Primary Thyroid Lymphoma Research Articles

Primary Thyroid Diffuse Large B-cell Lymphoma in a Child with Hashimoto’s Thyroiditis: A Case Report

Primary thyroid lymphoma (PTL) is a rare thyroid gland cancer, with diffuse large B-cell lymphomas (DLBCL) being extremely rare in children and adolescents. Thus, optimal therapy is debatable. We describe a rare case of thyroid DLBCL in an adolescent girl with a history of Hashimoto thyroiditis (HT), the difficulty in diagnosis and the outcome of treatment. A 12-year-old girl with a nine-year history of HT was admitted with a right-sided painless progressive swelling of the neck. Physical examination and imaging including ultrasound (US), computed tomography (CT) and positron emission tomography/CT revealed an enlarged thyroid gland with right side lymphadenopathy and no metastasis. Two fine needle aspirations were done showing suspected lymphoblastic lesions for non-Hodgkin lymphoma without precise diagnosis. US guided core needle biopsy was finally performed confirming the diagnosis of DLBCL. She was treated according to LMB 96-group B protocol with no surgical removal of thyroid. The patient responded very well to treatment and 14 months later there is no evidence of relapse or metastases. PTL is an extremely rare cause of thyroid malignancy in children. However, it should be considered in the differential diagnosis of a thyroid mass in adolescents presenting with a rapidly enlarging neck mass and a history of HT. It is a treatable condition with a good prognosis, even in aggressive histological subtypes, with no need for thyroidectomy.

Thyroid lymphoma: Correlation of clinical, radiological, and pathological features

Primary thyroid lymphoma (PTL) comprises 5% of all thyroid malignancies. In this case series, we aim to review its clinical presentation, diagnosis, and treatment. We included five PTL patients. All were females (mean age of 59.8 years). All patients presented with a rapidly growing neck swelling, and only two had obstructive symptoms. All patients had solitary masses, aside from one patient who had two lesions. All were causing mass effect and two with invasion of the surrounding tissue. All were diagnosed with diffuse large B-cell lymphoma. Cytology examination for PTL demonstrates atypical lymphoid cells. Four patients in our series had chemotherapy and currently in remission. The fifth died early after the clinical presentation. Two had thyroid surgeries.

High frequency ultrasound combined with ultrasound-guided core needle biopsy for the diagnosis of primary thyroid lymphoma

Objective: To investigate the sonographic features of primary thyroid lymphoma (PTL) and to evaluate the clinical significance of ultrasound-guided core needle biopsy (US-CNB) in PTL. Methods: A total of 24 patients with suspected PTL in Sir Run Run Shaw Hospital from January 2013 to June 2018 were analyzed retrospectively. All cases were confirmed by pathology, of them 23 patients received US-CNB and 1 patient chose operation without US-CNB, including 5 males and 19 females, aged from 39 to 75 years old. The effectiveness and safety of 23 patients with US-CNB were evaluated, and the sonographic features of 20 patients with PTL diagnosed by pathology were analyzed. Descriptive statistical methods were used in the study. Results: In the 23 patients with suspected PTL underwent US-CNB, 18 patients were diagnosed as PTL, 4 patients were respectively diagnosed as subacute thyroiditis, anaplastic carcinoma, Hashimoto's thyroiditis, and fibro thyroiditis, and the another patient was hard to diagnose by US-CNB and then was diagnosed as PTL by surgical biopsy. The success rate of US-CNB for diagnosis of PTL was 18/19, and no severe complications occurred in the patients with US-CNB. The other case was diagnosed as PTL by surgical biopsy without US-CNB. Sonographic features of 20 cases with PTL (18 cases diagnosed by US-CNB and 2 cases by surgery or surgery biopsy) were as follows: (1) Most nodules had irregular shapes and unsmooth margins; (2) Hypoechoic or markedly hypoechoic nodules with honeycombed or cord structures were observed in most cases; (3) Calcification was rare; (4) Multiple lesions were common; (5) Abundant intralesional vascularization was commonly observed; (6) Most cases had intensification of posterior acoustic enhancement; (7) Thyroid gland enlargement or with irregular shape; and (8) PTL often accompanied with lymph nodes enlargement in lateral neck or central region. Conclusion: PTL has certain sonographic features, with assistance of US-CNB, more accurate diagnosis of PTL can be obtained.

