Thyroid lymphoma

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Thyroid lymphoma
Specialty ENT surgery, endocrinology, oncology

Thyroid lymphoma is a rare cancer constituting 1% to 2% of all thyroid cancers and less than 2% of lymphomas. Thyroid lymphomas are classified as non–Hodgkin's B-cell lymphomas in a majority of cases, although Hodgkin's lymphoma of the thyroid has also been identified. [1]

Contents

Signs and symptoms

As with other thyroid lesions, thyroid lymphoma affects predominantly females over 70 years of age with a history of Hashimoto's thyroiditis. Thus, Hashimoto's thyroiditis is considered a risk factor for thyroid lymphoma development. Thyroid lymphoma manifests as a rapidly enlarging neck mass which may compress the nearby trachea thereby causing narrowing or obstruction of the airway resulting in breathing difficulties or even respiratory failure. On physical examination, affected people typically exhibit a firm thyroid gland and enlarged lymph nodes.[ citation needed ]

Diagnosis

Thyroid lymphoma poses a diagnostic and therapeutic challenge. This is because several manifestation patterns are similar to those of anaplastic thyroid cancer (ATC). Fine-needle aspiration (FNA) helps distinguish the two entities preoperatively.[ citation needed ]

Histopathology

The majority of thyroid lymphomas are non–Hodgkin's B-cell lymphomas; a minority exhibit properties of T-cell lymphomas .[ citation needed ]

Staging

Staging of thyroid lymphoma is shown in the table below[ citation needed ]

StageCharacteristics
Lymphoma is located within the thyroid
Lymphoma is located within the thyroid and regional lymph-nodes
Lymphoma is located at both sides of diaphragm
Dissemination of lymphoma

Treatment

Combined modality therapy is the most common approach for the initial treatment of thyroid lymphomas. The CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisone) has been shown to be highly effective for many types of thyroid lymphoma.[ medical citation needed ] However, it is suggested to perform radiation therapy only for MALT resulting a 96% complete response, with only a 30% relapse rate. Surgical treatment might be performed for patients with thyroid lymphoma in addition to chemotherapy and radiation, particularly for MALT lymphomas.[ citation needed ]

Prognosis

The factors of poor prognosis for people with thyroid lymphoma are advanced stage of the tumor, large size (>10 cm) as well as spreading to mediastinum. The overall survival for primary thyroid lymphoma is 50% to 70%, ranging from 80% in stage IE to less than 36% in stage IIE and IVE in 5 years.[ citation needed ]

Related Research Articles

Non-Hodgkin lymphoma Type of cancer of lymph nodes

Non-Hodgkin lymphoma (NHL) is a group of blood cancers that includes all types of lymphomas except Hodgkin lymphomas. Symptoms include enlarged lymph nodes, fever, night sweats, weight loss and tiredness. Other symptoms may include bone pain, chest pain or itchiness. Some forms are slow-growing, while others are fast-growing.

Lymphoma Hematologic cancer that affects lymphocytes

Lymphoma is a group of blood malignancies that develop from lymphocytes. The name often refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enlarged lymph nodes, fever, drenching sweats, unintended weight loss, itching, and constantly feeling tired. The enlarged lymph nodes are usually painless. The sweats are most common at night.

Tumors of the hematopoietic and lymphoid tissues Medical condition

Tumors of the hematopoietic and lymphoid tissues or haematopoietic and lymphoid malignancies are tumors that affect the blood, bone marrow, lymph, and lymphatic system. Because these tissues are all intimately connected through both the circulatory system and the immune system, a disease affecting one will often affect the others as well, making myeloproliferation and lymphoproliferation closely related and often overlapping problems. While uncommon in solid tumors, chromosomal translocations are a common cause of these diseases. This commonly leads to a different approach in diagnosis and treatment of haematological malignancies.

Hashimotos thyroiditis Autoimmune disease

Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis and Hashimoto's disease, is an autoimmune disease in which the thyroid gland is gradually destroyed. Early on, symptoms may not be noticed. Over time, the thyroid may enlarge, forming a painless goiter. Some people eventually develop hypothyroidism with accompanying weight gain, fatigue, constipation, depression, hair loss, and general pains. After many years the thyroid typically shrinks in size. Potential complications include thyroid lymphoma. Furthermore, because it is common for untreated patients of Hashimoto’s to develop hypothyroidism, further complications can include, but are not limited to, high cholesterol, heart disease, heart failure, high blood pressure, myxedema, and potential pregnancy problems.

Follicular lymphoma Medical condition

Follicular lymphoma (FL) is a cancer that involves certain types of white blood cells known as lymphocytes. The cancer originates from the uncontrolled division of specific types of B-cells known as centrocytes and centroblasts. These cells normally occupy the follicles in the germinal centers of lymphoid tissues such as lymph nodes. The cancerous cells in FL typically form follicular or follicle-like structures in the tissues they invade. These structures are usually the dominant histological feature of this cancer.

Thyroid disease Medical condition

Thyroid disease is a medical condition that affects the function of the thyroid gland. The thyroid gland is located at the front of the neck and produces thyroid hormones that travel through the blood to help regulate many other organs, meaning that it is an endocrine organ. These hormones normally act in the body to regulate energy use, infant development, and childhood development.

