Thyroid Lymphoma

• • Often history of hypothyroidism, specifically Hashimoto thyroiditis

Epidemiology

• • 2.2-2.6% of all cases of non-Hodgkin lymphoma

  • Incidence of 0.5-1/100,000

  • Approximately 2% of all thyroid malignancies

  • Strong female prevalence

  • Median age of onset is late seventh decade

  • Hashimoto thyroiditis is frequent precursor

  • Vast majority are B-cell type

  • 42-60% of patients present with stage IE disease

Symptoms and Signs

• • Rapidly enlarging neck mass

  • Hoarseness

  • Stridor

  • Dysphagia, odynophagia

  • Thyroid is firm and fixed

Rule Out

• • Anaplastic thyroid carcinoma

• • History and physical exam

  • Needle biopsy or open biopsy

  • Full staging with neck, chest, abdomen, and pelvis CT

• • Little role for surgical therapy except for incisional biopsy

  • Multiple agent chemotherapy and radiation therapy

  • Radiation therapy can abrogate airway compromise

Surgery

Indications

• • Tracheostomy if airway compromise

Medications

• • Multiple agent chemotherapy

Prognosis

• • Poor; predicted by dysphagia, hoarseness, initial tumor size > 10 cm, and stage at presentation beyond IE

  • 5-year survival for stage IE is 80%

  • 5-year survival for stage IIE is 50%

Practice Guidelines

• • The National Comprehensive Cancer Network

  • http://www.NCCN.org/