Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (1): 165-170. doi: 10.19723/j.issn.1671-167X.2019.01.028

Previous Articles     Next Articles

A retrospective analysis of 12 cases of primary thyroid lymphoma

Yang ZHANG1,Ji-xin ZHANG2,Jian SHI3,Nan YU1,Zhen-fang YUAN1,Gui-zhi LU1,Ying GAO1,(),Yan-ming GAO1,Xiao-hui GUO1   

  1. 1. Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
    2. Department of Pathology,Peking University First Hospital, Beijing 100034, China
    3. Department of Ultrasound, Peking University First Hospital, Beijing 100034, China
  • Received:2017-11-17 Online:2019-02-18 Published:2019-02-26
  • Contact: Ying GAO E-mail:bjgaoying@yahoo.com
  • Supported by:
    Supported by Capital Foundation of Medical Developments(2018-4-4077);and Thyroid Research Program of Young and Middle-aged Physicians from China International Medical Foundation(2017N14)

RICH HTML

  

Abstract:

Objective: To discuss the clinical characteristics and diagnostic and therapeutic considerations of primary thyroid lymphoma (PTL) by reviewing PTL cases. Methods: In the study, 12 cases of PTL diagnosed and treated in Peking University First Hospital between January 1995 and September 2015 were identified. The clinical characteristics, management experiences and prognosis of these cases were reviewed retrospectively. Results: A total of 12 PTL patients (four males and eight females) were collected, with an average age of 63 years (42 to 81 years) at the time of diagnosis. The average time to clarify diagnosis was 5 months (0.5 to 24 months). Eleven patients presented with a rapidly growing neck mass and visited surgical department, except one complained of coughing and suffocated. Seven patients were hypothyroid, and four were euthyroid at the time of diagnosis. In sonography of 11 cases, nine showed bilateral nodules, with an average diameter of 3.87 cm. Pathologic diagnosis of non-Hodgkin’s lymphoma was confirmed in all the 12 cases by means of partial thyroidectomy (four) or core needle biopsy (eight). The pathological subtypes were diffuse large B cell lymphoma in nine patients, mucosa-associated lymphoid tissue lymphoma (MALToma) in two, and small B cell lymphoma in the other one patient. Five patients were concomitant with Hashimoto’s thyroiditis. Eleven patients received chemotherapy. Only one patient did not have any further treatment after operation due to an inertia type of tumor. The median overall survival time was 24 months (1-117 months), three patients died. Among the patients who survived, seven completed chemotherapy without disease progression, one MALToma case did not receive chemotherapy after thyroidectomy but was still alive with PTL, and one patient just finished his second course of chemotherapy. Conclusion: The diagnosis of PTL should be considered when dealing with rapidly growing goiters in elder female Hashimoto’s thyroiditis patients whose B ultrasound indicates hypoechogenicity in thyroid nodules or parenchyma, especially with lymphadenopathy and tracheal compressions. Timely use of coreneedle biopsy on suspicious cases can avoid unnecessary surgical trauma, and chemotherapy is the main treatment.

Key words: Lymphoma, Thyroid neoplasm, Hashimoto’s thyroiditis;

CLC Number: 

  • R736.1

Table 1

The clinical characteristics of twelve cases of thyroid lymphoma"

