Thyroid lymphoma: a rare pathology: study on 9 cases
Voichita Mogos1, Carmen Vulpoi1, Cristina Burlacu1, Elena Cotea2, Dan Niculescu2, Niculina Florea3, Delia Ciobanu3 & Dan Ferariu3
Thyroid lymphoma accounts for less than 5% of thyroid malignancies. The aim of this study was to analyze the particularities of 9 patients (7 females and 2 males, aged 42 to 76 years) diagnosed with thyroid lymphoma, representing 2.45% of 340 cases of thyroid malignancies. Patients were assessed by ultrasound examination (7 cases), fine needle biopsy (FNB) (8 cases), lymph node biopsy (2 cases), and histological examination after surgery (7 cases). Clinically, 6 cases presented rapid growing multinodular goiter, and lymph node enlargement, and 3 cases had apparently uninodular goiter. In 6 cases ultasound showed multiple hypoechoic nodules with enlarged hypoechoic lymph nodes. One case presented with painful thyroid and a hypoechoic, large non-vascular nodule, which first responded well to glucocorticoids, but continued to grow after few time. FNB was suspicious for malignancy in 4 cases and showed lymphocytes in 4. Antithyroid antibodies were positive in 3 cases. Total thyroidectomy was performed in 7 cases, only lymph node biopsy in 1 case, and biopsy of an amigdala metastasis in 1 case. Pathology showed MALT type lymphoma in 8 cases, among which one with important plasmocytic differentiation, and one of large B cell lymphoma. In one case thyroid lymphoma was limited to one lobe and in the controlateral lobe an occult papillary microcarcinoma was found. In 4 cases the surrounding thyroid tissue had lesions of Hashimotos thyroiditis. After surgery external irradiation and chemotherapy was performed in 3 cases and chemotherapy in 6 cases.
Conclusion: Our cases presented typical features for thyroid lymphoma: middle- to old-age persons, predominant females, with rapidly growing mass in the thyroid, associated in >1/3 cases with Hashimoto thyroiditis. Although useful, FNB was diagnostic in only 50% cases. Thyroidectomy was followed only by chemotherapy in most cases and radiochemotherapy in a few cases which accepted external irradiation.