Thyroid Lymphoma Research Articles

Primary Thyroid Lymphoma: A Case Report

Background. Primary thyroid lymphoma (PTL) is a rare thyroid gland malignancy. In addition to airway compression symptoms and signs, which are the most common clinical findings, PTL may present with hypothyroidism or B symptoms of lymphoma, including night sweats, weight loss, and fever. Hashimoto thyroiditis is considered a significant risk factor and the most important underlying cause of PTL. Treatment options for PTL include chemotherapy, radiotherapy, and surgery. In this study, we present a patient who exhibited airway compression symptoms and was treated via total thyroidectomy. Case Report. A 62-year-old woman presented with complaints of weakness and fatigue lasting for approximately four years. The thyroid gland appeared enlarged on inspection and firm on palpation. The patient was diagnosed with hypothyroidism, characterized by elevated autoimmune antibody levels. Ultrasound imaging revealed thyroid enlargement with parenchymal heterogeneity. Despite achieving euthyroidism through thyroid hormone replacement therapy, thyroid enlargement and ultrasound features persisted during follow-up, accompanied by ongoing complaints of neck pain and redness. On magnetic resonance imaging, the thyroid gland appeared markedly enlarged with abnormal superior and inferior extensions. Due to the rapid, diffuse growth of the goitre, the patient underwent bilateral total thyroidectomy. She was discharged on the first postoperative day after an uneventful recovery. In her postoperative first-week follow-up, she reported no complaints and was doing well. Following the histopathological diagnosis of B-cell marginal zone lymphoma, the patient was referred to the Department of Hematology, and a close follow-up was arranged. At her postoperative ninth-month follow-up, she remains asymptomatic and recurrence-free. Conclusions. Thyroid lymphoma can present with rapid growth in the thyroid gland. In addition to chemotherapy and radiotherapy, surgery may be indicated in cases with symptoms and signs of airway compression.

Variability in primary thyroid lymphoma: A clinicopathological exploration of diffuse large B-cell, marginal zone, and follicular lymphoma.

Primary thyroid lymphoma (PTL) is a rare condition, posing significant diagnostic challenges due to limited incidence and data. However timely and accurate diagnosis is crucial for effective management. This study aims to analyze the clinicopathological features of PTL cases observed over 15years at a tertiary national referral hospital. PTL cases from 2009 to 2023 at Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital archives were retrospectively analyzed, with an assessment of clinical data, histopathological, and immunohistochemistry analysis. Statistical analysis was conducted using Chi-Square and Kruskal Wallis. Women constituted the majority of cases (male-to-female ratio was 1: 2.6), with a median patient age of 55years. Of the 40 identified PTL cases, only one was a T-cell lymphoma among the non-Hodgkin lymphomas (NHL). The NHL subtypes included diffuse large B-cell lymphoma (DLBCL [72.5 %]), marginal zone lymphoma (15.0%), and follicular lymphoma (FL [10.0 %]). An enlarged neck mass (94.7%) was the most frequent symptom, and 42.1% had a history of Hashimoto's thyroiditis. The overall surviving proportion in the present study is 80.7%, with the median survival duration of 14.5months, ranging from 1 to 54months. The longest duration of survival documented in FL case and the shortest in DLBCL case. Lymphoepithelial lesions could be found in all lymphoma types. The main diagnostic and treatment modality used was surgery. Prompt diagnosis and personalized treatment approaches are important to improve survival outcomes. PTL should be anticipated in middle-aged women with rapid enlarged neck mass and a history of Hashimoto's thyroiditis.

Primary thyroid B-cell lymphoma: molecular insights into its clonal evolution and relapse.

