Diagnosis Of Thyroid Lymphoma Research Articles

ODP473 Critical Airway Obstruction Resolving with Medical Management of Newly Diagnosed Thyroid Lymphoma

Abstract Background Thyroid lymphoma is a rare malignancy that accounts for 1-5% of thyroid malignancies. The classic presentation of thyroid lymphoma is a rapidly enlarging, painless goiter. The main modalities used to confirm lymphoma are thyroid ultrasound and FNA. We report a case of critical airway obstruction (<5 mm) requiring core needle biopsy to diagnose thyroid lymphoma, with resolution of obstruction following chemotherapy. Case A 60-year-old man with a history of hypertension and BPH presented to the hospital with two weeks of progressive shortness of breath and dysphagia. He denied weight loss, night sweats, or thyroid dysfunction. CT demonstrated thyromegaly with substernal extension along with extension into tracheal-esophageal grooves, encasing the trachea with possible right sided tracheal invasion and tracheal narrowing to 4 mm. Thyroid ultrasound demonstrated an enlarged thyroid replaced by heterogenoushypoechoic lobular masses. Additional imaging demonstrated a 4 cm perirenal mass. Laboratory evaluation demonstrated TSH 0.97 uIU/mL (0.4–4. 0 uIU/mL), free T4 0.8 ng/dL (0.6-1.5 ng/dL), anti-TPO 16.9 IU/mL (<5. 0 IU/mL), and LDH 262 U/L (<240 U/L). He underwent a bronchoscopy which showed 60% tracheal obstruction 1 cm below the vocal cords. He underwent 2 FNAs which both resulted as Bethesda 3. The first FNA demonstrated lympho-histiocytic infiltrate, scant spindled cells and follicular cell groups with oncocytic features. The second FNA demonstrated chronic lymphocytic thyroiditis. Due to worsening respiratory status, he was given high dose dexamethasone and planned for tracheal stenting. He subsequently underwent a core needle biopsy demonstrating marked atypical B cell infiltration, concerning for mature large B cell lymphoma. Immunoperoxidase studies demonstrated atypical cells positive for CD10, 20, 79a, BCL-2, 6, and PAX5 with a 90% Ki67 proliferation diagnosing diffuse large B cell lymphoma. Biopsy of his perirenal mass was negative for lymphoma or carcinoma. He began R-CHOP chemotherapy and after one cycle experienced resolution of difficulty breathing, dysphagia, and thyromegaly. Tracheal stenting and thyroidectomy were thus avoided. After 4 cycles of R-CHOP, a PET CT demonstrated no evidence of residual lymphoma. A repeat thyroid ultrasound also demonstrated resolution of both thyromegaly and hypoechoic nodules. Conclusions Patients with a rapidly enlarging goiter and obstructive symptoms should undergo evaluation for thyroid lymphoma, particularly if they have a history of Hashimoto's thyroiditis or positive TPO antibodies even when euthyroid upon presentation. Though FNA is the first line modality used to diagnose thyroid lymphoma, our case highlights the need to proceed with a timely core needle biopsy if FNA is non-diagnostic to obtain a definitive diagnosis. Once the diagnosis of thyroid lymphoma is confirmed, management with R-CHOP chemotherapy rapidly improves obstructive symptoms, avoiding unnecessary surgical intervention even in the setting of critical airway obstruction.

Effectiveness of core needle biopsy in the diagnosis of thyroid lymphoma and anaplastic thyroid carcinoma: A systematic review and meta-analysis.