Case Age/
Gender
Clinical symptoms Thyroid function,
TSH/(mIU/L)
Thyroid
antibody
B ultrasound Diagnose
method
Pathology Pathological
confirmed HT
Phase Chemotherapy Follow up/
months
Thyroid Lymph nodes
1 58/F Neck mass Normal TgAb+ Unknown Unknown Surgery DLBCL + RCHOP 74
2 61/M Neck mass Hypo, 8.19 TgAb+,
TPOAb+
Nodular type,bilobal lesion, lesion with inconspicuous border - Surgery MALToma + ⅡE No 46
3 58/F Neck mass, night sweats and weight loss Normal TgAb+ Diffuse type, bilobal lesion, lesion with clear boundary - CNB Small B cell
lymphoma
+ RCHOP 41*
4 42/F Neck mass with pain, difficulty swallowing Hypo, 8.36 - Diffuse type, bilobal lesion, lesion with inconspicuous border + CNB DLBCL - G-CHOP 24
5 73/F Neck mass Hypo, 13.37 - Diffuse type,left lobe lesion, lesion with clear boundary + FNA/CNB MALToma Unable to judge ⅡE RCHOP 24
6 73/F Neck mass with breathing and swallowing difficulty, hoarseness and drinking water cough Hypo, 10.17 TgAb+,
TPOAb+
Diffuse type,bilobal lesion, lesion with clear boundary + CNB DLBCL Unable to judge ⅡE RCHOP 22
7 81/M Neck mass with eating choked and difficulty
breathing
Hypo, 38.5 Not checked Mixed type, left lobe lesion, lesion with clear boundary, tracheal compression + CNB DLBCL Unable to judge COP 1*
8 75/M Hoarse voice and coughing Hypo, 132.01 TPOAb+ Mixed type, bilobal lesion, lesion with clear boundary, tracheal compression + CNB DLBCL Unable to judge ⅡE RCHOP 1*
9 53/M Submandibullar mass with swallowing and breathing difficulty Normal Not checked Nodular type,left lobe lesion, lesion with inconspicuous border + FNA/CNB DLBCL Unable to judge ⅡE RCHOP 105
10 73/F Neck mass Unknown Not checked Nodular type,bilobal lesion, lesion with clear boundary + Surgery DLBCL Unable to judge ⅡE CHOP 117
11 53/F Neck mass Normal Not checked Nodular type, right lobe lesion, lesion with inconspicuous border - Surgery DLBCL + ⅡE RCHOP 87
12 58/M Neck mass Hypo, 6.16 Not checked Mixed type, bilobal lesion, lesion with clear boundary + CNB DLBCL + RCHOP 2
[1] Stein SA, Wartofsky L . Primary thyroid lymphoma: a clinical review[J]. J Clin Endocrinol Metab, 2013,98(8):3131-3138.
doi: 10.1210/jc.2013-1428 pmid: 23714679
[2] Sarinah B, Hisham AN . Primary lymphoma of the thyroid: diagnostic and therapeutic considerations[J]. Asian J Surg, 2010,33(1):20-24.
doi: 10.1016/S1015-9584(10)60004-8 pmid: 20497878
[3] Onal C, Li YX, Miller RC , et al. Treatment results and prognostic factors in primary thyroid lymphoma patients: a rare cancer network study[J]. Ann Oncol, 2011,22(1):156-164.
doi: 10.1093/annonc/mdq310 pmid: 20587509
[4] Mack LA, Pasieka JL . An evidence-based approach to the treatment of thyroid lymphoma[J]. World J Surg, 2007,31(5):978-986.
doi: 10.1007/s00268-005-0768-z
[5] Alzouebi M, Goepel JR, Horsman JM , et al. Primary thyroid lymphoma: the 40 year experience of a UK lymphoma treatment centre[J]. Int J Oncol, 2012,40(6):2075-2080.
doi: 10.3892/ijo.2012.1387 pmid: 22367111
[6] Sakorafas GH, Kokkoris P, Farley DR . Primary thyroid lymphoma (correction of lympoma): diagnostic and therapeutic dilemmas[J]. Surg Oncol, 2010,19(4):e124-e129.
doi: 10.1016/j.suronc.2010.06.002
[7] 李昌幼, 罗佐杰 . 原发性甲状腺淋巴瘤的发病机制及诊治现状[J]. 实用医学杂志, 2013,2(3):341-342.
doi: 10.3969/j.issn.1006-5725.2013.03.001
