Thyroid Lymphoma Research Articles

Thyroid lymphoma - lessons learned when time is of the essence

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

The role of core needle biopsy in the diagnosis of primary thyroid lymphoma and anaplastic thyroid carcinoma: a systematic review and meta-analysis

The role of core needle biopsy in the diagnosis of primary thyroid lymphoma and anaplastic thyroid carcinoma: a systematic review and meta-analysis

Primary Large Diffuse B Cell Lymphoma Presenting as Rapidly Enlarging Thyroid Mass with Compressive Symptoms: A Case Report

Background: Primary thyroid lymphoma are seen occasionally accounting for 5% among thyroid tumors. Commonest of these lymphomas is diffuse large B cell type. Case report: A 66 years old female presented to our Department with rapidly enlarging thyroid mass having difficulty in swallowing as well as breathing. She underwent left hemithyroidectomy 30 years ago for a benign disease. Clinicallly it was a large mass 20 × 20 cm hard inconsistency and clinically attached to sternocleidomastoid muscles with no skin and lymph node involvement. Computed Tomography (CT) scan of neck with contrast showed large ill-defined mass noted arising from the right lobe of the thyroid gland encasing the common carotid with loss of fat planes between the mass and the right jugular vein, sternocleidomastoid, trachea, esophagus suggesting involvement. She underwent incisional biopsy of mass which showed Diffuse Large B Cell Lymphoma (DLBCL). Discussion: Most of thyroid lymphomas originate from B cells. Fine Needle Aspiration Cytology (FNAC) can diagnose 80-85% of cases but definitive diagnosis can be made by biopsy only. Surgery has a limited role in treatment and main modality is chemoradiotherapy. Conclusion: A rapidly enlarged thyroid swelling should be suspected of having lymphoma specially on the background of lymphocytic thyroiditis and multidisciplinary team approach should be used for management.

Radical Surgery for Primary Thyroid Lymphoma in Elderly Patients: A Short Report

Radical Surgery for Primary Thyroid Lymphoma in Elderly Patients: A Short Report

Differential diagnosis of non-diffuse primary thyroid lymphoma and papillary thyroid carcinoma by ultrasound combined with computed tomography

BackgroundPrimary 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.MethodsThe clinical and imaging data of 50 patients with non-diffuse PTL and 100 patients with PTC confirmed by pathology were retrospectively analysed.ResultsOf 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.ConclusionsSonographic 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.

Metastases to the thyroid gland: ultrasonographic findings and diagnostic value of fine-needle aspiration cytology.

IntroductionIn the present study, we aimed to analyze ultrasonographic findings of metastases to the thyroid and explore the role of fine-needle aspiration cytology (FNAC) in the diagnosis of metastases to the thyroid.MethodsTwelve cases of cytologically or/and pathologically confirmed metastatic tumors of the thyroid gland were reviewed. All the primary thyroid lesions and lymphomas were excluded. The location, maximum size, echogenicity, shape, margin, presence of calcifications, vascularity, and cervical lymph nodes were assessed on ultrasonography. In addition, the results of cytology or pathology (or both) were noted retrospectively.ResultsEight of 10 patients were diagnosed correctly with FNAC. Two cases presented with diffuse involvement in both thyroid lobes. Nine cases demonstrated a hypoechoic nodule with an irregular margin, four of which had microcalcifications. One case presented with a mixed solid and cystic mass with an oval shape. The lesions with cervical lymph nodes were found in seven cases.ConclusionMost metastatic thyroid cancer has similar ultrasound features to primary thyroid cancer. In some cases with atypical US features, ultrasound diagnosis should be combined with the medical history. FNAC might be helpful in the diagnosis.

Thyroid Lymphoma: Case Series Review.