Bcl-2-negative IGH-BCL2 translocation-negative follicular lymphoma of the thyroid differs genetically and epigenetically from Bcl-2-positive IGH-BCL2 translocation-positive follicular lymphoma.

Follicular lymphoma (FL), comprising a minor subset of primary thyroid lymphomas, is divided into two groups based on Bcl-2 expression and IGH-BCL2 translocation. The clinicopathological features exhibited by Bcl-2-negative IGH-BCL2 translocation-negative FL of the thyroid (Bcl-2- /IGH-BCL2- tFL) are different from those of conventional FL; however, its lymphomagenesis remains unclear. Here, we collected samples from seven patients with Bcl-2- /IGH-BCL2- tFL to investigate their epigenetic and genetic aberrations. The immunohistochemical profiles of epigenetic modifiers and the methylation status of histones were examined, including EZH2, MLL2/KMT2D, CBP/CREBBP, EP300, H3K27me3 and H3K4me3, in Bcl-2- /IGH-BCL2- tFL and Bcl-2-positive IGH-BCL2 translocation-positive FL of the thyroid (Bcl-2+ /IGH-BCL2+ tFL). Most Bcl-2- /IGH-BCL2- tFLs retained the positivity of epigenetic modifiers and lower expression of H3K27me3, although Bcl-2+ /IGH-BCL2+ tFLs exhibited aberrant immunohistochemical patterns of EZH2 and CBP/CREBBP and overexpression of H3K27me3. Samples from seven cases were further analysed using targeted sequencing, focusing on the exons of 409 key tumour suppressor genes and oncogenes. Bcl-2- /IGH-BCL2- tFLs do not have pathogenic mutations of epigenetic modifiers, such as EZH2, MLL2/KMT2D, MLL3/KMT2C, EP300 and ARID1A, which have been reported in FLs in the literature, whereas Bcl-2+ /IGH-BCL2+ tFLs are probably pathogenic/pathogenic missense mutations or frameshift mutations of these genes. Additionally, novel mutations in TET2 and EP400 were detected in Bcl-2- /IGH-BCL2- tFLs. Different genetic and epigenetic abnormalities might be involved in the oncogenesis of Bcl-2- /IGH-BCL2- tFLs from Bcl-2+ /IGH-BCL2+ tFLs and other FLs.

Primary thyroid lymphoma with double expression of MYC and B-cell lymphoma-2 Gene

Primary lymphomas of the thyroid (PTLs) are rare entities. We report a case of high-grade B-cell lymphoma double hit (DH) ofthe thyroid gland with dual expression of MYC and BCL-2 gene in a 55-year-old woman. Most PTLs have a good prognosis tocombined modality treatment but identification of DH lymphomas or double-expressor lymphomas is important as these are resistant tochemotherapy and radiotherapy and pose a challenge for the treatment of the same.

