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Thyroid & parathyroid

Other thyroid malignancies

Lymphoma

Author: Sheren Younes, M.D., Ph.D.

Last author update: 1 September 2015

Last staff update: 20 September 2023

Copyright: 2003-2024, PathologyOutlines.com, Inc.

PubMed Search: lymphoma thyroid

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Table of Contents

Cite this page: Younes S. Lymphoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/thyroidlymphoma.html. Accessed April 20th, 2024.

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:
- t(14;18) or bcl2 overexpression, usually CD10+ and WHO grade 1-2
- No t(14;18) or bcl2 overexpression, often CD10- and WHO grade 3 (Am J Surg Pathol 2009;33:22, Mod Pathol 2005;18:1471)
Hodgkin lymphoma: very rare, favorable prognosis, female predominance (Neuroimaging Clin N Am 2003;13:371)

Epidemiology

75% women, usually adults or elderly (Am J Surg Pathol 2000;24:623)

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

19 year old woman with syncytial variant of nodular sclerosing Hodgkin lymphoma (Acta Cytol 1995;39:543)
22 and 29 year old women with thyroid nodule as a first manifestation of Hodgkin lymphoma (Diagn Pathol 2013;8:116)
32 year old man with primary T cell lymphoma of thyroid (Med Oncol 2008;25:462)
37 year old woman with nodular sclerosing Hodgkin lymphoma (Ann Endocrinol (Paris) 2012;73:492)
48 year old woman with primary thyroid lymphoma (Diagn Cytopathol 2012;40:444)
54 year old man with primary mediastinal large B cell lymphoma (Int J Clin Exp Pathol 2015;8:5944)
62 year old woman with Hodgkin lymphoma presenting as abscess in thyroid gland (Indian J Pathol Microbiol 2012;55:122)
65 year old woman with thyroid MALT lymphoma (Ann Thorac Surg 2015;100:700)
70 year old man with diffuse large B cell lymphoma of thyroid (Cytojournal 2006;3:23)

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

AFIP images

Diffuse large cell lymphoma: fish flesh cut surface

Hodgkin lymphoma:
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

Contributed by Mark R. Wick, M.D.

Large cell type, reticulin stain

AFIP images

Diffuse large B cell lymphoma:

Tumor cells

Follicle in lower right

Fibrous bands

Tumor cells are CD45 (LCA)+

Keratin, thyroglobulin

Hodgkin lymphoma:

Nodular sclerosing subtype

Follicular lymphoma:

Residual thyroid follicles

Images hosted on other servers:

Large pleomorphic cells

Hodgkin lymphoma: nodular sclerosis type

Hodgkin lymphoma: CD30+

Follicular lymphoma: morphology

Follicular lymphoma: negative for bcl2 and IGH-BCL2

Follicular lymphoma: 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, C.T. and Mark R. Wick, M.D.