surgery and chemotherapy (one MALT, one FCC, one LBCL); and two chemotherapy alone (one LBCL, one MZL). Median survival was 79 mo (range 13-124 mo). The PTCL patient, a 34-yr-old man, died from disseminated disease at 13 mo despite secondary chemotherapy, and one LBCL patient with extensively invasive local disease died from stroke 17 mo after diagnosis. The remaining seven patients remain in remission with no local or systemic relapse at a mean of 86 mo. With appropriate therapy primary thyroid NHL has a favorable course; however, prognosis depends on the histology, local spread, and the stage of the disease at presentation, as well as the patient's performance status. Surgery in combination with chemotherapy and/or radiotherapy is still warranted for intermediate and high-grade thyroid NHLs, with over 77% of patients achieving long-term remission. Peripheral T-cell lymphoma carries a poor prognosis.
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Affiliation(s)
- Milica Colović
- Institute of Haematology, Clinical Center of Serbia, Beograd, Koste Todorovica 2, Serbia.
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24
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Niitsu N, Okamoto M, Nakamura N, Nakamine H, Bessho M, Hirano M. Clinicopathologic correlations of stage IE/IIE primary thyroid diffuse large B-cell lymphoma. Ann Oncol 2007; 18:1203-8. [PMID: 17429099 DOI: 10.1093/annonc/mdm094] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We studied the clinicopathological characteristics and prognoses of localized stage thyroid diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS This study included 32 patients with stage I/IIE thyroid DLBCL. Their median age was 66 years, the male/female ratio was 10/22. RESULTS As to the cellular immunophenotype, CD20 was positive in 31/32, CD5 in 0/32, CD10 in 4/32, CD23 in 1/32, BCL2 in 14/30, and BCL6 in 24/32. Twelve cases showed abnormal karyotypes: two cases with t(8;14)(q24;q32), four cases with 3q27, two cases with 17p11, and four cases with other abnormal karyotypes. As for treatment, eight cases were treated with chemotherapy alone and 24 cases were treated with chemotherapy followed by radiotherapy. Complete response was achieved in 94%. The 5-year progression-free survival was 84% and the 5-year overall survival was 90% with a median follow-up period of 62 months. The germinal center B-cell (GCB) type had a significantly better prognosis than the non-GCB type. CONCLUSION Localized stage thyroid DLBCL is a disease with a relatively good prognosis. It is, however, a heterogeneous disease with regard to histological type and pathological state. Localized stage thyroid DLBCL has a good prognosis and it is that there are more GCB-type DLBCL lymphomas.
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Affiliation(s)
- N Niitsu
- Division of Hematology, Department of Internal Medicine, Saitama Medical University, Saitama, Japan.
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25
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Untch BR, Olson JA. Anaplastic Thyroid Carcinoma, Thyroid Lymphoma, and Metastasis to Thyroid. Surg Oncol Clin N Am 2006; 15:661-79, x. [PMID: 16882503 DOI: 10.1016/j.soc.2006.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Anaplastic thyroid carcinoma, thyroid lymphoma, and secondary metastasis to the thyroid gland are uncommon thyroid malignancies. They represent significant challenges for the surgeon owing to difficulties in diagnosis, aggressive biology, and the infrequency of their presentation. An awareness and appreciation of multimodality treatment strategies is essential for their management.
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Affiliation(s)
- Brian R Untch
- Department of Surgery, Box 3382, Duke University Medical Center, Durham, NC 27708, USA
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26
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Bibb J, Hromas R, Rabinowitz I. A Bayesian approach to a patient with a residual mass after treatment for non-Hodgkin's lymphoma of the thyroid. J Clin Oncol 2006; 23:8911-3. [PMID: 16314654 DOI: 10.1200/jco.2005.02.7417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- John Bibb
- University of New Mexico Cancer Research and Treatment Center, University of New Mexico, 900 Camino de Salud, NE, Albuquerque, NM 87131, USA
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Affiliation(s)
- Mouhammed Habra
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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