Year: 2025
Type: article
Study design: Case Report
Abstract: Introduction Non-Hodgkin lymphoma (NHL) of the thyroid, a rare malignancy linked to autoimmune disorders, is poorly understood in terms of its pathogenesis and treatment outcomes. This study aims to review a single-center experience in managing primary thyroid non-Hodgkin B-cell lymphoma cases. Methods This retrospective case series was conducted at a single center from January 2020 to November 2024, including patients diagnosed with B-cell NHL of the thyroid who underwent surgical intervention. Data, including clinical, demographic, laboratory, and imaging information, were extracted from medical records. Diagnostic procedures involved core needle or surgical biopsy with immunohistochemistry analysis. Treatment included excisional biopsy, thyroidectomy, lobectomy, and chemotherapy. Quantitative data is presented as means and standard deviations, and qualitative data as frequencies and percentages. Results Among nine NHL cases, seven (77.8%) were female, with a mean age of 60.78 ± 12.53 years. Anterior neck swelling was the most common presentation in 6(66.7%) cases. Seven patients (77.8%) received R-CHOP chemotherapy; histopathology confirmed B-cell lymphoma in eight cases (88.9%). Thyroid function was euthyroid in four cases (44.4%), hypothyroid in three (33.3%), and hyperthyroid in one (11.1%). TI-RADS (Thyroid Imaging Reporting and Data Systems) classification showed five cases (55.6%) as TI-RADS 5. Follow-up revealed no recurrence in four cases (44.4%), and two deaths (22.2%). Conclusion Primary thyroid NHL is a rare condition requiring early diagnosis and personalized treatment. The variability in treatment responses highlights the need for individualized approaches to optimize patient outcomes. Introduction Non-Hodgkin lymphomas (NHLs) represent a heterogeneous group of lymphoid malignancies from lymphocytes, predominantly of B-cell origin. While many NHLs develop within lymph nodes, approximately 30-40% originate in extra-nodal sites [1]. Primary thyroid lymphoma is defined as a lymphoma that arises from the thyroid gland, excluding those that invade the thyroid due to either metastasis or direct extension. This rare malignancy accounts for approximately 5% of all thyroid malignancies and only 1-2% of all extra-nodal lymphomas, with an estimated annual incidence of 2 cases per million population [2]. The precise pathogenesis of primary thyroid lymphoma remains unclear. However, associations between autoimmune diseases, chronic antigenic stimulation, and the development of primary thyroid lymphoma have been identified. The most significant risk factor for primary thyroid lymphoma is the presence of hashimoto's thyroiditis, with patients affected having a risk of developing primary thyroid lymphoma that is 40 to 80 times higher. Notably, the incidence of hashimoto's thyroiditis among primary thyroid lymphoma patients is nearly 80% [3,4]. The proposed pathogenesis involves chronic antigenic stimulation from autoimmune processes leading to persistent lymphoid proliferation, eventually undergoing malignant transformation. Recent research has also implicated mutations in regulatory pathways, particularly the NF-κB signaling pathway through A20 gene mutations or deletions, in the development of certain thyroid B-cell lymphomas [5] Primary thyroid lymphomas are almost exclusively NHL, with B-cell phenotype representing over 95% of cases [6]. Histologically, diffuse large B-cell lymphoma is the most common subtype, accounting for approximately 60-70% of cases. Meanwhile, mucosa-associated lymphoid tissue lymphoma represents the second most common subtype, comprising about 20-30% of cases. Other less common variants include Burkitt lymphoma [7]. These subtypes exhibit varying clinical behaviors and prognoses, necessitating accurate diagnosis for appropriate management. Despite advances in understanding the pathophysiology and management of primary thyroid lymphoma, several knowledge gaps persist regarding optimal therapeutic strategies and long-term outcomes. This study aims to review a single-center experience in managing primary thyroid non-Hodgkin B-cell lymphoma cases. The eligibility of the references has been verified [8]. Methods Study design and setting This retrospective case series study was conducted at Smart Health Tower. It included patients diagnosed with NHL of B-cell origin in the thyroid gland based on pathological diagnosis who underwent surgical intervention, excisional biopsy, or thyroidectomy for definitive diagnosis. The study spanned from January 2020 to November 2024, with an average follow-up time of one year. Data Collection Data collection was performed over one month. Medical information, including demographic, clinical, and laboratory data, was retrospectively extracted from electronic medical records. Variables collected included past medic al history, surgical history, clinical presentation, thyroid status, thyroid function tests, autoimmune markers, fine needle aspiration