Primary thyroid lymphomas comprise largely extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (EMZL) and diffuse large B-cell lymphoma (DLBCL), followed by follicular lymphoma (FL). They commonly develop from a background of Hashimoto's thyroiditis (HT), where dysregulated immune responses trigger autoreactive infiltrates and drive clonal B-cell evolution. To understand how these lymphomas and their relapse evolve, we investigated 10 cases by mutation profiling, including five with metachronous lymphomas [primary lymphoma (EMZL = 4, DLBCL = 1) with local relapse (EMZL = 3, DLBCL = 2)], one composite EMZL and Epstein-Barr virus (EBV)-positive DLBCL, and four lymphomas (EMZL = 3, FL = 1) with prior or subsequent biopsy showing HT. In four cases with metachronous lymphomas, both common and distinct variants were seen in the paired lesions, indicating their divergent evolution from clonally related lymphoma precursor (CLP) cells. In the remaining case with metachronous lymphomas, the relapsed lesion was progressed from the initial lymphoma. In the case with composite lymphoma, the EBV-positive DLBCL was transformed from EMZL. Finally, in the four cases with paired lymphoma and HT biopsies, two showed shared mutations between the paired lesions, indicating involvement and divergent evolution from CLP cells. Thyroid lymphoma relapse may frequently develop via divergent evolution from a CLP cell, which is likely premalignant. © 2024 The Author(s). The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Role of Ultrasonography in Monitoring Chemotherapeutic Effects on Primary Thyroid Lymphoma: A Single-Center Retrospective Study.

Background and Objectives: In this study, we assessed the utility of ultrasonography in monitoring the chemotherapeutic effects on primary thyroid lymphoma (PTL). Materials and Methods: This retrospective analysis included 17 patients with PTL who received chemotherapy from 2012 to 2022. The sonographic features were examined pre- and post-treatment using ultrasound (US) to monitor the treatment response at the first to second, third to fourth, and end cycles of chemotherapy and follow-up, and progression-free survival (PFS) and overall survival (OS) were analyzed. Results: The sonographic findings for all the patients indicated diffuse or nodular infiltration with markedly hypoechoic masses, and "stripe-shaped" high echoes and posterior acoustic enhancement were observed. Following one to two cycles of chemotherapy, a US examination revealed varying tumor reduction degrees and diminished blood flow signals. After three to four cycles of chemotherapy, the US demonstrated an evaluation efficacy comparable to that of PET-CT in cases in which the lesion had entirely disappeared postchemotherapy; however, its ability to differentiate between treatment response and residual lesions was less effective compared to that of PET-CT. After the end cycle of chemotherapy, the lesion sizes had significantly decreased compared to those at the baseline (p < 0.05). Postchemotherapy, Adler's blood flow grades decreased significantly, with 80% graded as 0-1. Among the 10 patients with cervical lymph node enlargement, 70% showed reduced lesion sizes and blood flow signals. The cumulative 5-year PFS and OS rates were both 80% for the diffuse type and 82.5% and 78.8% for the nodular type, respectively (p > 0.05). Conclusions: US can be utilized to monitor the therapeutic response following chemotherapy for PTL, especially for early assessment and repeated dynamic monitoring, and can serve as a complementary follow-up method to PET-CT.

Comorbidity in incident rheumatoid arthritis—a nationwide case-control study with bidirectional follow-up

Abstract Objectives To investigate the association between risk of different co-morbidities and diagnosis of rheumatoid arthritis (RA) using a temporal approach. Methods Retrospective, case-control study. Data were extracted from all healthcare claims for Poland between 2011-2021. Prevalent RA(n = 262 265) patients were examined to evaluate morbidity patterns. Incident RA(n = 15 879) and age-, sex- and region-matched controls were sampled 1:10 from the general population (GP). Exposure was new-onset RA identified by interspaced, repeat claims and prescription. Follow-up was performed in a bidirectional, five-year timeframe from RA diagnosis(Dx). Results RA is associated with enhanced risk of multiple organ system disorders both pre- and post-Dx, especially hematologic (IRR 1.80, 95% CI 1.58, 2.05), pulmonary (IRR 1.57, 95% CI 1.53, 1.62), gastrointestinal (IRR 1.53, 95% CI 1.46, 1.60), and cardiovascular (IRR 1.25, 95% CI 1.22, 1.27) conditions. RA appears strongly associated with interstitial lung disease (pre-Dx IRR 2.97, 95% CI 2.20, 4.02; post-Dx IRR 4.66, 95% CI 3.91, 5.56) and inflammatory bowel disease (pre-Dx IRR 1.61, 95% CI 1.25, 2.07; post-Dx IRR 2.12, 95% CI 1.70, 2.63). Enhanced post-Dx risk of thyroid cancer (IRR 1.29, 95% CI 1.00, 1.66) and lymphoma (IRR 1.50, 95% CI 1.20, 1.88) was observed, in contrast to reduced risk of colon cancer (IRR 0.77, 95% CI 0.62, 0.94). Conclusion Enhanced risk of multiple comorbidities was observed both pre- and post-RA Dx, with varying patterns across different organ systems. These data highlight the multisystem nature of RA and warrant research into causal, bidirectional relationships.

