Thyroid Lymphoma 

  • Author: Fernando Cabanillas, MD; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Aug 9, 2011
 

Background

Primary thyroid lymphoma can be defined as a lymphoma that arises from the thyroid gland. This definition excludes those that invade the thyroid gland as a consequence of either metastasis or direct extension. Primary thyroid lymphomas are practically always of the non-Hodgkin type. Primary thyroid Hodgkin disease is extremely rare. Non-Hodgkin lymphomas (NHLs) can be further divided into aggressive and indolent cell types. The aggressive NHLs comprise a large number of cell types, the most common of which is large cell lymphoma. They most frequently arise from lymph nodes, but an extranodal site can be the primary source in approximately 30% of cases and the thyroid gland is among the most common of these extranodal sites.

Thyroid lymphomas constitute only 3% of all NHLs and approximately 5% of all thyroid neoplasms.[1, 2, 3] Thyroid NHL, although not a very common disorder, is highly curable, without the need for extensive surgery and, for this reason, should be recognized early and treated correctly.

Note the image below.

Rapidly enlarging thyroid mass occurring in associRapidly enlarging thyroid mass occurring in association with neck adenopathy.
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Pathophysiology

Interestingly, these disorders are very frequently associated with Hashimoto thyroiditis (HT). Conversely, there is a markedly increased incidence of primary thyroid lymphomas in patients with HT and it is thought that there is very likely a pathogenetic link between this autoimmune disorder and thyroid NHL.[4] Hypothyroidism has been observed in 30-40% of patients with thyroid lymphoma. As expected because of its association with HT, thyroid lymphomas occur more commonly in females, with a female-to-male ratio ranging from 2:1 and as high as 14:1 in some series.[2, 5] Similar to other NHLs, the median age is usually close to 60 years.[6]

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Contributor Information and Disclosures
Author

Fernando Cabanillas, MD  Adjunct Professor of Medicine, MD Anderson Cancer Center, University of Texas Medical School at Houston; Adjunct Professor, Moffitt Cancer Center; Medical Director, Auxilio Mutuo Cancer Center, Puerto Rico

Fernando Cabanillas, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, New York Academy of Sciences, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Lodovico Balducci, MD  Professor of Oncology and Medicine, University of South Florida College of Medicine; Division Chief, Senior Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Wendy Hu, MD  Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

References

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  2. Austin JR, el-Naggar AK, Goepfert H. Thyroid cancers. II. Medullary, anaplastic, lymphoma, sarcoma, squamous cell. Otolaryngol Clin North Am. Aug 1996;29(4):611-27. [Medline].

  3. Pasieka JL. Anaplastic cancer, lymphoma, and metastases of the thyroid gland. Surg Oncol Clin N Am. Oct 1998;7(4):707-20. [Medline].

  4. Holm LE, Blomgren H, Lowhagen T. Cancer risks in patients with chronic lymphocytic thyroiditis. N Engl J Med. Mar 7 1985;312(10):601-4. [Medline].

  5. Tupchong L, Hughes F, Harmer CL. Primary lymphoma of the thyroid: clinical features, prognostic factors, and results of treatment. Int J Radiat Oncol Biol Phys. Oct 1986;12(10):1813-21. [Medline].

  6. Ha CS, Shadle KM, Medeiros LJ, et al. Localized non-Hodgkin lymphoma involving the thyroid gland. Cancer. Feb 15 2001;91(4):629-35. [Medline].

  7. Velasquez WS, Jagannath S, Tucker SL, et al. Risk classification as the basis for clinical staging of diffuse large- cell lymphoma derived from 10-year survival data. Blood. Aug 1 1989;74(2):551-7. [Medline]. [Full Text].

  8. Swan F Jr, Velasquez WS, Tucker S, et al. A new serologic staging system for large-cell lymphomas based on initial beta 2-microglobulin and lactate dehydrogenase levels. J Clin Oncol. Oct 1989;7(10):1518-27. [Medline].

  9. Pappa VI, Hussain HK, Reznek RH, et al. Role of image-guided core-needle biopsy in the management of patients with lymphoma. J Clin Oncol. Sep 1996;14(9):2427-30. [Medline].

  10. Watanabe N, Noh JY, Narimatsu H, et al. Clinicopathological features of 171 cases of primary thyroid lymphoma: a long-term study involving 24 553 patients with Hashimoto's disease. Br J Haematol. Mar 4 2011;[Medline].

  11. Isaacson PG. Lymphoma of the thyroid gland. Curr Top Pathol. 1997;91:1-14. [Medline].

  12. International Non-Hodgkin Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin's lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med. Sep 30 1993;329(14):987-94. [Medline].

  13. Matsuzuka F, Miyauchi A, Katayama S, et al. Clinical aspects of primary thyroid lymphoma: diagnosis and treatment based on our experience of 119 cases. Thyroid. Summer 1993;3(2):93-9. [Medline].

  14. Miller TP, Dahlberg S, Cassidy JR, et al. Three cycles of CHOP (CHOP-3) plus radiotherapy (RT) is superior to eight cycles of CHOP (CHOP-8) alone for localized intermediate grade non-Hodgkin's lymphoma (NHL). A Southwest Oncology Group study. Proc Ann Meet Am Soc Clin Oncol. 1996;15 (A1257):411.

  15. Rodriguez J, Cabanillas F, McLaughlin P, et al. A proposal for a simple staging system for intermediate grade lymphoma and immunoblastic lymphoma based on the 'tumor score'. Ann Oncol. Nov 1992;3(9):711-7. [Medline].

  16. Miller TP, Dahlberg S, Cassady JR, et al. Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin's lymphoma. N Engl J Med. Jul 2 1998;339(1):21-6. [Medline].

  17. Glick JH, Kim K, Earle J, et al. An ECOG randomized phase III trial of CHOP vs. CHOP + radiotherapy (XRT) for intermediate grade early stage non-Hodgkin's lymphoma (NHL) [abstract]. Proceedings of the American Society of Clinical Oncology. 1995;14 (A-1221):391.

  18. Laing RW, Hoskin P, Hudson BV, et al. The significance of MALT histology in thyroid lymphoma: a review of patients from the BNLI and Royal Marsden Hospital. Clin Oncol (R Coll Radiol). 1994;6(5):300-4. [Medline].

 
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Rapidly enlarging thyroid mass occurring in association with neck adenopathy.
 
 
 
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