Thyroid & parathyroid
Other thyroid malignancies
Lymphoma


Topic Completed: 1 September 2015

Minor changes: 27 January 2021

Copyright: 2003-2021, PathologyOutlines.com, Inc.

PubMed Search: lymphoma thyroid

Sheren Younes, M.D.
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Cite this page: Younes S. Lymphoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/thyroidlymphoma.html. Accessed May 11th, 2021.
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

AFIP images
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Diffuse large cell lymphoma: fish flesh cut surface

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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.
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Large cell type, reticulin stain



AFIP images

Diffuse large B cell lymphoma:
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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



Hodgkin lymphoma:
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Nodular sclerosing subtype


Follicular lymphoma:
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Residual thyroid follicles



Images hosted on other servers:
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Large pleomorphic cells

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Hodgkin lymphoma: nodular sclerosis type

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Hodgkin lymphoma: CD30+

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Follicular lymphoma: morphology

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Follicular lymphoma: negative for bcl2 and IGH-BCL2

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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., Mark R. Wick, M.D.

DLBCL

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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

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Hodgkin lymphoma: Reed-Sternberg cell


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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