Primary thyroid lymphoma (PTL) is a rare malignancy accounting for about 5% of all thyroid malignancies and less than 2% of extra-nodal lymphomas. Diffuse B-cell lymphoma is the most common pathological subtype of PTL. This is a retrospective review of all patients diagnosed with thyroid lymphoma in our hospital during the period from 2011 to 2021. All patients had clinical, radiological, and pathological evaluation. We have followed up these patients since diagnosis till now. Eight patients were included in our review. Four patients were males and four were females. Mean age at diagnosis was 63 ± 32years of age. Diagnosis was confirmed only with tissue histology. Six patients had stage IIE disease and two had stage IVE disease. Four patients had disease related mortality. Of the other four patients, two had chemotherapy (RCHOP) and one had local radiotherapy; all achieved complete remission, and the last one had hemithyroidectomy to relieve airway compression and still under treatment. Primary thyroid lymphoma is rare malignancy of the thyroid gland. Advanced stage and age at the time of diagnosis, the presence of compression manifestations, large tumor mass, and presence of distant metastasis, all are poor prognostic criteria. Our knowledge of the disease pathology, diagnosis, and management is still limited and more research studies are required.

A Dramatic Response of a Thyroid Lymphoma to R-CHOP Chemotherapy Reversing Mechanical Airway Obstruction and Respiratory Failure

Primary thyroid lymphoma is an extremely rare thyroid malignancy that usually occurs in patients with preexisting Hashimoto thyroiditis and commonly presents in older women. The most common type is non-Hodgkin's lymphoma of B-cell origin, particularly diffuse large B-cell lymphoma (DLBCL), which is primarily treated with chemotherapy and radiotherapy. We reported an 83-year-old woman with a past medical history of hypothyroidism who suffered dysphagia and dyspnea secondary to a large thyroid mass. Her CT neck scan showed an enlarged thyroid mass with pathological cervical lymphadenopathy and marked tracheal narrowing. The ultrasound-guided biopsy confirmed the diagnosis of DLBCL of the thyroid. A few days later, she experienced respiratory distress and failure that required endotracheal intubation and mechanical ventilation. She was not considered for tracheostomy or surgical interventions, and after discussion with her family, the decision was made to start R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) which resulted in a marked reduction of the thyroid size and reversal of the mechanical airway obstruction, enabling her extubation. This case report demonstrated the dramatic response of a large thyroid lymphoma to R-CHOP therapy, reducing the thyroid size and its fatal obstructive complications, including mechanical airway obstruction, within a few days of the initiation of R-CHOP therapy.

Clinicopathologic Characteristics and A20 Mutation in Primary Thyroid Lymphoma.

Primary thyroid lymphoma (PTL) is a rare disease frequently arising against a background of autoimmune thyroiditis. It has recently been reported that the inactivation of the NF-κB negative regulator A20 by deletion and/or mutation could be involved in the pathogenesis of subsets of B-cell lymphomas. This study investigated the clinicopathologic characteristics and A20 mutation in patients with PTL. We analyzed the characteristics of 45 PTL patients (14 men and 31 women), with a median age of 71 (range, 35-90) years. A20 mutations were analyzed in DNA extracted from 20 samples consisting of 19 tumor tissue samples and 1 sample from Hashimoto's thyroiditis. Thirty-five patients (82%) had a history of Hashimoto's thyroiditis, and 29 (64%) had diffuse large B-cell lymphoma (DLBCL) and presented with larger tumors including bulky mass, elevated soluble interleukin-2 receptor levels, and a longer history of Hashimoto's thyroiditis than that of patients with mucosa-associated lymphoid tissue (MALT) lymphoma (n=16). A20 mutations were identified in 3 of 19 PTL patients (16%), in 2 of the 10 (20%) with DLBCL and in 1 of the 9 (11%) with MALT lymphoma. Interestingly, all patients with A20 mutations had Hashimoto's thyroiditis. Furthermore, they had a common missense variant in exon 3 (rs2230926 380T>G; F127C), which reduces the ability of A20 to inhibit NF-κB signaling. Our study suggests that the histological features of PTL affect clinical outcomes and that A20 mutations are related to PTL pathogenesis in some patients with Hashimoto's thyroiditis.

