Thyroid Lymphoma

Question 1

Thyroid lymphoma- basic demographics

Answer 1

fewer than 5% of malignancies

• women > men (4:1 ratio)
• majority are non-Hodgkin’s lymphomas of B-cell origin
• 50% of lymphomas arise from background of pre-existing Hashimoto’s thyroiditis
• subgroup of MALT

Question 2

Clinical presentation thyroid lymphoma

Answer 2

rapidly enlarging thyroid mass and compressive symptoms
history of hypothyroidism (remember association with Hashimoto’s)
-few patients have B symptoms
-diagnosis considered in patients with goiter

Question 3

Work-up of thyroid lymphoma

Answer 3

CT neck, chest, abdo with or without PET

-if FNA not diagnostic, then core needle biopsy

Question 4

Management of thyroid lymphoma

Answer 4

diffuse large B cell lymphoma
CHOP chemotherapy followed by radiation for stage IE or IIE disease
C- cyclophosphamide
H- hydroxydanorubocin (Doxorubin)
O- oncovin (Vincristine)
P- prednisone

Question 5

Role of surgery in thyroid lymphoma

Answer 5

surgery generally not required but subset of patients with significant compressive symptoms from big tumours could benefit from palliative total or subtotal thyroidectomy
-can use surgery for diagnostic biopsy when diagnosis cannot be made by FNAB or CNB