Thyroid gland
Other malignancies
Lymphoma - General

Author: Sheren Younes, M.D. (see Authors page)

Revised: 17 February 2017, last major update September 2015

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: lymphoma thyroid

See also Follicular lymphoma, Hodgkin lymphoma
Cite this page: Lymphoma - General. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/thyroidlymphoma.html. Accessed March 25th, 2017.
Definition / General
  • Comprises 2.5% of extranodal lymphoma and 4 - 5% of thyroid malignancies
  • Usually arise on top of Hashimoto thyroiditis or lymphocytic thyroiditis
  • Most are diffuse large B cell lymphoma, marginal zone B cell / MALT lymphoma or mixtures of these two
    • Rarely follicular cell lymphoma
  • Hong Kong / Chinese cases are only rarely EBV+ (Am J Clin Pathol 1999;112:263)
Epidemiology
Clinical Features
  • Rapidly growing neck mass
  • Compression symptoms including dysphagia and hoarseness
  • Can present with diffuse thyroid enlargement
  • May be accidentally discovered
  • Hypothyroid manifestations may develop
  • Cold nodule
  • Virtually all primary thyroid lymphomas are MALT-type arising after 20 - 30 years of lymphocytic thyroiditis in older patients (mean age 64 years)
  • Sequence similarity in clonal IgH bands suggests lymphoma may arise from thyroiditis (J Clin Pathol 2008;61:438)
  • Secondary involvement seen in 20% dying of generalized lymphoma, although usually does not produce clinical hypothyroidism
  • Regional lymph node enlargement can be seen
Prognostic Factors
  • Overall 5 year survival is 80%
  • Poor prognostic factors: diffuse B cell lymphoma subtype, perithyroidal soft tissue invasion, stage 2E or higher
  • Good prognostic factors: marginal zone lymphoma subtype or stage IE
Case Reports
Treatment
  • Often curable by radiation or chemotherapy (particularly MALT), in contrast to anaplastic carcinoma
  • Surgery is rare (Eur J Surg Oncol 2008;34:576)
Gross Description
  • Variable sized, rubbery / soft mass
  • White cut surface with fish flesh appearance
  • Necrosis could be found
Gross Images

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Diffuse large cell lymphoma:

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Fish-flesh cut surface (AFIP)

Micro Description
  • Varies by histologic type
  • Diffuse large B cell lymphoma:
    • Diffuse infiltrate destroying thyroid follicles
    • Large cells with moderate amphophilic cytoplasm, vesicular nuclei, prominent nucleoli
    • Bizarre cells may be seen
  • MALT lymphoma:
    • Infiltration of thyroid epithelium creates lymphoepithelial lesions (lymphocytes "stuff" glandular lumina, Arch Pathol Lab Med 2007;131:1673)
    • May have background lymphocytic thyroiditis
Micro Images

Images hosted on PathOut server:

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Large cell type, reticulin stain contributed by Dr. Mark R. Wick

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Follicular lymphoma, AFIP



Diffuse large B cell lymphoma (AFIP):

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Tumor cells

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Follicle in lower right

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Fibrous bands

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Tumor cells are CD45 (LCA)+

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Keratin, thyroglobulin



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Large pleomorphic cells



MALT lymphoma:

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Centrocyte-like cells

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AE1 / AE3, CAM 5.2

Cytology Description
  • Monotonous population of large atypical lymphoid cells (scant cytoplasm, finely granular chromatin, prominent nucleoli), lymphoglandular bodies present (cytoplasmic fragmentation), karyorrhexis (Cytojournal 2005;2:21)
  • MALT features: see Acta Cytol 2015;59:26
  • May be misdiagnosed as lymphocytic thyroiditis
Cytology Images

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Large cell type, contributed by Dr. Mark R. Wick



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Intermediate grade lymphoma

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MALT lymphoma



Diffuse large B cell lymphoma:

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Large and irregular lymphoid cells

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Misdiagnosed as anaplastic carcinoma

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High grade lymphoma

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CD45 / LCA+, CD20+, keratin-

Positive Stains
Molecular / Cytogenetics Description
Differential Diagnosis
Additional References