[8] Holm LE, Blomgren H, Lowhagen T . Cancer risks in patients with chronic lymphocytic thyroiditis[J]. N Engl J Med, 1985,312(10):601-604.
doi: 10.1056/NEJM198503073121001
[9] Noureldine SI, Tufano RP . Association of Hashimoto’s thyroiditis and thyroid cancer[J]. Curr Opin Oncol, 2015,27(1):21-25.
doi: 10.1097/CCO.0000000000000150 pmid: 25390557
[10] 朱坚, 费健 . 原发性甲状腺淋巴瘤的诊断和治疗分析[J]. 外科理论与实践, 2013,18(2):156-158.
[11] 谢婧, 邓先兆, 樊友本 , 等. 原发性甲状腺淋巴瘤疗效分析[J]. 中国普外基础与临床杂志, 2014,21(9):1097-1101.
[12] Ota H, Ito Y, Matsuzuka F , et al. Usefulness of ultrasonography for diagnosis of malignant lymphoma of the thyroid[J]. Thyroid, 2006,16(10):983-987.
doi: 10.1089/thy.2006.16.983 pmid: 17042683
[13] 杨光旭, 彭格红 . 原发性甲状腺淋巴瘤超声表现与病理对比分析[J]. 现代医药卫生, 2017,33(4):566-567.
doi: 10.3969/j.issn.1009-5519.2017.04.034
[14] Yang L, Wang A, Zhang Y , et al. 12 cases of primary thyroid lymphoma in China[J]. J Endocrinol Invest, 2015,38(7):739-744.
doi: 10.1007/s40618-015-0250-6 pmid: 25736543
[15] 骆惊涛, 魏玺, 张仑 . 原发性甲状腺淋巴瘤的超声表现病理及其他影像学特征分析[J]. 中国肿瘤临床, 2014,41(2):123-126.
doi: 10.3969/j.issn.1000-8179.20131453
[16] 彭晓琼, 蒲大容, 涂波 , 等. 原发性甲状腺恶性淋巴瘤的声像图特征及误诊分析[J]. 重庆医学, 2015,44(16):2260-2262.
doi: 10.3969/j.issn.1671-8348.2015.16.037
[17] 杨盼, 孙映荷, 马步云 , 等. 原发性甲状腺非霍奇金淋巴瘤的超声征象分析[J]. 中国普外基础与临床杂志, 2014,21(9):1092-1096.
[18] 张雨涵, 龚洪翰, 张宁 , 等. 原发甲状腺淋巴瘤的CT诊断与鉴别诊断[J]. 实用放射学杂志, 2014,30(7):1238-1240.
[19] Basu S, Li G, Bural G , et al. Fluorodeoxyglucose positron emission tomography (FDG-PET) and PET/computed tomography imaging characteristics of thyroid lymphoma and their potential clinical utility[J]. Acta Radiol, 2009,50(2):201-204.
doi: 10.1080/02841850802620689 pmid: 19089692
[20] Derringer GA, Thompson LD, Frommelt RA , et al. Malignant lymphoma of the thyroid gland: a clinicopathologic study of 108 cases[J]. Am J Surg Pathol, 2000,24(5):623-639.
doi: 10.1097/00000478-200005000-00001
[21] 张秉均, 薛勇敢, 刘洪军 , 等. 20例原发性甲状腺淋巴瘤的临床分析[J]. 解放军医学院学报, 2015,36(5):419-423.
doi: 10.3969/j.issn.2095-5227.2015.05.004
[22] 夏青萍, 卫骆云 . 原发性甲状腺恶性淋巴瘤合并桥本氏甲状腺炎11例诊治分析[J]. 浙江实用医学, 2015,20(5):335-337.
[23] Sangalli G, Serio G, Zampatti C , et al. Fine needle aspirationcytology of primary lymphoma of the thyroid: a report of 17 cases[J]. Cytopathology, 2001,12(4):257-263.
doi: 10.1046/j.1365-2303.2001.00338.x pmid: 11488875
[24] 朱庆莉, 姜玉新, 李文波 , 等. 超声引导组织活检对原发性甲状腺淋巴瘤的诊断价值[J]. 协和医学杂志, 2014,5(1):3-7.
doi: 10.3969/j.issn.1674-9081.2014.01.002
[25] Matsuzuka F, Miyauchi A, Katayama S , et al. Clinical aspects of primary thyroid lymphoma: diagnosis and treatment based onour experience of 119 cases[J]. Thyroid, 1993,3(2):93-99.
doi: 10.1089/thy.1993.3.93
[26] Wang SA, Rahemtullah A, Faquin WC , et al. Hodgkin’s lymphoma of the thyroid: a clinicopathologic study of five cases andreview of the literature[J]. Mod Pathol, 2005,18(12):1577-1584.
doi: 10.1038/modpathol.3800501 pmid: 16258502
[27] Pyke CM, Grant CS, Habermann TM , et al. Non-Hodgkin’s lymphoma of the thyroid: is more than biopsynecessary?[J]. World J Surg, 1992,16(4):604-609.
doi: 10.1007/BF02067333 pmid: 1413831
[28] Molina A . A decade of rituximab: improving survival outcomes in non-Hodgkin’s lymphoma[J]. Annu Rev Med, 2008,59:237-250.
doi: 10.1146/annurev.med.59.060906.220345 pmid: 18186705
[29] Penney SE, Homer JJ . Thyroid lymphoma: acute presentation and long-termoutcome[J]. J Laryngol Otol, 2011,125(12):1256-1262.