BackgroundBoth anaplastic thyroid carcinoma (ATC) and thyroid lymphoma (TL) clinically present as rapidly enlarging neck masses. Unfortunately, in this situation, like in any other thyroid swelling, a routine fine-needle aspiration (FNA) cytology is the first and only diagnostic test performed at the initial contact in the average thyroid practice. FNA, however, has a low sensitivity in diagnosing ATC and TL, and by the time the often “inconclusive” result is known, precious time has evolved, before going for core-needle biopsy (CNB) or incisional biopsy (IB) as the natural next diagnostic steps.ObjectivesTo determine the diagnostic value of CNB in the clinical setting of a rapidly enlarging thyroid mass, via a systematic review and meta-analysis of the available data on CNB reliability in the differential diagnosis of ATC and TL.MethodsA PubMed, Embase and Web of Science database search was performed on June 23th 2021. Population of interest comprised patients who underwent CNB for clinical or ultrasonographical suspicion of ATC or TL, patients with a final diagnosis of ATC or TL after CNB, or after IB following CNB.ResultsFrom a total of 17 studies, 166 patients were included. One hundred and thirty-six were diagnosed as TL and 14 as ATC following CNB. CNB, with a sensitivity and positive predictive value of 94,3% and 100% for TL and 80,1% and 100% for ATC respectively, proved to be superior to FNA (reported sensitivity for TL of 48% and for ATC of 61%). Furthermore, the need for additional diagnostic surgery after CNB was only 6.2% for TL and 17.6% for ATC.ConclusionsImmediately performing CNB for a suspected diagnosis of ATC and TL in a rapidly enlarging thyroid mass is more appropriate and straightforward than a stepped diagnostic pathway using FNA first and awaiting the result before doing CNB.

Thyroid lymphoma progressed with Hashimoto′s thyroiditis diagnosed by core-needle biopsy : case report and literature review

Objective To explore the significance of core-needle biopsy (CNB) in the diagnosis of thyroid lymphoma. Methods A case of Hashimoto′s thyroiditis for several decades, showed a thickening of the neck for several months, and no abnormalities were found by the method of fine-needle aspiration(FNA), then we performed CNB and flow cytology analysis. Results Thyroid lymphoma was finally diagnosed through CNB and flow cytology. Conclusion Thyroid lymphoma should be considered when the neck became thickened in short time in patients with chronic Hashimoto′s thyroiditis. Core-needle biopsy accompanied with flow cytometry and immunohistochemistry analysis should be suggested as routine diagnostic method especilly when fine-needle aspiration was negative. Key words: Hashimoto′s thyroiditis; Thyroid lymphoma; Core-needle biopsy; Fine-needle aspiration

Core-needle biopsy in proper time is helpful in the diagnosis of thyroid lymphoma——Comment on " Thyroid lymphoma progressed with Hashimoto′s thyroiditis diagnosed by core-needle biopsy: case report and literature review"

Core-needle biopsy in proper time is helpful in the diagnosis of thyroid lymphoma——Comment on " Thyroid lymphoma progressed with Hashimoto′s thyroiditis diagnosed by core-needle biopsy: case report and literature review"

Abstract #1000: Diagnosis of Thyroid Lymphoma may be Suggested by use of Dexamethasone

Abstract #1000: Diagnosis of Thyroid Lymphoma may be Suggested by use of Dexamethasone

Primary Thyroid Lymphoma

The purpose of this study was to describe the sonographic findings of primary thyroid lymphoma and evaluate the role of ultrasound-guided biopsy in diagnosing thyroid lymphoma. This study included 6 patients (age range, 56-72 years; mean, 62.5 years). We searched the database of our institution and retrospectively collected data on the thyroid lymphomas that were confirmed pathologically. All of the sonograms and medical records were reviewed retrospectively. All 6 patients had an enlarged neck mass and underwent ultrasound-guided fine-needle aspiration biopsy. The most notable sonographic feature of primary thyroid lymphoma was a marked hypoechoic mass compared with the residual thyroid tissue. Among the 6 patients with a diagnosis of thyroid lymphoma, 3 (50%) had a diagnosis of lymphoma by ultrasound-guided fine-needle aspiration biopsy. Final pathologic results were obtained by ultrasound-guided core needle biopsy (3/6 patients [50%]) or thyroidectomy (3/6 [50%]). Most patients with thyroid lymphoma (5/6 [83.3%]) were found to have diffuse large B-cell lymphoma and were treated with chemotherapy with or without radiotherapy. In 1 patient with follicular lymphoma, diagnosis and treatment were accomplished by total thyroidectomy. Our results show that ultrasound-guided core needle biopsy can be a safe and accurate method for diagnosing thyroid lymphoma and may be a suitable replacement for diagnostic thyroid surgery.