Primary Thyroid Diffuse Large B-Cell Lymphoma: A Case Report.

Primary thyroid lymphoma is rare. Hashimoto's disease is usually found as a risk factor. Among thyroid lymphoma, diffuse large B-cell lymphoma (DLBCL) is the most aggressive and frequent one. A 56-year-old man with a medical history of Hashimoto's disease presented with a neck mass and dysphonia. A computed tomography scan revealed a large thyroid mass. Fine-needle aspiration cytology (FNAC) was consistent with lymphoma, confirmed by a core needle as a DLBCL. The patient was transferred to the Department of Hematology and Oncology for chemotherapy with good results. Primary thyroid lymphoma accounts for less than 5% of all thyroid gland malignancies and less than 2% of extranodal lymphomas. It frequently affects women in the sixth or seventh decade. Hashimoto's disease is a major risk factor. DLBCL is the most common histological subtype with aggressive evolution. Radiology and FNAC are not usually very precise and a biopsy is needed. Treatment includes surgery, radiotherapy, chemotherapy, and targeted therapy.

Bibliometric analysis and visualization of global research trends in primary thyroid lymphoma via CiteSpace.

Primary thyroid lymphoma (PTL) is a rare malignancy of the thyroid gland that poses significant clinical challenges due to its rarity and the varied therapeutic approaches it demands. Although recent years have seen an increasing focus on PTL, there is a notable lack of bibliometric analyses that consolidate the evolving research within this field. This study aims to analyze and highlight the research hotspots and trend changes in PTL, elucidating their clinical implications and guiding future research. We conducted a systematic bibliometric analysis of literature on PTL published from 2000 to 2023. This involved a structured search in the Web of Science Core Collection, using medical subject headings (MeSH) from the MeSH database to refine and eliminate duplicates, forming a precise search formula. Relevant publications were limited to English-language articles and reviews, which were then processed and analyzed using CiteSpace (6.2.R4) for visualization. The analysis, performed with CiteSpace software, facilitated the visualization of trends and hotspots in PTL research by mapping citation networks and identifying key themes and influential works. Our search yielded 281 literature records on PTL, demonstrating a curvilinear upward trend in publications over the years. The majority of publications originated from China, with the most influential contributions coming from the United States. Hirokawa Mitsuyoshi and Derringer Ga were identified as the most prolific and most co-cited authors, respectively. Keyword and co-citation analyses indicated a growing interest in clinicopathological features, treatment modalities, survival outcomes of different PTL subtypes, risk factors, complementary diagnostic techniques, and immunotherapeutic approaches. This bibliometric analysis underscores the significant clinical relevance of understanding the pathologies, diagnostic challenges, and treatment strategies for PTL. The identified research hotspots, particularly in pathological typing, diagnosis and treatment modalities, gene expression profiles, targeted therapies, clinical trials, and survival rates, highlight critical areas requiring continued research focus. These insights have pivotal implications for improving patient outcomes and advancing the clinical management of PTL.

Institutional Experience of Lymphoproliferative Disorders with Initial Diagnosis Made via Fine Needle Aspiration at Otolaryngology Clinic.

