Thyroid lymphoma
SpecialtyENT surgery, endocrinology, oncology

Thyroid lymphoma is a rare cancer constituting 1% to 2% of all thyroid cancers and less than 2% of lymphomas. Thyroid lymphomas are classified as non–Hodgkin's B-cell lymphomas in a majority of cases, although Hodgkin's lymphoma of the thyroid has also been identified.[1]

Signs and symptoms

As with other thyroid lesions, thyroid lymphoma affects predominantly females over 70 years of age with a history of Hashimoto's thyroiditis. Thus, Hashimoto's thyroiditis is considered a risk factor for thyroid lymphoma development. Thyroid lymphoma manifests as a rapidly enlarging neck mass which may compress the nearby trachea thereby causing narrowing or obstruction of the airway resulting in breathing difficulties or even respiratory failure. On physical examination, affected people typically exhibit a firm thyroid gland and enlarged lymph nodes.

Diagnosis

Thyroid lymphoma poses a diagnostic and therapeutic challenge. This is because several manifestation patterns are similar to those of anaplastic thyroid cancer (ATC). Fine-needle aspiration (FNA) helps distinguish the two entities preoperatively.

Histopathology

The majority of thyroid lymphomas are non–Hodgkin's B-cell lymphomas; a minority exhibit properties of T-cell lymphomas .

Staging

Staging of thyroid lymphoma is shown in the table below

StageCharacteristics
1ЕLymphoma is located within the thyroid
2ЕLymphoma is located within the thyroid and regional lymph-nodes
3ЕLymphoma is located at both sides of diaphragm
4ЕDissemination of lymphoma

Treatment

Combined modality therapy is the most common approach for the initial treatment of thyroid lymphomas. The CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisone) has been shown to be highly effective for many types of thyroid lymphoma.[2] However, it is suggested to perform radiation therapy only for MALT resulting a 96% complete response, with only a 30% relapse rate. Surgical treatment might be performed for patients with thyroid lymphoma in addition to chemotherapy and radiation, particularly for MALT lymphomas.[3][4][2]

Prognosis

The factors of poor prognosis for people with thyroid lymphoma are advanced stage of the tumor, large size (>10 cm) as well as spreading to mediastinum. The overall survival for primary thyroid lymphoma is 50% to 70%, ranging from 80% in stage IE to less than 36% in stage IIE and IVE in 5 years.[5][2]

References

  1. ↑ Sakorafas GH, Kokkoris P, Farley DR (2010). "Primary thyroid lymphoma (correction of lympoma): diagnostic and therapeutic dilemmas". Surg. Oncol. 19 (4): 124–29. doi:10.1016/j.suronc.2010.06.002. PMID 20620043.
  2. 1 2 3 Pavlidis, Efstathios T; Pavlidis, Theodoros E (March 2019). "A Review of Primary Thyroid Lymphoma: Molecular Factors, Diagnosis and Management". Journal of Investigative Surgery. 32 (2): 137–142. doi:10.1080/08941939.2017.1383536. ISSN 1521-0553. PMID 29058491. S2CID 25210610.
  3. ↑ Saito, Yoshiyuki; Watanabe, Natsuko; Suzuki, Nami; Saito, Naoko; Narimatsu, Hiroto; Takami, Hiroshi; Kameyama, Kaori; Yoshioka, Kana; Masaki, Chie; Akaishi, Junko; Hames, Kiyomi Yamada; Matsumoto, Masako; Fukushita, Miho; Yoshihara, Ai; Okamura, Ritsuko (March 2023). "Role of Surgery in Patients with Stage IE Primary Thyroid MALT Lymphoma Staged by a Modified Classification System: The Tokyo Classification". Cancers. 15 (5): 1451. doi:10.3390/cancers15051451. PMC 10000773. PMID 36900242.
  4. ↑ Fattahi Masuom, Seyed Hossein; Amirian-far, Azam; Rezaei, Reza (Summer 2022). "Radical Surgery for Primary Thyroid Lymphoma in Elderly Patients: A Short Report". Journal of Cardio-Thoracic Medicine. 10 (3): 1044–1047.
  5. ↑ Zhimin Bai; Lingyu Li; Tao Guan; Jiangtao Wang; Jin Zhao; Liping Su; Bai, Zhimin; Li, Lingyu; Guan, Tao; Wang, Jiangtao; Zhao, Jin; Su, Liping (2021-02-12). "Clinical prognosis and bioinformatic analysis of primary thyroid lymphoma". Medicine. 100 (6): e24598. doi:10.1097/MD.0000000000024598. ISSN 0025-7974. PMC 7886455. PMID 33578562.
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