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

Primary Thyroid Lymphoma Diagnosed on Rapid Onsite and Cytology: A Rare Case Report

Introduction

Rapid on-site evaluation (ROSE) is an essential component of thyroid cytopathology, particularly important in thyroid lymphoma, anaplastic carcinoma, metastasis to avoid unnecessary surgery. Follicular epithelial neoplasms are the most common tumors arising from the thyroid, whereas primary thyroid lymphomas are uncommon, accounting for less than 5% of all thyroid malignancies.

Case description

A 45-year-old male patient presented to our ENT outpatient department with swelling in the anterior neck for 3 years duration. Non-aspirational needling was done along with rapid on-site evaluation using 1% aq. toluidine blue and was reported as Malignant thyroid neoplasm- possibility of Non-Hodgkin lymphoma (NHL). Cellblock sample also confirmed as B-cell NHL followed by Immunohistochemistry.

Discussion

Primary thyroid lymphomas (PTL) are uncommon malignant neoplasms. They represent < 5% of all thyroid malignancies and 1-2% of all extra-nodal lymphomas. If diagnosed cytologically, unnecessary surgery can be avoided in thyroid lymphoma. ROSE helps in the rapid diagnosis and sample adequacy. Cellblock can avoid the biopsy procedure used for confirmation and subtyping of lymphoma.

Multimodal Sonographic Appearance and Survival Outcomes of 69 Cases of Primary Thyroid Lymphoma Over 10 Years

OBJECTIVES

To investigate ultrasound appearance and the survival outcomes for patients with primary thyroid lymphoma (PTL).

METHODS

Ultrasonic images and clinical characteristics from pathologically confirmed 69 PTL patients (2008-2019) were retrospectively analyzed. The clinical characteristics, ultrasonic characters, and prognostic factors were analyzed. Survival curves were plotted using the Kaplan-Meier method. Univariate and multivariate analyses were performed.

RESULTS

Of the 69 study patients, 23 were indolent PTL and 46 were aggressive PTL. Age (>70 years old) and elevated lactate dehydrogenase levels were statistically different clinical features between aggressive and indolent PTL. From ultrasonic images, 34 cases were nodular, 11 diffuse, and 24 mixed pattern. Mixed types displayed high invasiveness (45.7%) while diffuse types displayed higher inertness (39.1%), with statistically significant differences (P = .000). Invaded thyroid capsule and increased chaotic vascularity also showed significant differences between aggressive and indolent PTL. We also observed statistical difference in overall survival rates between aggressive and indolent PTL (P = .032). Single factor K-M analyses showed that age >70 years, aggressive pathology, and Ki67 >30% were positively correlated with the risk of poor PTL survival (P < .05).

CONCLUSIONS

Multimodal ultrasound provides accurate ultrasonographic information and facilitates PTL invasiveness diagnostics for improved clinical treatment. In addition, PTL patients aged >70 years, with aggressive pathology, and Ki67 >30% were more likely to have a poor survival outcome.

Primary Burkitt lymphoma of the thyroid associated with Hashimoto's thyroiditis

Primary Burkitt lymphoma of the thyroid is an extremely rare entity with only a few reported cases. A female patient in her 70s with Hashimoto's thyroiditis presented with a 2-month history of progressive left-sided neck swelling. Ultrasound examination revealed a multinodular goitre and fine needle aspiration (FNA) showed no signs of malignancy. The rapid growth of the thyroid mass raised the concern of a lymphoproliferative process. After left thyroid lobectomy and histopathological examination, the diagnosis of Burkitt lymphoma was made and the patient was included in a randomised study providing chemotherapy following a dose adjusted EPOCH-R regimen. Clinical remission was reached after 6 cycles of chemotherapy. There were no signs of relapse on follow-up, 1.5 years after the end of the treatment. Fast growing thyroid nodules in HT warrant a high index of suspicion. Despite no signs of malignancy after FNA cytology, these nodules may need further investigations.