This study characterizes lymphomas presenting as palpable head and neck masses and evaluates the role of fine needle aspiration (FNA) and flow cytometry (FC) in diagnosis. A 5-year retrospective review of FNAs performed by pathologists in an ENT clinic identified cases with a predominant lymphoid population that lacked an epithelial component. Cytology, FC, and subsequent surgical pathology diagnoses were correlated. Of 821 FNAs, 154 (19%) met selection criteria. Reactive lymph nodes accounted for 43% (67/154), with most diagnosed as 'negative for malignancy,' except one 'atypical' (ATY) case. Lymphoma was confirmed in 57% (87/154) of cases, categorized as ATY (55%), suspicious for lymphoma (SFM) (36%), or positive for lymphoma (PFM) (9%). Lymphoma patients were older (median 66 vs. 46 years). Thyroid and salivary gland lymphomas typically indicated systemic involvement, except for two cases of marginal zone lymphoma (MZL) in patients with Sjögren syndrome. FC alone had a sensitivity of 67.5% for detecting lymphoma, but when combined with cytology, the sensitivity increased to 100%. The combined approach maintained a specificity of 98%. More abnormal clonal cells were identified by FC in PFM cases compared to SFM or ATY cases (P=0.004). Cytologic atypia with negative FC occurred in 29% of lymphomas, including Hodgkin and diffuse large B-cell lymphoma (DLBCL). Lymphomas presenting as neck masses are diverse, with FNA playing a key diagnostic role. Cytologic atypia and FC complement each other, as some cases show minimal atypia but positive FC, while others show significant atypia with negative FC.

7008 Challenges in the Management of Thyroid Lymphoma - Case Report

Abstract Disclosure: F. Toloza Bonilla: None. P. Veeraraghavan: None. R. Lakhotia: None. M. Roschewski: None. N. Nilubol: None. S. Gubbi: None. J. Klubo-Gwiezdzinska: None. Introduction: Primary thyroid lymphoma is an extremely rare thyroid malignancy accounting for less than 5% thyroid malignancies. The management depends on the histological subtype and tumor staging, typically involving chemotherapy alone or combined with radiotherapy. Although, surgical intervention is generally not recommended, given the potential surgical risks and the absence of additional benefits compared to chemoradiation therapy, it is reserved to obtain tissue diagnosis and to treat compressive symptoms. Clinical Case: A 66-year-old Caucasian female presented with dysphagia to solid food and acute neck swelling for a few weeks. History was negative for fever, weight loss or nocturnal diaphoresis. The patient had a history of primary hypertension, pre-diabetes, and Hashimoto’s hypothyroidism. A neck computed tomography (CT) scan showed a thyromegaly (8.3 x 5.8 cm) and bilateral cervical lymphadenopathy. Thyroid ultrasound showed sub centimeter nodules in the right mid-gland and a heterogeneous and irregular left thyroid lobe. TSH was normal (0.87 mcIU/mL [0.27-4.2]). She was treated for suspected subacute thyroiditis with prednisone for two weeks, showing initial clinical improvement, but symptoms recurred after steroids were stopped. Subsequently, a CT neck and fludeoxyglucose F18 (FDG) positron emission tomography (PET) scan demonstrated FDG avid thyroid enlargement with local adenopathy and rightward tracheal deviation. Lymph node, FNA, core biopsies and molecular testing were consistent with stage IIE MYC/BCL6 rearranged diffuse large B-cell lymphoma as she had no bone marrow or central nervous system (CNS) involvement. The patient’s treatments included four cycles of etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab with ibrutinib added after the first cycle and intrathecal methotrexate with cycles 3-6, to reduce the risk of CNS involvement. A 6-month post-therapy follow-up showed complete response (CR) on imaging with symptoms resolution. Four months later, she experienced worsening symptoms, including dysphagia with solids and liquids, and hoarseness despite CR to therapy and stable CT imaging. Laryngoscopic evaluation noted left vocal cord paralysis and extrinsic compression of the tracheoesophageal groove. Patient opted for a left hemithyroidectomy, experiencing excellent symptom relief. Surgical pathology showed findings consistent with a necrotic tumor and residual areas of lymphocytic thyroiditis. No active DLBCL was appreciated. The patient remains in remission and continues to be symptoms-free 24 months post-thyroid lymphoma treatment. Conclusion: While thyroidectomy is not typically recommended as the initial treatment for primary thyroid lymphoma, it emerges as a potentially effective option to manage recurrent or persistent compression symptoms following the completion of medical therapy. Presentation: 6/3/2024