Thyroiditis Medical condition

Thyroiditis is the inflammation of the thyroid gland. The thyroid gland is located on the front of the neck below the laryngeal prominence, and makes hormones that control metabolism.

The mucosa-associated lymphoid tissue (MALT), also called mucosa-associated lymphatic tissue, is a diffuse system of small concentrations of lymphoid tissue found in various submucosal membrane sites of the body, such as the gastrointestinal tract, nasopharynx, thyroid, breast, lung, salivary glands, eye, and skin. MALT is populated by lymphocytes such as T cells and B cells, as well as plasma cells and macrophages, each of which is well situated to encounter antigens passing through the mucosal epithelium. In the case of intestinal MALT, M cells are also present, which sample antigen from the lumen and deliver it to the lymphoid tissue. MALT constitute about 50% of the lymphoid tissue in human body. Immune responses that occur at mucous membranes are studied by mucosal immunology.

MALT lymphoma Medical condition

MALT lymphoma (MALToma) is a form of lymphoma involving the mucosa-associated lymphoid tissue (MALT), frequently of the stomach, but virtually any mucosal site can be afflicted. It is a cancer originating from B cells in the marginal zone of the MALT, and is also called extranodal marginal zone B cell lymphoma.

T-cell lymphoma Medical condition

T-cell lymphoma is a rare form of cancerous lymphoma affecting T-cells. Lymphoma arises mainly from the uncontrolled proliferation of T-cells and can become cancerous.

Gastric lymphoma Medical condition

Primary gastric lymphoma is an uncommon condition, accounting for less than 15% of gastric malignancies and about 2% of all lymphomas. However, the stomach is a very common extranodal site for lymphomas. It is also the most common source of lymphomas in the gastrointestinal tract.

Mediastinal tumors Medical condition

A mediastinal tumor is a tumor in the mediastinum, the cavity that separates the lungs from the rest of the chest. It contains the heart, esophagus, trachea, thymus, and aorta. The most common mediastinal masses are neurogenic tumors, usually found in the posterior mediastinum, followed by thymoma (15–20%) located in the anterior mediastinum. Lung cancer typically spreads to the lymph nodes in the mediastinum.

B-cell lymphoma Medical condition

The B-cell lymphomas are types of lymphoma affecting B cells. Lymphomas are "blood cancers" in the lymph nodes. They develop more frequently in older adults and in immunocompromised individuals.

Aggressive lymphoma Medical condition

Aggressive lymphoma, also known as high-grade lymphoma, is a group of fast growing Non-Hodgkin Lymphoma.

Marginal zone B-cell lymphoma Group of lymphomas

Marginal zone B-cell lymphomas, also known as marginal zone lymphomas (MZLs), are a heterogeneous group of lymphomas that derive from the malignant transformation of marginal zone B-cells. Marginal zone B cells are innate lymphoid cells that normally function by rapidly mounting IgM antibody immune responses to antigens such as those presented by infectious agents and damaged tissues. They are lymphocytes of the B-cell line that originate and mature in secondary lymphoid follicles and then move to the marginal zones of mucosa-associated lymphoid tissue, the spleen, or lymph nodes. Mucosa-associated lymphoid tissue is a diffuse system of small concentrations of lymphoid tissue found in various submucosal membrane sites of the body such as the gastrointestinal tract, mouth, nasal cavity, pharynx, thyroid gland, breast, lung, salivary glands, eye, skin and the human spleen.

Nodular lymphocyte predominant Hodgkin lymphoma Medical condition

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is an indolent CD20(+) form of lymphoma.

Hodgkin lymphoma Type of blood and immune-system cancer

Hodgkin lymphoma (HL) is a type of lymphoma, in which cancer originates from a specific type of white blood cells called lymphocytes, where multinucleated Reed–Sternberg cells are present in the patient's lymph nodes. Symptoms may include fever, night sweats, and weight loss. Often, nonpainful enlarged lymph nodes occur in the neck, under the arm, or in the groin. Those affected may feel tired or be itchy.

Primary mediastinal B-cell lymphoma Medical condition

Primary mediastinal B-cell lymphoma, abbreviated PMBL, is a rare type of lymphoma that forms in the mediastinum and predominantly affects young adults.

In CT scan of the thyroid, focal and diffuse thyroid abnormalities are commonly encountered. These findings can often lead to a diagnostic dilemma, as the CT reflects the nonspecific appearances. Ultrasound (US) examination has a superior spatial resolution and is considered the modality of choice for thyroid evaluation. Nevertheless, CT detects incidental thyroid nodules (ITNs) and plays an important role in the evaluation of thyroid cancer.

Indolent lymphoma Medical condition

Indolent lymphoma, also known as low-grade lymphoma, is a group of slow growing non-Hodgkin Lymphoma (NHL). Because indolent lymphoma is usually very slow growing and slow to spread, it tends to have fewer signs and symptoms when first diagnosed and may not require treatment straight away. Possible symptoms include one or more swollen but painless lymph nodes, unexplained fever and unintended weight loss.

References

  1. Sakorafas GH, Kokkoris P, Farley DR (2010). "Primary thyroid lymphoma (correction of lympoma): diagnostic and therapeutic dilemmas". Surg. Oncol. 19 (4): 124–29. doi:10.1016/j.suronc.2010.06.002. PMID   20620043.
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