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

To investigate ultrasound appearance and the survival outcomes for patients with primary thyroid lymphoma (PTL). 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. 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). 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 thyroid lymphoma (PTL): a rare case report and review of the literature

Primary thyroid lymphoma (PTL) is a rare malignancy of the thyroid, accounting for 5% of all thyroid malignancies and approximately 2% of extranodal lymphomas. PTL occurs mainly in elderly females and diffuse large B-cell lymphoma (DLBCL) is most common. Here we report a case of non-germinal center diffuse large B-cell lymphoma (non-GC DLBCL) occurring in a 62-year-old female who was admitted to the hospital because of multiple palpable left neck masses. The patient then underwent thyroid ultrasound, detecting multiple nodules in the two lobes and isthmus of the thyroid gland, in which the largest nodule was in the left lobe with TIRADS 5 measuring 47x33 mm, and many cervical lymph nodes. Microscopically, thyroid tissue showed proliferation of tumor cells with large nuclei, coarse chromatin, narrow rims of cytoplasm, and scattered mitoses. There was 01 destructured lymph node, proliferating cells with characteristics similar to those in the thyroid gland; the remaining lymph nodes were chronically inflamed. Immunohistochemically, the tumor cells were positive for CD20, CD79a, Ki67 (40%), and negative for CD10, BCL6, MUM1, CD5, BCL2, c-MYC, CD15, CD30, EBV. Primary thyroid lymphomas are rare with the prognosis of patients depending on the histological classification of the tumor and the stage of the disease. They need to be evaluated and treated individually because there is no unified treatment due to their rarity.

Primary thyroid lymphoma: case report

Primary thyroid lymphoma: case report

Abstract #1183874: A Lump by Any Other Name: A Case of Primary Diffuse Large B-Cell Lymphoma of the Thyroid

Primary thyroid diffuse large B cell lymphoma (DLBCL) is a rare form of extranodal lymphoma responsible for nearly 1% to 5% of thyroid malignancies. Many patients diagnosed with primary thyroid lymphoma carry a concomitant diagnosis of hypothyroidism. This report will discuss the case of a female patient who presented with a history of hypothyroidism and an enlarging neck mass that was eventually diagnosed as primary thyroid DLBCL.

Abstract #1181020: Hashimoto’s Thyroiditis and Primary Thyroid Lymphoma

Hashimoto’s thyroiditis (HT) is an autoimmune thyroid disorder discovered by Hakaru Hashimoto in 1912. The disease, which is the most common cause of hypothyroidism in adults, is characterized by a diffusely enlarged or atrophic thyroid with lymphocytic infiltration and the presence of thyroid autoantibodies. It arises from interactions between genetic, epigenetic, and environmental factors. HT has a prevalence of up to 10% in the US adult population and is more frequent among females. Primary thyroid lymphoma (PTL) is a rare cancer, accounting for less than 5% of all thyroid malignancies, and affecting mainly females.

Abstract #1185163: Severe Respiratory Compromise due to Primary Thyroid Lymphoma

Primary thyroid lymphoma is a rare condition making up 5% of thyroid malignancies and 2.5% of all lymphomas. Most primary thyroid lymphomas are diffuse large B-cell lymphoma, which is the most aggressive type.

Clinical differences between IgG4 Hashimoto's thyroiditis and primary thyroid lymphoma.