Primary diffuse B-cell thyroid lymphoma: A case report

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

Primary Thyroid Lymphoma: Could Surgery Be Avoided

Background: Primary thyroid lymphoma is a rare thyroid disease that makes up only 1 to 5% of all thyroid oncological disorders. The average patient with primary thyroid lymphoma is a woman in her sixth or seventh decade with a history of Hashimoto’s thyroiditis. Clinical Case: 28-year-old woman complained of hoarseness, rapidly enlarging mass of the neck. She was referred to an otorhinolaryngologist by her family physician who suspected upper airway pathology. Otorhinolaryngologist observed swelling of patients’ larynx and prescribed treatment for suspected bacterial larynx infection. Symptoms kept worsening despite of treatment and patient was referred to an endocrinologist for a consultation. Blood lab tests were unremarkable. Ultrasound of the thyroid was performed which revealed a large (4,5 cm), hypoechoic, solid, homogenous node with Doppler signs of increased intranodular vascularity. Additionally, enlarged submandibular salivary gland lymph nodes on both sides of the neck were observed. FNAC (fine-needle aspiration cytology) was performed to diagnose possible thyroid malignancy, however findings showed atypia of undetermined significance (3rd category of Bethesda classification), to differentiate from lymphocytic thyroiditis. Because of high risk of malignancy, it was decided to perform thyroidectomy. During surgery, urgent intraoperative biopsy revealed undifferentiated thyroid carcinoma. As radical tumor extirpation due to prominent surrounding fibrosis was impossible, then only one side lobectomy was performed. Final histological examination revealed large B cell lymphoma, phenotype: CD20+, BCL6+, MuM1+, CD21+, cMyc-, BCL2-, CD10-, CD30-, Ki-67 up to 97%. More accurate disease staging was performed post-operatively, PET scan and computed tomography revealed disseminated primary thyroid lymphoma. Final diagnosis was Stage IV primary large B cell lymphoma of the thyroid. Patient was treated with chemotherapy according to Rx7-CHOP14x6 (Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) protocol. The treatment was tolerated well, 3 months after, complete remission of the disease was observed. During outpatient visits patient remained in remission for all 5 years of planned regular check-ups. Conclusion: This case demonstrates the diagnostic challenge of primary thyroid lymphoma. In the presence of rapidly enlarging thyroid mass, thyroid lymphoma is not usually suspected. FNAC as golden standard of thyroid malignancy often does not allow differentiation of this pathology. In this case, a core biopsy could have helped to make correct preoperative diagnosis and to avoid unnecessary surgery.

Primary Thyroid Lymphoma: Maintaining Diagnostic Scrutiny

Background: Primary thyroid lymphoma (PTL) is a rare condition representing <5% of thyroid malignancies with diffuse large B-cell lymphoma (DLBCL) as the most common subtype (1). Although not commonly managed in the endocrine sphere, identification is paramount to prognosis and treatment. We present a case of PTL to highlight the importance of diagnostic scrutiny and clinical follow up. Clinical Case: A 69-year-old man with a history of Hashimoto’s thyroiditis presented with an enlarging neck mass. The patient noted development of a left-sided anterior neck mass 3 days prior to seeking care. He denied compressive symptoms and B symptoms (weight loss, fevers, and night sweats). Physical exam revealed a large, firm left-sided thyroid nodule. Serum studies were notable for TSH 39.1 mcIU/mL (0.30-4.7 mcIU/mL), FT4 0.9 ng/dL (0.80-1.70 ng/dL), and TPO Ab 127 IU/mL (<=20 IU/mL). Levothyroxine 100 mcg daily was started. Neck ultrasonography showed a 54 mm hypoechoic, solid left thyroid nodule without calcifications. No abnormal cervical lymph nodes were present. FNA revealed a mixed population of small lymphocytes with no monoclonal B cell population or T cell aberrancies on flow cytometry. In the setting of ongoing nodular growth, the patient underwent core needle biopsy which revealed DLBCL (Ki67 proliferation index >80%, EBV-EBER negative). For diagnostic confirmation and staging, a whole-body FDG-PET scan was performed with an intensely FDG-avid left thyroid mass and no metabolic evidence of additional lymphoproliferative disease. Bone marrow biopsy did not show lymphomatous involvement. The patient was diagnosed with primary thyroid lymphoma and started on chemotherapy with R-CHOP. Conclusion: PTL commonly presents as a rapidly enlarging, painless neck mass that may be accompanied by B symptoms. Hashimoto’s thyroiditis is a known risk factor. Our case in particular required more diligence in the setting of an FNA with mixed lymphoid cells and negative flow cytometry. Initial differential diagnosis included intrathyroidal lymph node, Hashimoto’s thyroiditis, thyroid adenoma/malignancy with a false FNA, and lymphoma. Notably, FNA biopsy is only associated with 71% sensitivity in diagnosing PTL, whereas core biopsy has a 93% sensitivity rate (2). Upon histopathologic disease diagnosis, collaboration with oncology is needed for further staging and initiation of chemotherapy +/- radiation.

