Thyroid gland
Other malignancies
Lymphoma - general

Topic Completed: 1 September 2015

Revised: 15 March 2019

Copyright: 2003-2018,, Inc.

PubMed Search: lymphoma thyroid

See also: Follicular lymphoma, Hodgkin lymphoma

Sheren Younes, M.D.
Page views in 2018: 3,038
Page views in 2019 to date: 1,738
Cite this page: Younes S. Lymphoma - general. website. Accessed July 24th, 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)
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
  • 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

Images hosted on PathOut server:

Diffuse large cell lymphoma:
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Fish flesh cut surface (AFIP)

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
Microscopic (histologic) images

Images hosted on PathOut server:

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Follicular lymphoma

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

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

Images hosted on other servers:
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Large pleomorphic cells

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MALT lymphoma: 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

Images hosted on PathOut server:

Contributed by Ayana Suzuki,
Cytotechnologist, Japan:


Contributed by Dr. Mark R. Wick:

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Large cell type

Images hosted on other servers:
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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
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