TITLE:
The Role of Surgery in Primary Thyroid Lymphoma: Experience in the Last 10 Years of a Specialized Unit
AUTHORS:
Raquel Alfonso-Ballester, María José Terol Castera, Omar García Rodríguez, Carolina Martínez Ciarpaglini, Marta Maia Boscá-Watts, Norberto Cassinello Fernández, Joaquín Ortega Serrano
KEYWORDS:
Thyroid, Lymphoma, Thyroidectomy, Endocrine Surgery, Extranodal Lymphoma, Malt Lymphoma, Rituximab
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.7 No.13,
December
23,
2016
ABSTRACT: Primary
Thyroid Lymphoma (PTL) is an uncommon disease, although its incidence is of 5%.
Ultrasound and Fine Needle Aspiration Cytology (FNAC) usually do not provide
the diagnosis. Surgery is one of the treatment options because it enables histological
diagnosis and can also relieve compression symptoms in patients with rapid
growth cervical mass. We present 7 cases of PTL diagnosed in the last 10 years
in our unit. Five were female (71.4%) and 2 were male (28.6%). The mean age was
64.2 (range: 40 - 81); 4 patients (57.1%) had associated Hashimoto’s
Thyroiditis (HT). One patient (14.2%) had concomitant Graves disease. 5 cases
presented with compressive symptoms and cervical mass. Ultrasound was not
diagnostic in any case. FNAC was diagnostic only in one patient (14.3%). Five
patients underwent total thyroidectomy (71.4%). All the cases were diagnosed
with lymphoma postoperatively. Two interventions consisted of left
hemithyroidectomies (28.6%). No complications appeared. 5 patients (71.4%) were
classified as Mucosa-Associated
Lymphoid Tissue (MALT) lymphoma. We also observed 1 Follicular grade I lymphoma
and 1 Burkitt case. When the extension study was done, 1 patient was at stage
IIIE (14%), 2 at IIE (28.5%) and 4 at IE (57.14%). Rituximab, cyclophosphamide, doxorubicin, vincristine and
prednisone (R-CHOP) and Iphosphamide, ethoposide and high dose Cytarabine (IVAC) were the treatment scheme
when chemotherapy was used (in three cases).
Two cases were treated only with total thyroidectomy, and 2 with
total thyroidectomy and rituximab, and the latter was MALT. Complete Remission (CR) was achieved in all
patients in the first year. All are still alive and in CR. In our experience,
PTL diagnose can be challenging before surgery. Although surgery is not the
gold standard for treatment, when it is done, it should be curative in MALT lymphomas confined to
the thyroid.