6781 A Rare Case of Diffuse Large B Cell Lymphoma of the Thyroid

Abstract Disclosure: D. Deyar: None. M. Herrera: None. M. Ahmad: None. P. Ucciferro: None. Introduction: Primary thyroid lymphoma (PTL) is rare, comprising less than 5% of thyroid cancers. It is frequently seen in middle-aged women and 1.5% of patients with Hashimoto’s thyroiditis. PTL may present with rapidly growing mass, dysphagia, stridor, or hoarseness. We describe a case of a female patient presenting with a neck mass and new onset hypothyroidism who was found to have DLBCL of the thyroid. We aim to raise clinical awareness regarding PTL and elucidate its association with Hashimoto’s disease and discuss treatment strategies. Case presentation: The patient was a 62-year-old female with a past medical history of type 2 diabetes, hypertension, and hyperlipidemia, presenting for worsening neck swelling for the past four weeks. She reported tenderness around the mass along with voice hoarseness and difficulty swallowing. She also reported increased shortness of breath associated with the mass while lying flat and denied any heat intolerance, cold intolerance, weight changes or bowel habit changes. The patient’s vitals were as follows: blood pressure: 146/104 mmHg, heart rate: 58 beats per minute, temperature: 36.3 C, respiratory rate: 20 breaths per minute. Initial blood work demonstrated the following: sodium: 137 mmol/L, potassium: 4.2 mmol/L, 9.4 mg/dL, white blood cell count: 12.1 × 109/L, hemoglobin: 14.5 g/dL, platelets: 330 × 109/L, thyroid stimulating hormone: 17.1 uIU/mL, free T4: 0.4 ng/dL, and TPO antibodies: 300 IU/mL. A CT scan of her neck demonstrated a left sided mass measuring 6.6 cm, by 5.6 cm, by 11 cm. The patient was started on 50 mcg of levothyroxine and was assessed by otorhinolaryngology and underwent fine needle aspiration biopsy. The patient’s biopsy demonstrated diffuse large B cell lymphoma of the thyroid gland. The patient was started on R-CHOP chemotherapy for her lymphoma as an outpatient and had a significant decrease in the size of her neck mass and improvement in her compressive symptoms. She is scheduled for six cycles of R-CHOP therapy and continues to follow with oncology. Discussion: Diffuse Large B Cell Lymphoma (DLBCL) of the thyroid is rare and necessitates distinct therapeutic considerations. Patients with Hashimoto's thyroiditis have been found to be 60-fold times more likely to develop primary thyroid lymphoma as compared to those without thyroiditis. The pathophysiology regarding this association remains unclear, however some suggest it may be due to chronic lymphocytic inflammation of the thyroid gland leading to monoclonal lymphocyte growth. Treatment of DLBCL of the thyroid requires immunotherapy, most commonly with the R-CHOP therapy which distinguishes it from the conventional management of thyroid carcinomas. Physicians should be vigilant in considering these treatment differences and to consider PTL as an etiology of growing thyroid mass in patients with Hashimoto’s thyroiditis. Presentation: 6/2/2024

A Rare Case of Primary Thyroid Lymphoma: Case Report and Literature Review

A Rare Case of Primary Thyroid Lymphoma: Case Report and Literature Review

Management of acute onset stridor caused by thyroid lymphoma: A case report and review of literature

Management of acute onset stridor caused by thyroid lymphoma: A case report and review of literature

A rare thyroid cancer - case report of a follicular thyroid lymphoma

A rare thyroid cancer - case report of a follicular thyroid lymphoma

Primary thyroid lymphoma: A multi-center retrospective review

BackgroundPrimary thyroid lymphoma (PTL) is rare and diagnosis is challenging. MethodsWe conducted a multicenter retrospective study of patients with PTL from 1990 to 2023 to determine method of diagnosis, treatment, and outcomes. ResultsThe study cohort included 31 patients with PTL; all had thyroid enlargement; 21 (68 ​%) had compressive symptoms, 11 (35 ​%) had hypothyroidism and 3 had (10 ​%) B symptoms. Diagnosis was established from incisional biopsy in 8 (26 ​%), needle biopsy in 4 (13 ​%), excisional lymph node biopsy in 1 (3 ​%), and thyroidectomy specimens in 18 (58 ​%). 15 (48 ​%) patients had Hashimoto thyroiditis. Treatment included chemotherapy in 19 (61 ​%); surgery alone in 7 (23 ​%); and radiation alone or with surgery in 5 (16 ​%) patients. One (3 ​%) patient recurred, and 4 (13 ​%) patients died after a median 4.2 years. ConclusionDiagnosis of PTL was made in only 13 ​% of patients preoperatively. There may be opportunity for needle biopsy to facilitate earlier diagnosis and treatment.

