Introduction: Primary thyroid lymphoma (PTL) is responsible for 0.65% of all cases of thyroid cancer and less than 2% of all extranodal lymphomas. PTL is more common in elderly women and are commonly of B-cell origin. Current treatment regimens for PLC consist of chemotherapy and external beam radiation. Surgery plays an important role, including the control of symptoms in large obstructive lymphomas.
Aims and methods: Retrospective data review of pts with PTL diagnosis followed at our Institutions Endocrinology Department.
Case reports: Four female patients (pts), with 5378 years (median 65). Three pts presented with a multinodular goiter, one pt with a solitary thyroid nodule and all had compressive symptoms. Thyroid function tests were normal at presentation and lymphocytic thyroiditis (LT) had been previously diagnosed in one pt. Cytological exam was suspicious for lymphoma in one case. Two pts were submitted to total and two pts to subtotal thyroidectomy. Histopathology revealed diffuse large B-cell lymphoma in two pts, a marginal zone B cell lymphoma and a Burkitts lymphoma. LT was described in two patients report. Three patients received combination chemotherapy (CHOP regime in two pts and BFM protocol in one pt). One pt received local radiotherapy. Imaging modalities revealed other areas of involvement in two pts. Three patients showed complete response to treatment and in one pt chemotherapy had to be stopped because of its toxicity.
Discussion: Primary lymphoma is a rare type of thyroid cancer and its cytological diagnosis can be complex because of the discrimination from LT, which is associated with an increased risk of TPL. Thyroid lymphoma should be suspected in the presence of a rapidly enlarging neck mass causing compressive symptoms, mostly in elderly woman with a LT diagnosis. The disease can often be cured without the need for extensive surgery if recognized early.
27 Apr - 01 May 2013
European Society of Endocrinology