J Korean Soc Endocrinol.  2005 Jun;20(3):268-272. 10.3803/jkes.2005.20.3.268.

A Case of Thyroid MALT Lymphoma without Autoimmune Thyroiditis

• Kong ON
• Joo SH
• Shin SH
• Na MA
• An JH
• Kang YH
• Park DY
• Son SM
• Kim IJ
• Kim YK

• KMID: 2200567
• DOI: http://doi.org/10.3803/jkes.2005.20.3.268

Abstract

A primary thyroid lymphoma is rare among all types of thyroid malignancy. Usually, a thyroid lymphoma is associated with underlying chronic autoimmune thyroiditis. Recently, we experienced a primary thyroid mucosa-associated lymphoid tissue(MALT) lymphoma, with an incidental micropapillary thyroid carcinoma, but lacking evidence of autoimmune thyroiditis. A female patient visited our hospital for further evaluation of a rapidly enlarging, painless thyroid mass which had been stable for 8 years. Lymphocytic thyroiditis or a lymphoma was suspected from fine needle aspiration performed at another hospital. The thyroid function test and other routine laboratory tests were normal. The histopathological findings after a total thyroidectomy revealed a MALT lymphoma with a micropapillary thyroid carcinoma. There was no evidence of chronic autoimmune thyroiditis. This is, to the best of our knowledge, the first case report of a MALT lymphoma arising from the thyroid gland without evidence of chronic autoimmune thyroiditis in Korea

MeSH Terms

Biopsy, Fine-Needle
Female
Humans
Korea
Lymphoma
Lymphoma, B-Cell, Marginal Zone*
Thyroid Function Tests
Thyroid Gland*
Thyroid Neoplasms
Thyroidectomy
Thyroiditis, Autoimmune*

Figure

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  Fig. 1 Computed tomography of the neck shows soft tissue mass in isthmus of thyroid gland (arrow)

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  Fig. 2 Sections from thyroid gland showing proliferation of multiple lymphoid follicles with intervening thyroid follicular epithelial cells (H-E, ×40)

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  Fig. 3 Atypical lymphoid cells infiltrating thyroid follicular cells, so-called lymphoepithelial lesions are seen (H-E, ×200)

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  Fig. 4 Atypical lymphoid cells are positive for CD20 (IHC, ×200)

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  Fig. 5 Sections from thyroid gland showing typical histologic features of papillary carcinoma (H-E, ×100)

Reference

1. Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J, Lister TA, Bloomfield CD. The World Health Organization classification of neoplastic disease of the hematopoietic and lymphoid tissue: Report of the Clinical Advisory Committee Meeting, Airlie House, Virginia, November 1997. Histopathology. 2000. 36:69–86.

2. Cavalli F, Isaacson PG, Gascoyne RD, Zucca E. MALT lymphomas. Hematology. 2001. 1:241–258.

3. Ansell SM, Grant CS, Habermann TM. Primary thyroid lymphoma. Semin Oncol. 1999. 26:316–323.

4. Sasai K, Yamabe H, Haga H, Tsutsui K, Dodo Y, Ishigaki T, Shibamoto Y, Abe M. Non-Hodgkin's lymphoma of the thyroid. A clinical study of twenty-two cases. Acta Oncol. 1996. 35:457–462.

5. Matsuzuka F, Miyauchi A, Katayama S, Narabayashi I, Ikeda H, Kuma K, Sugawara M. Clinical aspects of primary thyroid lymphoma: diagnosis and treatment based on our experience of 119 cases. Thyroid. 1993. 3:93–99.

6. Williams R. Williams textbook of endocrinology. 2002. 10th ed. Philadelphia: WB Saunders Co;477.

7. Anscombe AM, Wright DH. Primary malignant lymphoma of the thyroid-a tumour of mucosa-associated lymphoid tissue: review of seventy-six cases. Histopatholoy. 1985. 9:81–97.

8. Hykek E, Isaacson PG. Primary B cell lymphoma of the thyroid and its relationship to Hashimoto's thyroiditis. Hum Pathol. 1988. 19:1315–1326.

9. Isaacson PG, Wright DH. Malignant lymphoma of mucosa-associated lymphoid tissue. A distinctive type of B cell lymphoma. Cancer. 1983. 52:1410–1416.

10. Harris NL, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML, Delsol G, De Wolf-Peeters C, Falini B, Gatter KC. A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood. 1994. 84:1361–1392.

11. Derringer GA, Thompson LD, Frommelt RA, Bijwaard KE, Heffess CS, Abbondanzo SL. Malignant lymphoma of the thyroid gland: a clinicopathologic study of 108 cases. Am J Surg Pathol. 2000. 24:623–639.

12. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison's principles of internal medicine. 2004. 16th ed. McGraw-Hill;649–650.

13. Wirtzfeld DA, Winston JS, Hicks WL Jr, Loree TR. Clinical presentation and treatment of non-Hodgkin's lymphoma of the thyroid gland. Ann Surg Oncol. 2001. 8:338–341.

16. Wozniak R, Beckwith L, Ratech H, Surks MI. Malt oma of the thyroid in a man with Hashimoto's thyroiditis. J Clin Endocrinol Metab. 1999. 84:1206–1209.

17. Laing RW, Hoskin P, Hudson BV, Hudson GV, Harmer C, Bennett MH, MacLennan KA. The significance of MALT histology in thyroid lymphoma: a review of patients from the BNLI and Royal Marsden Hospital. Clin Oncol (R Coll Radiol). 1994. 6:300–304.