Low echogenicity of Hashimoto's disease could be useful in detecting early phase of thyroid lymphomas, especially diffuse large B cell lymphomas

BackgroundHashimoto's disease, characterized by low echogenicity on ultrasonography, is associated with thyroid lymphomas. Most thyroid lymphomas are diffuse large B cell lymphomas (DLBCLs) and mucosa-associated lymphoid tissue (MALT) lymphomas. DLBCLs have a worse prognosis than MALT lymphomas. This study aimed to evaluate the early signs, especially the low echogenicity, of Hashimoto's disease and thyroid lymphomas. MethodsThis retrospective cohort study was conducted at Noguchi Thyroid Clinic and Hospital Foundation. A total of 9008 cases were operated on between 2008 and 2016, of which 162 had operated with suspected thyroid lymphoma, because of low echogenicity and aspiration biopsy cytology. The final diagnosis revealed 28 Hashimoto's disease, 134 thyroid lymphomas (91 MALT lymphomas and 43 DLBCLs). The primary outcomes were clinicopathological characteristics including low echogenicity of the thyroid. Early signs of thyroid lymphomas, especially DLBCLs were also investigated. ResultsAge, echo pattern, echogenicity anti-thyroid peroxidase antibody (TPOAb) and lactate dehydrogenase (LDH) were significantly different between Hashimoto's disease and thyroid lymphomas. Echogenicity, echo pattern and age were significant early signs of thyroid lymphomas. Age, echogenicity, soluble interleukin-2 receptor (IL2R), lactate dehydrogenase (LDH), and the neutrophil-to-lymphocyte ratio were significantly different between MALT lymphomas and DLBCLs. Echogenicity, and IL2R were significant early signs of DLBCL. The ROC analysis of low echogenicity for thyroid lymphomas compared to Hashimoto's disease revealed that Area Under the Curve (AUC) was 0.80 and the ROC analysis for DLBCL compared to Hashimoto's disease and MALT lymphoma revealed that the AUC was 0.73. ConclusionsLow echogenicity of Hashimoto's disease could be a useful early sign of thyroid lymphomas, especially DLBCL. Data availabilityThe data that supports the findings of this study are available in the supplementary material of this article.

Ultrasound scanning in diagnosing primary thyroid lymphoma.

This study aimed to summarize the clinical manifestations and ultrasound characteristics of primary thyroid lymphoma (PTL) and explore the key aspects in the process of diagnosing PTL. We conducted a retrospective analysis of the clinical and ultrasound features of 11 patients with PTL who were admitted to Shandong Provincial Third Hospital, China, between May 2009 and August 2023. The pathology was confirmed in all cases through an ultrasound-guided core needle biopsy or surgical resection. The mean age of the 11 patients was 64.45±9.85 years. In six patients, the main clinical manifestation was a palpable mass in the neck, five of whom had a significant increase in the size of the mass within 3 months to 2 years. Eleven patients had coexisting Hashimoto's thyroiditis (HT). Three patients were diagnosed as having diffuse-type PTL, wherein the ultrasound showed enlargement of the affected thyroid gland with diffusely uneven hypoechoic parenchyma. In 7 patients with nodular type PTL and 1 case of mixed type PTL, the ultrasonographic features of the nodular lesions were of irregular morphology and yet had distinct borders, and only 1 case had gross calcification. There were 7 cases of hypoechoic lesions (7/11 cases, 63.6%), 9 cases where the lesions had linear echo chains (9/11 cases, 81.8%), and 10 cases (90.9%) where there was echogenic enhancement posterior to the lesion. In elderly patients with HT, the thyroid volume increases significantly in a short period of time and symptoms associated with compression in the neck region appear. The ultrasound characteristics were extremely hypoechoic lesions in the thyroid parenchyma, with more linear echo chains visible inside, accompanied by posterior echo enhancement. When encountering such presentations, physicians must consider the possibility of PTL. Performing a core needle biopsy in cases that raise suspicion can reduce the incidence of misdiagnosis.