Thyroid Lymphoma: A Rare Cause of Thyroid Malignancy

Background: Primary Thyroid Lymphoma is rare accounting for 2-5% of all thyroid malignancies and less than 2% of extranodal lymphomas. Data has suggested annual incidence to be 2 per 1 million. (1)Clinical Case: A 72-year-old female with coronary artery disease, hyperlipidemia and hypothyroidism was diagnosed with extranodal follicular cell lymphoma of the breast. FDG-PET showed evidence of diffuse avidity within her thyroid gland, with SUV of 13.8. She denied any drastic change in the size of her neck or any compressive symptoms. Thyroid ultrasound performed months before her diagnosis of lymphoma, showed a two-fold increase, most notable to the right lobe compared to prior imaging; her gland remained otherwise unchanged with heterogenous echotexture.Fine needle aspiration and flow cytometry were obtained on thyroid tissue that showed follicular cell lymphoma. She was started on single-therapy Rituxan regimen with oncology. Several months later appearance and examination of her neck had improved with decrease in size of thyroid gland.Repeat FDG-PET scans, with the most recent being 11 months after starting Rituxan therapy, showed reduction in the avidity within the thyroid gland and decreasing size; with SUV of 7.8.Repeat thyroid ultrasound continued to show heterogeneous echotexture with overall decrease in volume in gland size by nearly 50% within the right lobe and approximately 30% within the left lobe. Conclusion: Thyroid lymphoma should be suspected in a rapidly enlarging thyroid gland with or without pain or compressive symptoms. However, we propose that it should also be considered in the setting of FDG-PET avidity in thyroid tissue in setting of clinical suspicion.Diffuse FDG-PET scan avidity in the thyroid gland does not automatically equate to malignancy as prospective and retrospective information has shown that diffuse uptake can be seen incidentally, in cases of diffuse goiter, Graves disease or chronic lymphocytic thyroiditis and that the uptake has been seen to range between 5.6-16.8 SUV. (2) The American Thyroid Association 2015 thyroid cancer guidelines propose that if diffuse uptake is seen within the thyroid gland on PET imaging that thyroid ultrasound imaging and functional testing be undertaken. If imaging shows findings suggestive of only chronic lymphocytic thyroiditis (diffuse heterogeneous gland) that no further action is required. In this patient a different approach was taken with investigations pursued in the setting of enlarging thyroid gland on imaging and known extranodal lymphoma allowing for ultimate diagnosis.

