Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Thyroid Lymphoma

  • Author: Fernando Cabanillas, MD; Chief Editor: Emmanuel C Besa, MD  more...
 
Updated: Aug 12, 2014
 

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 non-Hodgkin lymphomas (NHLs). Primary thyroid Hodgkin disease is extremely rare.

NHLs can be divided into aggressive and indolent cell types. 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 NHL represents approximately 1.2 to 1.7% of all NHLs.[1] It is highly curable, without the need for extensive surgery. Accordingly, early recognition and correct treatment of this condition is vital. The most common cell type is diffuse large-cell lymphoma, either associated or unassociated with mucosa-associated lymphoid tissue (MALT) lymphoma (MALToma). The best treatment results for primary thyroid large-cell lymphoma are with combined-modality therapy; for primary thyroid MALToma, radiation therapy alone is probably adequate.[2]

Next

Pathophysiology

Thyroid lymphomas are very frequently associated with Hashimoto thyroiditis (HT). Conversely, there is a markedly increased incidence of primary thyroid lymphomas in patients with HT.[3] Such lesions are an aggressive or high-grade variant, whereas a low-grade MALT is an indolent type.

Like other low-grade MALTomas, such as those presenting in the parotid in association with Sjögren syndrome, those arising in the thyroid also occur in association with an autoimmune disorder (in this case, HT). The hypothesis is that chronic antigenic stimulation secondary to the autoimmune disorder leads to chronic proliferation of lymphoid tissue, which eventually undergoes a mutation that leads to the development of lymphoma.

Previous
Next

Epidemiology and Prognosis

Primary thyroid lymphoma is rare, constituting only 1-2% of all extranodal lymphomas and approximately 2-8% of all thyroid malignancies.[4, 3, 6, 5] As with other non-Hodgkin lymphomas, the median age of presentation in patients with thyroid lymphoma is usually close to 60 years.[5, 6] Most cases occur in women.

The prognosis for patients with thyroid large-cell lymphoma usually is favorable because they typically present with localized disease, which is amenable to treatment with chemotherapy and radiation. The cure rate is typically high (see Treatment). A large population-based study that evaluated prognostic factors found that older age, advanced stage, histologic subtype, and lack of radiation/surgical treatment were adverse factors for survival.[7]

Previous
 
 
Contributor Information and Disclosures
Author

Fernando Cabanillas, MD Professor of Medicine, University of Puerto Rico School of Medicine; 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 the Advancement of Science, American Association for Cancer Research, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, New York Academy of Sciences, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, 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 Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

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

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

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

  3. Ansell SM, Grant CS, Habermann TM. Primary thyroid lymphoma. Semin Oncol. 1999 Jun. 26(3):316-23. [Medline].

  4. Peppa M, Nikolopoulos P, Korkolopoulou P, Lapatsanis D, Dimitriadis G, Hadjidakis D, et al. Primary mucosa-associated lymphoid tissue thyroid lymphoma: a rare thyroid neoplasm of extrathyroid origin. Rare Tumors. 2012 Jan 2. 4(1):e2. [Medline]. [Full Text].

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

  6. 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. 1986 Oct. 12(10):1813-21. [Medline].

  7. Graff-Baker A, Sosa JA, Roman SA. Primary thyroid lymphoma: a review of recent developments in diagnosis and histology-driven treatment. Curr Opin Oncol. 2010 Jan. 22(1):17-22. [Medline].

  8. 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. 1996 Sep. 14(9):2427-30. [Medline].

  9. Ha CS, Shadle KM, Medeiros LJ, et al. Localized non-Hodgkin lymphoma involving the thyroid gland. Cancer. 2001 Feb 15. 91(4):629-35. [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. 2011 Mar 4. [Medline].

  11. 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. 1993 Sep 30. 329(14):987-94. [Medline].

  12. 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. 1993 Summer. 3(2):93-9. [Medline].

  13. 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.

  14. Coiffier B, Thieblemont C, Van Den Neste E, Lepeu G, Plantier I, Castaigne S, et al. Long-term outcome of patients in the LNH-98.5 trial, the first randomized study comparing rituximab-CHOP to standard CHOP chemotherapy in DLBCL patients: a study by the Groupe d'Etudes des Lymphomes de l'Adulte. Blood. 2010 Sep 23. 116(12):2040-5. [Medline]. [Full Text].

  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. 1992 Nov. 3(9):711-7. [Medline].

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

  19. 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. 1998 Jul 2. 339(1):21-6. [Medline].

  20. 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. 1989 Oct. 7(10):1518-27. [Medline].

  21. 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. 1989 Aug 1. 74(2):551-7. [Medline]. [Full Text].

 
Previous
Next
 
Rapidly enlarging thyroid mass occurring in association with neck adenopathy.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.