Co-Existence of Papillary Thyroid Carcinoma and B Cell Lymphoma in Hashimoto’s Thyroiditis. Our Approach from the Diagnosis to the Treatment. Case Report

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, whereas primary thyroid lymphoma (PTL) is a rare disease, accounting for 2% to 5% of all thyroid malignancies.

Clinicopathological characteristics of methotrexate-related lymphoproliferative disorder of the thyroid: A study of 11 patients

Methotrexate (MTX) is a well-known agent that can potentially cause lymphoproliferative disorder (LPD), known as MTX-related LPD (MTX-LPD). Only two cases of thyroid MTX-LPD have been reported to date. This study aimed to report 11 cases of MTX-LPDs arising in the thyroid gland and discuss their clinicopathological characteristics. Of the 747 patients with cytologically suspected lymphoma, 11 had received MTX. The mean age of the patients with MTX-LPD was 70.2 years (range: 51–82 years), and all were female. The duration of MTX administration ranged from 5 to 31 years (mean: 19.5 years). Nine patients (81.8 %) tested positive for anti-thyroglobulin antibody and/or anti-thyroid peroxidase antibody. In three patients, the tumor decreased in size or disappeared without surgery or chemotherapy after withdrawal of MTX therapy. Histologically, all eight nodules examined were B-cell lymphomas, and seven were mucosa-associated lymphoid tissue (MALT) lymphomas. Epstein-Barr virus-encoded small RNA in situ hybridization showed negative results for all six nodules examined. All five patients who were followed-up at our hospital exhibited progression-free survival for >3 years without chemotherapy. Six patients were transferred to other hospitals, and their follow-up details are unknown. MTX-LPDs occurring in the thyroid are characterized by a high female predominance, positivity for anti-thyroid autoantibodies, high prevalence of MALT lymphomas, negativity for Epstein-Barr virus, and good outcomes without chemotherapy. We recommend that patients with thyroid lymphoma should be checked for a history of MTX.

A Case of Primary Thyroid Maltoma

Mucosa-associated lymphoid tissue (MALT) lymphomas comprise 7.6% of non-Hodgkin’s lymphomas (NHLs) and they are recently recognized B-cell subset of NHLs. They are originated from gastrointestinal tract most frequently but may also occur in other organs including head and neck, lung, skin, thyroid and breast. Primary thyroid lymphomas (PTLs) constitute up to 5% of all thyroid malignancies. Diffuse large B-cell lymphoma is most common type of PTLs and MALT lymphoma is relatively rare subtype of PTLs. Thyroid MALToma arises in chronic inflammatory conditions with autoimmune or infectious etiologies. The optimal treatment regimen still remains controversial. However, It is reported that localized thyroid MALT lymphoma has excellent survival rate after surgical resection alone. We report a case of 48-years-old woman with primary thyroid MALToma.

An Interesting Case Report of Medullary Thyroid Carcinoma Co-Exisiting with Hashimoto’s Thyroiditis

Medullary thyroid carcinoma (MTC) is a rare malignant tumor, which accounts for &lt;5% of all thyroid malignancies, derived from parafollicular C cells. Hashimoto’s thyroiditis, which is the most common cause of hypothyroidism is an autoimmune disease. Many studies have been done in association with Hashimoto’s thyroiditis, Papillary thyroid carcinoma and thyroid lymphomas. Very few cases of Hashimoto’s thyroiditis with coexisting medullary thyroid carcinoma have been reported, because of its rarity. MTC produces various tumor biomarkers mainly Calcitonin, Carcinoembryonic antigen (CEA) and Chromogranin A. For determining the severity of the condition, preoperative serum calcitonin and CEA values are crucial. Postoperatively, Serum levels of calcitonin and CEA can be used to assess for distant metastases and recurrence. Here we present a rare case of Medullary thyroid carcinoma coexisting with Hashimoto’s thyroiditis.