A Rare Case of Classical Hodgkin Lymphoma of the Thyroid Gland

Background: Hodgkin lymphoma (HL) classically occurs in the lymph nodes and only in about 5% of cases occurs in extra-nodal sites. Primary thyroid lymphomas, most of which are non-Hodgkin lymphomas, comprise less than 5% of all thyroid malignancies. Only a few cases of HL of the thyroid have been reported in the literature, and in most of these cases, fine-needle aspiration biopsy (FNAB) was unreliable for diagnosis. We present a case of classical Hodgkin lymphoma of the thyroid that was falsely negative from both FNAB and core needle biopsy specimens and was diagnosed after surgery.Clinical Case: A 51-year-old female was seen for a rapidly enlarging neck mass associated with progressive dyspnea and dysphagia. Despite being a telemedicine visit due to the COVID-19 pandemic, significant enlargement and deformity of the neck were startling. The patient was clinically and biochemically euthyroid with a TSH of 2.49 mIU/L (0.5-5.0 mIU/L) and normal FT4. She denied a personal or family history of thyroid disease and neck irradiation. Thyroid ultrasound revealed a 5.3 cm hypoechoic, wider than tall nodule with smooth margins in the left lobe, and a 1.9 cm hypoechoic and taller than wide nodule in the right lobe of the thyroid. A CT scan of the neck also revealed a 1.2 cm lymph node in the left lateral aspect of the thyroid. FNAB of the nodules showed Hurthle cells in a background of crushed lymphocytes with occasional large atypical lymphoid cells. Flow cytometry performed on a repeat FNAB specimen revealed no evidence of lymphoma. A repeat CT scan of the neck performed 2 weeks later due to worsening symptoms demonstrated middle mediastinal lymphadenopathy and a large 8x4.7x4.7 cm mass contiguous with the thyroid with a 3.8 cm cystic collection within. The patient was scheduled for an oncology consultation due to the high likelihood of lymphoma but was admitted to another institution with symptoms. She underwent a thyroid core biopsy and flow cytometry, which again failed to reveal her diagnosis. She then underwent left partial thyroidectomy, and pathology demonstrated infiltrates of small lymphocytes with histiocytes, interspersed with clusters of large, irregular, multilobate cells consistent with Reed-Sternberg cells. She was diagnosed with nodular sclerosing variant of classical HL. Chemotherapy was instituted with rapid improvement in symptoms.Clinical Lesson: Primary HL of the thyroid is extremely rare and most often presents as a rapidly enlarging neck mass with or without compressive symptoms. Diagnosis with FNAB is challenging and can be misinterpreted as lymphocytic thyroiditis. In our patient, flow cytometry was performed twice and was falsely negative. The treatment of HL differs entirely from that of other primary thyroid cancers and thyroiditis. Hence, in patients presenting with classic symptoms, a high index of suspicion is needed to make an accurate and prompt diagnosis of HL.

Sarcoidosis-Lymphoma Syndrome Associated With Primary Thyroid Lymphoma: A Case Report

Background: Sarcoidosis is occasionally accompanied by hematologic malignancies, including lymphoma, called sarcoidosis-lymphoma syndrome. Although the mechanism underlying the induction of lymphomas is still unknown, understanding the immunological background of sarcoidosis could help explain the possible mechanisms of the induction of lymphomas. Case Presentation: A 52-year-old woman was diagnosed chronic thyroiditis with normal thyroid function. One year later, she underwent a screening chest radiograph and identified bilateral hilar adenopathy and mediastinum lymphadenopathy. Subsequent mediastinoscopy demonstrated sarcoidosis. Because of the lack of clinical symptoms, steroid treatment was not initiated and regular follow-up was performed. One and a half years after the diagnosis of chronic thyroiditis, she presented with rapid swelling of the thyroid gland. FDG-PET/CT showed intense uptake of FDG in the thyroid gland and multiple lymphadenopathy. Fine-needle aspiration (FNA) cytology of the thyroid gland was only suggestive of a lymphoproliferative disorder and did not provide a definitive diagnosis. Partial thyroidectomy was performed, and the pathology indicated diffuse large B-cell lymphoma (DLBCL) such as high-grade transformation of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma. The results of an examination of a paraffin block histopathology specimen by fluorescence in-situ hybridization (FISH) detected BCL6 rearrangement (3q27), which is the most common chromosomal abnormality in DLBCL. After the treatment with R-EPOCH (rituximab, etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone) chemotherapy, the thyroid gland enlargement has improved markedly, while the lymph nodes remained swelling, that suggested lymph node involvements were due to sarcoidosis. Conclusions: Rapid swelling of the thyroid gland in the setting of chronic thyroiditis should raise suspicion for thyroid lymphoma. Furthermore, our present case might suggest that sarcoidosis accelerate the development and high-grade transformation of thyroid lymphoma. To our knowledge, this is the first reported case of sarcoidosis and primary thyroid lymphoma in the same patient.