BackgroundHashimoto’s thyroiditis (HT) can be divided into IgG4 HT and non-IgG4 HT based on IgG4 and IgG immunohistochemical staining. In clinical practice, it is often necessary to identify diseases such as primary thyroid lymphoma (PTL) and IgG4 HT when a patient presents with a rapidly enlarged thyroid. The aim of our study was to uncover the differential points between the two diseases.MethodsClinical information from 19 IgG4 HT and 10 PTL patients was obtained from the patients’ medical records, including age, sex, main clinical manifestation, thyroid functional status, the presence of serum anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies, and thyroid ultrasonography results. Thyroid sections from all patients were collected to detect IgG4 and IgG expression by immunohistochemical staining.ResultsThe IgG4 HT patients were significantly younger than those in the PTL group (39.68 ± 10.95 vs 66.20 ± 10.23 years, P < 0.001). There were no significant differences in the sex distribution or TgAb- or TPOAb-positive rates. The PTL group had a higher prevalence of clinical hypothyroidism than the IgG4 HT group (P = 0.016). In the PTL group, thyroid lesions were more likely to exhibit hypoechogenicity (6/6 vs 1/19, P < 0.001) on ultrasound images. In the PTL group, two patients met the immunohistochemical cut-off value of the criteria for IgG4 HT.ConclusionsSimply relying on immunohistochemistry for IgG4 cannot diagnose IgG4 HT correctly when a patient presents with rapid thyroid enlargement. A combination of clinical and pathological analyses will help distinguish IgG4 HT from PTL which may be with abundant IgG4-positive plasma cells.

The Relationship Between Primary Thyroid Lymphoma and Various Types of Thyroid Autoimmunity: A Retrospective Cohort Study of 498 Cases, Including 9 Cases with Graves' Disease.

Background: Primary thyroid lymphoma (PTL) is known to develop mostly in patients with Hashimoto's thyroiditis (HT), and it is rare for it to develop in patients with Graves' disease (GD). The objective of this study was to investigate the clinical features, pathological findings, and long-term outcomes of PTL patients, grouped according to the presence of GD, HT, or no autoimmune thyroid disease (AITDs). The GD group was of major interest due to limited knowledge of the relationship with PTL. Methods: In this single-center retrospective cohort study, we reviewed the medical records of all patients diagnosed with PTL between August 1979 and October 2021, and we characterized the patients according to the presence of HT, GD, or no AITDs. Pathological specimens were classified according to the World Health Organization classification. Staging was performed in accordance with the Ann Arbor classification. Results: During the 42-year period, 498 participants were diagnosed with PTL. The median age was 68 (interquartile range 61-76) years, and 221 patients were stage IE, whereas the remaining 277 patients were stage IIE. Of the PTL patients, 431 (86.6%) were diagnosed with HT, 9 (1.8%) were diagnosed with GD, and 58 (11.6%) did not have AITDs. All nine patients with GD were positive for anti-thyroglobulin antibody and/or anti-thyroid peroxidase antibody. All patients with GD were treated with anti-thyroid medication. There were no significant differences in the proportions of each subtype of PTL between the PTL patients with GD and all subjects with PTL (p = 0.51), PTL patients with HT (p = 0.51), or PTL patients without AITDs (p = 0.48). The median follow-up time was 6.2 (interquartile range 3.0-10.7) years after the diagnosis of PTL. The Kaplan-Meier curve analyses showed no significant differences in overall survival and event-free survival between PTL patients with GD and those with HT (p = 0.37), or between PTL patients with GD and those without AITDs (p = 0.43). Conclusions: The PTL was observed with HT in a majority of cases, and rarely with GD (1.8%). The proportions of each pathological subtype of PTL and the prognosis of PTL were not different between the patients with GD and those with HT or those without AITDs.