findings, imaging studies, and treatment modalities. Pathological data were independently reviewed by an expert pathologist using specimen slides. Laboratory and Imaging Assessments Comprehensive laboratory evaluations were conducted to assess thyroid function, autoimmune markers, and general health status. Thyroid function tests included thyroid-stimulating hormone and free thyroxine. Autoimmune markers measured included thyroid peroxidase antibodies and thyroglobulin antibodies. Additional tests included viral screenings and hemoglobin levels (complete blood count). Imaging studies included preoperative ultrasound to evaluate thyroid morphology, with hypoechoic lesions defined as having reduced echogenicity relative to normal thyroid tissue, while very hypoechoic lesions exhibited even lower echogenicity compared to adjacent musculature (Figure 1). Computed tomography (CT) and positron emission tomography (PET) scans were performed to assess disease extent in selected cases. Diagnostic Biopsy Procedures A core needle biopsy was performed using a spring-loaded Tru-Cut biopsy needle (18G). All patients underwent core needle or surgical biopsy for accurate diagnosis and immunohistochemistry analysis for markers. Treatment Modalities Surgical intervention primarily served a diagnostic role rather than a curative approach, with excisional biopsy, thyroidectomy, or lobectomy performed for tissue diagnosis. Chemotherapy protocols included the CHOP regimen, consisting of cyclophosphamide (750 mg/m²), adriamycin (50 mg/m²), vincristine (1.4 mg/m²), and prednisolone (100 mg/day), often combined with rituximab (375 mg/m²) to enhance therapeutic efficacy. Ethical Considerations The study was approved by the ethical committee of the Kscien organization. The study adhered to the principles of the Declaration of Helsinki. Due to its retrospective nature, neither patient approval nor informed consent was required. Statistical analysis The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 27.0. Quantitative data were presented as means and standard deviations. Qualitative data were expressed as frequency and percentages. Results Among the nine cases, seven (77.8%) were female and two (22.2%) were male, with male-female ratio was 1:3.5. The mean age of patients was 60.78 ± 12.53 years. Clinically, anterior neck swelling was the most common presentation, observed in six cases (66.7%), while one case (11.1%) was on follow-up for preexisting thyroid conditions. The CT imaging revealed locally invasive thyroid masses involving the trachea, retrosternal space, or esophagus in three cases (33.3%), three cases (33.3%) had no available CT data. A history of prior thyroid surgery was noted in only one case (11.1%) (Table 1). Table 1. Clinical, Diagnostic, and Imaging Features of Patients. Cases Age (year) Gender PMH PSH Presentation Thyroid status Nodule location (Ultrasound) TI-RADS score CT scan PET scan Case 1 70 Female Hypothyroidism, Hypertension Thyroid surgery Follow Up Hypothyroid Right nodule TI-RADS 5 Right thyroid mass with tracheal invasion No abnormal metabolic activity, except in the thyroid gland Case 2 67 Male Type 2 diabetes mellitus, Colon cancer None Anterior neck swelling Euthyroid Bilateral nodule TI-RADS 5 Right thyroid mass with retrosternal extension, Suspicious left thyroid lesion No abnormal metabolically active lesion Case 3 79 Female Hypothyroidism, Atherosclerosis None Anterior neck swelling Hypothyroid Right nodule TI-RADS 5 Right thyroid mass with esophagus invasion No abnormal metabolically active lesion Case 4 62 Female Heart failure None Anterior neck swelling Euthyroid Bilateral nodule TI-RADS 3 Left lung focal ground glass appearance No abnormal metabolically active lesion Case 5 52 Female Hypertension None Anterior neck swelling Euthyroid Left nodule TI-RADS 4 NA No abnormal metabolically active lesion Case 6 47 Female Cerebrovascular accident None Anterior neck swelling Hyperthyroid Left nodule TI-RADS 5 Right thyroid mass NA Case 7 41 Female Systemic lupus erythematosus None Thyroid problem Hypothyroid Left nodule TI-RADS 2 NA No abnormal metabolically active lesion Case 8 72 Female Hydatid cyst None Thyroid problem Euthyroid Left nodule TI-RADS 5 Left thyroid nodule No abnormal metabolically active lesion Case 9 57 Male Negative None Anterior neck swelling NA Right nodule TI-RADS 4 NA No abnormal metabolically active lesion PMH: Past medical history, PSH: Past surgical history, NA: Not applicable, TI-RADS: Thyroid Imaging Reporting and Data Systems, CT: Computed tomography, PET: positron emission tomography Seven (77.8%) cases received R-CHOP chemotherapy, with six (66.7%) completing six
Source: Barw Medical Journal
Authors: Abdulwahid M. Salih, Aras J. Qaradakhy, Shaho F. Ahmed, Rebaz M. Ali, Hiwa O. Baba, Ari M. Abdullah, Imad J. Habibullah, Dana O. Kareem, Shko H. Hassan, Ayman M. Mustafa, Harun Amanj Ahmed, Abdullah A. Qadir, Rebaz O. Mohammed
Institution: University of Sulaimani
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4408957705