An Unusual Riddle of Thyroid Swelling; Hodgkin’s Lymphoma Masquerading as Riedel’s Thyroiditis

Introduction: Thyroid swellings are one of the most common encountered endocrinological presentations however the prevalence of malignancy is about 4-6.5%. Hodgkin lymphomas usually present as neck swelling in form lymphadenopathy and Hodgkin disease affecting the thyroid gland is extremely rare (1-2.5% of all lymphomas). It usually occurs in middle age and has predilection for female gender. It can pose a diagnostic challenge with the histology of sclerosing fibrosis mimicking Riedel’s thyroiditis; another rare cause of stony hard goitre. Case History: A 39yr old female presented with rapidly enlarging painful thyroid mass. She complained of mild dysphagia but denied to have dyspnoea, dysphonia wheeze or stridor. There was no history of weight loss, B symptoms or any significant past illness. Clinically and biochemically she was euthyroid with normal TSH 0.73mU/l(0.35-3.50), Free thyroxine 13pmol/L (8-21), Free T3 3.9pmol/L (3.8-6.0). Blood count showed mild neutrophilia 8.21 (2-7x109/L). IGG subclasses 1-4 were all with normal limits. Initial Ultrasonography demonstrated 4.6 X 3.6cm U3 thyroid nodule extending retrosternally. FNA x2 was THY. Core biopsy demonstrated dense core of fibrous tissue with crushed aggregates of mature lymphoid cells and mixed neutrophils and histiocytes in keeping with fibro inflammatory process suggestive of Riedel’s thyroiditis. Patient was initiated on Prednisolone 100mg OD by the ENT surgeons after MDT discussion and patient had some symptomatic improvement in pain but no discernible reduction in size. Due to side effects from steroids she was referred to endocrinology department. Tamoxifen 20mg BD was started for symptom management. CTNCAP was organised to rule out lymphoproliferative disorder which was negative barring the known thyroid mass. She had no response to Tamoxifen either hence she underwent surgical resection. Surgical resection deemed very difficult due to mass infiltrating the strap muscles and neck vasculature hence wedge resection of the isthmus was done. Histology now revealed bands of dense fibrous tissue with admixed large lymphoid cells showing enlarged, red nucleoli. Immunohistochemistry of the large atypical lymphoid cells expressed CD30, CD15, MUM1, PAX5, CD20, CD79a and BCL6 and diagnosis was revised to Classic Hodgkin lymphoma, nodular sclerosis subtype. She was then referred to haematologist who initiated ABVD chemotherapy and her latest FDG PET scan shows complete metabolic response with significant reduction in the thyroid mass to 17mm X16 mm. Conclusion: Primary thyroid lymphoma can mimic Riedel’s and other forms of fibrosing thyroiditis. Most lymphomas arise from Hashimoto’s thyroiditis. Stony hard neck swellings are difficult to FNA and even core biopsy may not reveal the diagnosis, hence surgical resection and histological diagnosis should be sought earlier as most lymphomas respond well to chemotherapy.

68Ga-FAPI PET/CT imaging in a patient with primary thyroid lymphoma.

68Ga-FAPI PET/CT imaging in a patient with primary thyroid lymphoma.

Incidence and prognostic factors of primary thyroid lymphoma and construction of prognostic models for post-chemotherapy and postoperative patients: a population-based study