doi: 10.1017/S0022215111001812 pmid: 21835073
[30] Belal AA, Allam A, Kandil A , et al. Primary thyroid lymphoma: a retrospective analysis of prognostic factors and treatment outcome for localized intermediate and high grade lymphoma[J]. Am J Clin Oncol, 2001,24(3):299-305.
doi: 10.1097/00000421-200106000-00019
[1] Yun-fei SHI,Hao-jie WANG,Wei-ping LIU,Lan MI,Meng-ping LONG,Yan-fei LIU,Yu-mei LAI,Li-xin ZHOU,Xin-ting DIAO,Xiang-hong LI. Analysis of clinicopathological and molecular abnormalities of angioimmunoblastic T-cell lymphoma [J]. Journal of Peking University (Health Sciences), 2023, 55(3): 521-529.
[2] Qian SU,Xin PENG,Chuan-xiang ZHOU,Guang-yan YU. Clinicopathological characteristics and prognosis of non-Hodgkin lymphoma in oral and maxillofacial regions: An analysis of 369 cases [J]. Journal of Peking University (Health Sciences), 2023, 55(1): 13-21.
[3] LIAO Xu-he,WANG Rong-fu,LIU Meng,CHEN Xue-qi,XIONG Yan,NONG Lin,YIN Lei,ZHANG Bing-ye,DU Yu-jing. Semiquantitative parameters of 18F-FDG PET/CT, gene mutation states of epidermal growth factor receptor and anaplastic lymphoma kinase in prognosis evaluation of patients with lung adenocarcinoma [J]. Journal of Peking University (Health Sciences), 2021, 53(2): 246-254.
[4] CHI Yan-ting,ZHANG Yan-ping,ZHANG Qiu-lu,LIU Cui-ling,LI bin-bin. Clinicopathological analysis of mucosa associated lymphoid tissue lymphoma secondary to Sjögren’s syndrome in salivary gland [J]. Journal of Peking University (Health Sciences), 2021, 53(1): 40-45.
[5] Gong CHENG,Xia ZHANG,Fei YANG,Jia-yu CHENG,Yan-ying LIU. Angioimmunoblastic T-cell lymphoma with fever, arthritis and skin pigmentation: A case report [J]. Journal of Peking University (Health Sciences), 2020, 52(6): 1150-1152.
[6] Yan TIAN,Jun ZHU. Relationship between p53 rs1625895 polymorphism and prognosis in diffuse large B-cell lymphoma [J]. Journal of Peking University(Health Sciences), 2019, 51(5): 791-796.
[7] Qian SU,Xin PENG,Chuan-xiang ZHOU,Guang-yan YU. Clinicopathological features and possible prognostic factors in parotid lymphomas [J]. Journal of Peking University(Health Sciences), 2019, 51(1): 35-42.
[8] LIU Ai-chun, CHEN Yong, JIA Jin-song, GAO Song-yuan, LIU Yan-ying. Non-Hodgkin’s lymphoma mimicking Mikulicz disease: a case report [J]. Journal of Peking University(Health Sciences), 2016, 48(6): 1074-1076.
[9] WAN Wenli, WANG Jing, ZHU Mingxia,ZHANG Wei, KE Xiaoyan. Retrospective analyses of CHOPE plus L-asparaginase regimen in treatment of T-cell lymphoma [J]. Journal of Peking University(Health Sciences), 2016, 48(5): 841-845.
[10] ZHANG Meng-Xue-1, PEI Fei-1△, WANG Tian-Li-2, HAN Xiang-3, YOU Jiang-Feng-1, ZOU Peng-Cheng-1, WANG Yue-Qi-1, LI Xu-Wen-1, LIU Xin-1, ZHONG Gao-Gao-1, LIU Yan-1, WANG Yu-Xiang-1, WANG Hua-1, ZHANG Bo-1. Anaplastic lymphoma kinase fusion gene expression, clinical pathological characteristics and prognosis in 95 Chinese patients with non-small cell lung cancer [J]. Journal of Peking University(Health Sciences), 2014, 46(4): 582-588.
[11] FU Zhi-Ying, ZHU Jun, SONG Yu-Qin, LIU Wei-Ping, JI Xin-Qiang, ZHAN Si-Yan. Prognostic analysis of 525 Chinese patients with diffuse large B cell lymphoma [J]. Journal of Peking University(Health Sciences), 2014, 46(3): 405-411.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!