Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
LETTER TO THE EDITOR
Year : 2012  |  Volume : 8  |  Issue : 1  |  Page : 159-161

Primary thyroid lymphoma arising from hashimotos thyroiditis diagnosed by fine needle aspiration cytology


1 Department of Pathology, KS Hegde Medical Academy of Nitte University, Deralakatte, Mangalore, India
2 Department of Radiology, KS Hegde Medical Academy of Nitte University, Deralakatte, Mangalore, India

Date of Web Publication19-Apr-2012

Correspondence Address:
Sunil Kumar Yeshvanth
Associate Professor, Department of Pathology, K S Hegde Medical Academy, Deralakatte, Mangalore 575018, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.95205

Rights and Permissions

How to cite this article:
Yeshvanth SK, Lakshminarayana KH, Upadhyaya VS, Shetty JK. Primary thyroid lymphoma arising from hashimotos thyroiditis diagnosed by fine needle aspiration cytology. J Can Res Ther 2012;8:159-61

How to cite this URL:
Yeshvanth SK, Lakshminarayana KH, Upadhyaya VS, Shetty JK. Primary thyroid lymphoma arising from hashimotos thyroiditis diagnosed by fine needle aspiration cytology. J Can Res Ther [serial online] 2012 [cited 2019 Sep 21];8:159-61. Available from: http://www.cancerjournal.net/text.asp?2012/8/1/159/95205

Sir,

Primary thyroid lymphoma (PTL) are rare neoplasms accounting for 0.6-5% of all thyroid malignancies. [1],[2] There are very few reports of fine needle aspiration cytology (FNAC) of PTL in the literature. [1] We present a case of PTL diagnosed by FNAC based on distinctive cytological features.

A 52-year-old female, known case of Hashimotos thyroiditis since 10 years on treatment came with dysphagia, dyspnea and rapidly enlarging thyroid swelling since 1 month. Local examination revealed enlarged thyroid, predominantly right lobe measuring 6 × 3 cm. Computerized tomography scan revealed circumscribed hypoechoeic nodule in the right lobe of the thyroid measuring 11 × 7 × 4 cm with retrosternal extention, compressing the trachea (big arrow) and carotid vessels (small arrow) [Figure 1]a. No other lymph nodes and organomegaly were present. FNAC from the right lobe showed monotonous population of intermediate to large lymphoid cells having prominent nucleoli, cleaved nuclei and moderate amount of cytoplasm in the background of tingible body macrophages [Figure 1]b. Trucut biopsy showed monotonous population of intermediate to large atypical lymphoid cells with starry sky pattern [Figure 1]c. No residual thyroid tissue were seen. Immunohistochemistry showed positivity for CD45, CD20 [Figure 1]d, BCL2, and BCL6 with negativity for CD5, CD10, and CD23. Final diagnosis of primary diffuse large B-cell lymphoma with Burkitt-like areas of the thyroid gland was made. On chemotherapy (CHOP regimen with rituximab) the patient was symptomatically better and size decreased significantly. On completion of six cycles of chemotherapy, she is on regular follow up for radiotherapy.
Figure 1: (a) CT scan revealing circumscribed hypoechoeic nodule in the right lobe of the thyroid with retrosternal extention, compressing the trachea (big arrow) and carotid vessels (small arrow). (b) Cytological smears showing monotonous population of intermediate to large lymphoid cells having prominent nucleoli, cleaved nuclei and moderate
amount of cytoplasm in the background of tingible body macrophages (x45X, MGG stain). (c) Trucut biopsy showing monotonous population of intermediate to large atypical lymphoid cells (HandE, 45x). (d) Immunopositivity for CD20


Click here to view


Primary thyroid lymphoma are predominantly seen in middle and older age females, presents with rapidly growing mass, dysphagia, stridor and change of voice. Hypothyroidism is seen in 30-40% of patients. [3] On clinical examination, they are firm to hard mass and can compress the trachea and esophagus. FNAC is a useful preoperative diagnostic tool that helps in fast and accurate diagnosis of primary thyroid lymphoma and differentiating it from other malignancies (carcinomas) where surgery is the treatment of choice. [1] Cytological features include monotonous population of intermediate to large and rarely small lymphoid cells. The presence of polymorphous population and plasma cells favor Hashimotos thyroiditis. [1],[4] The diagnosis of PTL will be difficult when both neoplastic and nonneoplastic elements are found. [1] The closest differential diagnosis include small-cell anaplastic carcinoma that show cell clustering and nuclear molding. [1] Most PTL are non-Hodgkin lymphomas and subtypes include Diffuse large B-cell lymphoma (DLBCL), MALT lymphoma, and mixed type. DLBCL is the commonest (70%) type and are aggressive with almost 60% diagnosed with dissemination. [2],[4] MALT lymphomas comprise of 6-27% and have relatively indolent course. [2],[4] Hashimotos thyroiditis increases the risk of lymphoma by 50 times and takes 20-30 years for transformation. [2],[4],[5] The prognosis of patients with PTL is excellent and depends on the stage. [3] The recommended treatment guidelines for low grade (Stage IE) include radiation or surgery and chemotherapy followed by radiotherapy for intermediate to high-grade lymphomas. [1],[3] CHOP regimen with Rituximab has shown best combination for disease free survival. [3] Our case managed with the same regimen since it was a high-grade lymphoma and showed best response. The 10-year survival for low-grade lymphoma is 75% and for high grade 5-year survival is less than 50%. [4],[5] Our patient is doing well with 8 months of follow up.

We hereby conclude that, in a preexisting case of Hashimotos thyroiditis, PTL has to be ruled out especially if there is sudden increase in size, dysphagia, stridor, and hoarseness of voice. In our case, since PTL was diagnosed by FNAC and was later confirmed by trucut biopsy; the patient received chemotherapy instead of surgery and showed good response. This emphasizes the role of FNAC that is a good supplementary diagnostic tool that should be followed by trucut biopsy for accurate typing of PTL, so that morbidity associated with surgery can be avoided. [4],[5]

 
 > References Top

1.Amonkar G, Jashnani K, Shet T, Naik L, Rege J. Diagnostic fine needle aspiration cytology of primary thyroid lymphoma. J Cytol 2007;24:140-1.  Back to cited text no. 1
  Medknow Journal  
2.Gupta N, Nijhawan R, Srinivasan R, Rajwanshi A, Dutta P, Bhansaliy A, et al. Fine needle aspiration cytology of primary thyroid lymphoma: A report of ten cases. Cytojournal 2005;2:21.   Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Hahn JS, Chung HC, Min YH, Ko YW, Park CS, Suh CO, et al. Primary lymphoma of the thyroid. Yonsei Med J 1995;36:315-21.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Lee SK, Kwon SY, Kim YH, Choi JS, Sohn CH, Lee HJ, et al. Primary Mucosa- Associated Lymphoid Tissue (MALT) Lymphoma of thyroid gland arising from coexisting Hashimotos thyroiditis: A case report. J Korean Radiol Soc 2006;55:43-8.  Back to cited text no. 4
    
5.Matsuzuka F, Kuma K. Malignant lymphomas of the thyroid gland: Analysis of 79 patients with emphasis on histological prognostic factors. Cancer 1986;58:100-4.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  >Article Figures
  In this article
>References

 Article Access Statistics
    Viewed2822    
    Printed106    
    Emailed1    
    PDF Downloaded305    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]