BackgroundPrimary thyroid lymphoma (PTL) is a rare thyroid malignancy, there are few large sample studies on PTL and no standardized treatment regimen has been established due to the rarity. The aims of this study were to explore the incidence and prognostic factors of PTL and construct visual prognostic prediction models for post-chemotherapy and postoperative patients.MethodsThe incidence of PTL in 1975–2017 was extracted from the US Surveillance, Epidemiology, and End Results (SEER) database, then assessed using joinpoint regression software. A total of 1616 eligible PTL patients diagnosed in 1998–2016 were brought into prognostic analysis. Multivariate Cox regression analyses were carried out to reveal independent prognostic elements for overall survival (OS) and cancer-specific survival (CSS).ResultsPTL incidence showed a relatively steady increase in 1975–1994, which annual percent change (APC) was 4.0%, and steady decreasing in 1994–2017(APC − 2.4%). Age, marital status, lymphoma Ann Arbor stage, histological subtypes, surgery, chemotherapy, and radiation were significantly correlated to OS and CSS. Nomograms were constructed to predict OS and CSS in post-chemotherapy and postoperative PTL patients separately, and were verified to have good reliability.ConclusionsThe incidence of PTL increased and subsequently decreased. We revealed the prognostic implications and constructed reliable nomograms for post-chemotherapy and postoperative PTL patients.

Contrast-Enhanced Ultrasound in the Differential Diagnosis of Primary Thyroid Lymphoma and Nodular Hashimoto's Thyroiditis in a Background of Heterogeneous Parenchyma.

ObjectiveTo investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the differentiation of primary thyroid lymphoma (PTL) and nodular Hashimoto’s thyroiditis (NHT) in patients with background of heterogeneous diffuse Hashimoto’s thyroiditis (HT).MethodsSixty HT patients with 64 thyroid nodules (31 PTL and 33 NHT) who had undergone CEUS examination were included in this study. With histopathological results as the reference, we evaluated the imaging features of each nodule on both conventional ultrasonography (US) and CEUS. Quantitative CEUS parameters including peak intensity (PI), time to peak (TTP), and area under the time–intensity curve (AUC) were gathered in the nodule and background parenchyma. The ratio indexes of theses parameters were calculated by the ratio of the lesion and the corresponding thyroid parenchyma. Logistic regression and receiver operating characteristic (ROC) curves analyses of valuable US indicators were further preformed to evaluate the diagnostic capability of CEUS in discrimination of PTL and NHT.ResultsAmong all the observed US imaging features and CEUS parameters, 10 indicators showed significant differences between PTL and NHT (all P < 0.05). All the significant indicators were ranked according to the odds ratios (ORs). Eight of them were CEUS associated including imaging features of enhancement pattern, degree, homogeneity, and quantification parameters of PI, AUC, ratios of PI, AUC, and TTP, while indicators on conventional US, including vascularity and size ranked the last two with ORs less than 3. The five single CEUS parameters showed good diagnostic performance in diagnosis of PTL with areas under ROC curves of 0.72–0.83 and accuracies of 70.3–75.0%. The combination of CEUS imaging features and the ratios of PI, AUC, and TTP demonstrated excellent diagnostic efficiency and achieved area under ROC curve of 0.92, which was significantly higher than any of the five single parameters (all P < 0.05), with a sensitivity of 83.9%, specificity of 87.9%, and accuracy of 85.9%.ConclusionsCEUS is an efficient diagnostic tool in the differential diagnosis of PTL and NHT for patients with diffuse HT. Conjoint analysis of CEUS imaging features and quantification parameters could improve the diagnostic values.

Primary Thyroid Lymphoma: Two Case Reports and Review of Literature

Primary Thyroid Lymphoma: Two Case Reports and Review of Literature

Fluorodeoxyglucose positron emission tomography-computed tomography base response assessment in primary thyroid lymphoma

&lt;p class="abstract"&gt;Isolated primary thyroid lymphoma and lesion in the thyroid gland presenting as a lymphoma, both are uncommon entities. This subgroup of thyroid malignancies is managed in different ways as compared to common thyroid malignancies. A 63-year-old male diagnosed as non-Hodgkin’s lymphoma of the thyroid gland underwent for F-18 fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT). It revealed isolated FDG avid soft tissue mass in left lobe of thyroid gland. After two and six cycles of chemotherapy, PET-CT was perfomed and response assessed in Deauville scores. &lt;/p&gt;

Thyroid lymphoproliferative lesions in Asia.

