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primary thyroid lymphoma
Non-Hodgkin's lymphoma where the thyroid is the predominant or exclusive site of involvement. Approximately 10% of systemic lymphoma or leukemia have thyroid involvement.
Etiology:
- frequently associated with Hashimoto's thyroiditis
Epidemiology:
1) 1-5% of thyroid cancers
2) most common in women over 55 years of age
Pathology:
1) diffuse large B cell lymphoma is most common
2) MALT lymphoma most common [1]
2) antigenic stimulation due to Hashimoto's thyroiditis may play a role [2]
3) aberrant somatic hypermutation may play a role [2]
Clinical manifestations:
- enlarging neck mass (weeks)
- local compression on adjacent structures
- dysphagia
- hoarseness
- stridor
- jugular venous distension
- facial edema
- B symptoms of lymphoma may be present
Laboratory:
- flow cytometry
Special laboratory:
- core needle biopsy or excisional biopsy to establish diagnosis of lymphoma
Radiology:
- computed tomography of neck
- diffusely enlarged thyroid
- may show compression of trachea
Management:
- MALT lymphomas respond to chemotherapy [1]
- chemotherapy &/or radiation therap
- thyroidectomy generally not needed [1]
Interactions
disease interactions
General
non-Hodgkin's lymphoma
thyroid neoplasm (nodule)
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18.
American College of Physicians, Philadelphia 1998, 2012, 2015, 2018.
- 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.
PMID: 19844180
- Kim HC, Han MH, Kim KH et al
Primary thyroid lymphoma: CT findings.
Eur J Radiol. 2003 Jun;46(3):233-9.
PMID: 12758117