Primary thyroid lymphoma- case series of patients from a developing country

Primary Thyroid Lymphoma (PTL) is a rare disease, mostly affecting middle-to-old aged females. It has a strong association with pre-existing thyroiditis, which increases the risk of its development. The disease has been studied in detail in the Western populations. However, there is lack of data for south Asians, especially in Pakistani population. This study was carried out to learn more about the disease characteristics in our area. This was a retrospective study where we reviewed four diagnosed and/or treated cases of primary thyroid Lymphoma at tertiary care hospital of Pakistan (Aga Khan University Hospital), Karachi, Pakistan. Each patient's medical record was reviewed and studied. The participants' average age was 62.8±10.12 years,, with two males and two females. The histology of all of the patients was compatible with the Diffuse B cell Lymphoma subtype. One patient died as a result of complications, one patient was lost to follow up, and the remaining two patients are doing well with no active complaints and are being followed up on a regular basis.

Frequency of hashimoto thyroiditis in papillary thyroid cancer patients and its impact on their Outcome.

Hashimoto thyroiditis (HT) is an autoimmune disorder of thyroid gland and is the most common cause of hypothyroidism. Its association with thyroid lymphoma is well established but with papillary thyroid cancer (PTC), the studies have shown inconsistent results. It is a retrospective review of papillary thyroid cancer patients and 213 participants were included for final analysis. They were divided in two groups, based on presence or absence of Hashimoto thyroiditis. We noted their demographic details, histopathological diagnosis, presence of thyroid autoantibodies, TNM staging, outcome and duration of follow up. The frequency of Hashimoto thyroiditis in papillary thyroid cancer patients was found to be 34.27% (73). In Hashimoto thyroiditis and PTC patients, more patients were in T1 and T2 stage, i.e., 27.4% and 38.4% as compared to PTC alone group, who had more patients with T3 and T4 disease 44.3% and 5% respectively. Although lymph node metastasis was more common in PTC with Hashimoto thyroiditis 56.2%, but distant metastasis was observed more in isolated PTC group 14.3%. Cure was observed in 75.3% and 47.1% in PTC patients with and without Hashimoto thyroiditis respectively. While 22.9% patients having isolated PTC had persistent disease as compared to 6.8% when PTC was accompanied with Hashimoto thyroiditis. The papillary thyroid cancer patient who had concomitant Hashimoto thyroiditis, had a less aggressive disease in terms of T stage and distant metastasis and they had a better outcome in terms of higher cure rate and less persistent disease as compared to the papillary thyroid cancer without Hashimoto thyroiditis.

Hashimoto thyroiditis: an evidence-based guide to etiology, diagnosis and treatment.

Hashimoto thyroiditis (HT) is a common autoimmune disorder, affecting women 7–10 times more often than men, that develops because of genetic susceptibility, X chromosome inactivation patterns modulated by environmental factors as well as microbiome composition, and leads to an imbalance in self-tolerance mechanisms. The consequential thyroid infiltration by lymphocytes, potentiated by antibody-mediated autoimmune response through the antibodies against thyroid peroxidase (TPOAbs), leads to a destruction of thyrocytes. The presence of TPOAbs is associated with a 2 to 4-fold increase in the risk of recurrent miscarriages and preterm birth in pregnant women. The clinical presentation of HT includes: (A) thyrotoxicosis, when stored thyroid hormones are released to circulation from destroyed thyroid follicles; (B) euthyroidism, when preserved thyroid tissue compensates for destroyed thyrocytes; and (C) hypothyroidism, when thyroid hormone production by the affected thyroid gland is insufficient. The management of Hashitoxicosis is based on symptoms control usually with β-blockers, euthyroidism requires periodical thyroid stimulating hormone measurements to assess for progression to hypothyroidism, and hypothyroidism is treated with thyroid hormone replacement therapy. The dose of levothyroxine (LT4) used for treatment is based on the degree of preserved thyroid functionality and lean body mass, and usually ranges from 1.4 to 1.8 mcg/kg/day. There is insufficient evidence to recommend for or against therapy with triiodothyronine (T3), apart from in pregnancy when only levothyroxine is indicated, as T3 does not sufficiently cross fetal blood-brain barrier. HT is associated with 1.6 times higher risk of papillary thyroid cancer and 60 times higher risk of thyroid lymphoma than in general the population.