Primary thyroid lymphomas (PTLs) are rare and most commonly present as rapidly enlarging thyroid mass causing obstructive symptoms. Due to worldwide differences in clinical practices related to thyroid malignancy, this review was conducted to compare the clinicopathological and diagnostic modalities related to PTL and their similarities and differences between the Asian and Western countries. Using the search engine PubMed, published data on thyroid lymphomas was collected and reviewed. A total of 18 Asian and 22 Western studies were included. Most of PTLs were B-cell Non-Hodgkin lymphomas (NHL). While mucosa-associated lymphoid tissue (MALT) lymphoma was the commonest (41.1%) among Asians, diffuse large B cell lymphoma (DLBCL) (71.9%) predominated in the Western population. Some rare subtypes of PTL were also identified. Majority of all patients in Asian as well as Western studies presented with early stage (stage I/II) disease. Interestingly, when compared with Asian patients, a larger proportion of patients from the West presented with higher stage (stage III/IV) disease (12.2% vs. 3%). Ultrasonography (USG) and fine needle aspiration cytology (FNAC) in addition to histological examination usually by core needle biopsy and in some by open procedures were used for the diagnosis of PTL in both the cohorts. The various ancillary techniques used were immunocytochemistry (ICC), flowcytometry (FC), immunohistochemistry (IHC), and molecular testing. The use of ancillary techniques for PTL diagnosis was more common in the West compared to Asia and markedly increased the sensitivity of cytology to diagnose PTL. Treatment and prognosis largely depend upon the subtype of PTL and stage at presentation. To conclude, from the available published literature, there is an apparent difference between Asian and Western cohorts in the histological type and stage of presentation of PTL, but the results may be affected by publication and selection bias. Also, advanced ancillary techniques are more commonly adopted in the West.

Diffuse Large B-Cell Lymphoma of Thyroid: A Case Report and Review of Literature.

Primary thyroid lymphoma is a rare malignancy, accounting for 1-2% of extra-nodal lymphomas and 1-5% of thyroid malignancies. Diffuse large B-cell lymphoma is the most common type of primary thyroid lymphoma. It usually presents with a rapidly enlarging neck mass with cervical lymphadenopathy. Though rare, early diagnosis of this condition is important because its management is quite different from the treatment of other thyroid neoplasms. It is usually treated by chemotherapy with or without radiotherapy. We present the case of a 43years old male who presented with thyroid swelling which on histopathology and subsequent immunohistochemistry was confirmed as diffuse large B-cell lymphoma of the thyroid.

Diagnosis methods and treatment strategy for primary thyroid lymphoma: a retrospective analysis of 41 cases in China

Primary thyroid lymphoma (PTL) is a rare malignant tumor. It can manifest as a rapidly growing mass and produce various compression symptoms. However, PTL is easily missed or misdiagnosed for the lack of standardized diagnostic methods. Therefore, it is very necessary to analyze the diagnosis methods and treatment strategy of PTL to clarify the guide of diagnosis and treatment. In this study, we retrospectively analyzed PTL patients to determine their clinical, ultrasound and histological features. Forty-one PTL cases were analyzed. The pathological results of all cases were B-cell-derived non-Hodgkin's lymphoma. In these patients, 12 were mucosa-associated lymphoid tissue lymphomas, and 24 were diffuse large B-cell lymphomas. Through the analysis of the clinical, ultrasonographic and histological features of 41 patients with PTL, and the discussion of treatment strategies, we support that middle-aged women with a history of Hashimoto's thyroiditis should pay more attention to the possibility of PTL if they have a swelling neck. Thyroid function tests and neck ultrasound are routine examinations. Core biopsy is an important diagnostic method. PTL treatment is mainly based on radiotherapy and chemotherapy, and surgery is not the first choice.