Thyroid gland
Other malignancies
Lymphoma - general


Topic Completed: 1 September 2015

Revised: 18 September 2019

Copyright: 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: lymphoma thyroid

Sheren Younes, M.D.
Page views in 2018: 3,038
Page views in 2019 to date: 2,415
Cite this page: Younes S. Lymphoma - general. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/thyroidlymphoma.html. Accessed October 14th, 2019.
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)
  • Follicular lymphoma has two subgroups:
  • Hodgkin lymphoma: very rare, favorable prognosis, female predominance (Neuroimaging Clin N Am 2003;13:371)
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
  • Hodgkin lymphoma: thyroid mass, cervical lymphadenopathy, patient is euthyroid but may be hypothyroid
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
Diffuse large cell lymphoma (AFIP)
Missing Image

Fish flesh cut surface

Hodgkin lymphoma (AFIP)
Missing Image

Nodular sclerosing subtype

Microscopic (histologic) 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
  • Follicular lymphoma:
    • Usually prominent follicular pattern with prominent interfollicular neoplastic infiltrate, lymphoepithelial lesions are common
    • May arise on top of thyroiditis
Microscopic (histologic) images

Diffuse large B cell lymphoma (AFIP)
Missing Image

Tumor cells

Missing Image

Follicle in lower right

Missing Image

Fibrous bands

Missing Image

Tumor cells are CD45 (LCA)+

Missing Image

Keratin, thyroglobulin



Hodgkin lymphoma (AFIP)
Missing Image Missing Image

Nodular sclerosing subtype


Follicular lymphoma (AFIP)
Missing Image

Residual thyroid follicles


Contributed by Dr. Mark R. Wick
Missing Image

Large cell type, reticulin stain



Images hosted on other servers:


Missing Image

Large pleomorphic cells

Missing Image

MALT lymphoma: AE1 / AE3, CAM 5.2


Hodgkin lymphoma
Missing Image

Nodular sclerosis type

Missing Image

CD30+



Follicular lymphoma
Missing Image

Morphology

Missing Image

Negative for bcl2 and IGH-BCL2

Missing Image

Positive for bcl2 and IGH-BCL2

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
  • Hodgkin lymphoma: some atypical cells, may have marked fibrosis
Cytology images

Contributed by Ayana Suzuki,
Cytotechnologist, Japan

DLBCL



Contributed by Dr. Mark R. Wick

Missing Image

Large cell type



Images hosted on other servers:


Missing Image

Intermediate grade lymphoma

Missing Image

MALT lymphoma


Hodgkin lymphoma
Missing Image

Reed-Sternberg cell



Diffuse large B cell lymphoma
Missing Image

Large and irregular lymphoid cells

Missing Image

Misdiagnosed as anaplastic carcinoma

Missing Image

High grade lymphoma

Missing Image

CD45 / LCA+, CD20+, keratin-

Positive stains
Molecular / cytogenetics description
Differential diagnosis
Back to top