Diagnostic fine needle aspiration cytology of primary thyroid lymphoma

Primary thyroid lymphomas (PTL) are extremely uncommon neoplasms accounting for 5% of all thyroid malignancies. There are very few small series and occasional case reports of fine needle aspiration cytology (FNAC) of PTL in literature. We present an interesting and rare case of PTL diagnosed on FNAC. FNAC is an important tool in the diagnosis of thyroid lymphoma.

Hashimoto's Disease and Thyroid Lymphoma: Role of the Surgeon

With the turn of the century, the role of the surgeon in the treatment of diseases such as Hashimoto's and thyroid lymphoma has diminished. That is not to say that the surgeon must not have a thorough understanding of these diseases and the role he or she plays in their diagnosis and treatment. Hashimoto's disease is a common disease. Not infrequently the endocrine surgeon is faced with a thyroid nodule in a background of Hashimoto's disease. Interpretation of fine-needle aspiration (FNA) of a nodule in a patient with the background of Hashimoto's disease may be misleading if the surgeon fails to understand the limitations of FNA. The role of the surgeon in the treatment and diagnosis of thyroid lymphomas has evolved from surgical debulking to open biopsy. With the use of irradiation and chemotherapy, the need for surgical debulking has nearly disappeared. The recent development of ancillary techniques such as light chain restriction, flow cytometry, gene rearrangement, and immunohistochemical staining have enabled cytopathologists to diagnose thyroid lymphoma by FNA, further diminishing the surgeon's role in the diagnosis and treatment of this disease.

LYMPHOMA ARISING FROM HASHIMOTO'S THYROIDITIS: AN UNUSUAL CAUSE OF ACUTE STRIDOR

SUMMARY We report an unusual presentation of non‐Hodgkin's lymphoma of the thyroid which mimicked an acute infective thyroiditis and was associated with acute stridor and dysphagia. The mode of presentation and diagnosis of thyroid lymphoma are discussed and the value of early fine needle aspiration emphasised.

Lymphoepithelial Lesion in the Thyroid A Non-Specific Histological Finding

In order to assess the specificity of lymphoepithelial lesion (LEL) in the diagnosis of thyroid lymphoma, the thyroid glands of patients with Hashimoto's disease, lymphoid infiltrates in the vicinity of papillary carcinoma, focal thyroiditis in Graves' disease and malignant lymphoma of the thyroid were studied by conventional pathological and immunohistochemical techniques using a panel of antibodies against epithelial cells (CAM 5.2) and leucocytes (LCA, pan-T, and pan-B antisera). LEL was encountered in all cases. In cases of peritumoral lymphoid infiltrates LEL represented a focal phenomenon, whereas in Hashimoto's and Graves' diseases and lymphoma, it was found in multiple areas. In cases of malignant lymphoma LEL was encountered in the vicinity of areas where diffuse parenchymal destruction by tumor cells had occurred. The results suggested that although LEL is almost always present in lymphomas it can also be encountered in other diseases of the thyroid. If therefore LEL has no diagnostic specificity, the diagnosis of malignant lymphoma must be supported by other histological findings.

Malignant Lymphoma of the Thyroid.

Thyroid lymphoma is a relatively rare disease, but has attracted the attention of many investigators because of its putative relationship with chronic lymphocytic thyroiditis (CLTH). The definite diagnosis of thyroid lymphoma, especially the histologic distinction from small cell carcinoma or CLTH, has been problematical and even regarded as impossible during the past decades. Recent progress in immunological methods including moltxular biology have resolve'd many of the diagnostic problems in this field, thereby providing a scientific basis for approaching these diseases. In this review, we have summarized the results of our recent study on thyroid lymphoma reviewing the pertinent literature. Briefly, we have discussed the important role of CETH in the etiology of thyroid lymphoma; the histologic classification of thyroid lymphoma, with special emphasis on the rellatively high incidence of intermediate lymphocytic lymphoma; the B-cell nature of proliferating cells in thyroid lymphoma; the prognostic significance of the histologic classification Working Formulation and other clinical factors; local immunologic conditions in the thyroid affected by lymphoma compared with those encountered in CLTH alone and the positive role of aspiration cytology in the early detection of thyroid lymphoma.