Management of primary thyroid lymphoma

Abstract

Primary thyroid lymphoma is one of the least common thyroid malignancies. It accounts for 2–4% of thyroid malignancies and only 0.5% of all thyroid diseases. Almost all patients present a rapidly enlarging, soft neck mass, usually fixed to the adjacent structures. The disease has a predilection for females and usually occurs between the ages of 50 and 80 years. In the majority of patients, Hashimoto’s thyroiditis coexists, and in some cases hypothyroidism is also present. Early diagnosis and treatment are crucial to increase survival and improve patient prognosis. Almost all primary thyroid lymphomas are Non-Hodgkin lymphomas; Hodgkin lymphomas in the thyroid gland are extremely rare. Cytological examination after fine needle aspiration (FNA) is the first step towards early diagnosis and proper treatment. The coexistence of Hashimoto’s thyroiditis can sometimes prove to be a diagnostic dilemma; hence, core biopsy or even open biopsy are sometimes required since they are considered to be more credible and can solve the differential problem in diagnosis. Combined chemotherapy and radiotherapy are considered to be the first line of the therapeutic options, while surgical intervention is applicable in cases of MALT lymphomas without extra thyroidal spread.