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The thyroid may be affected primarily or secondary to lymphoma elsewhere. This article is concerned with primary thyroid lymphoma.
Thyroid lymphoma accounts for <5% of thyroid malignancies and ~2.5% of extranodal lymphoma.
Thyroid lymphoma is rare with an incidence of 1-2 per 1,000,000. It typically presents between 50-70 years of age with a strong female predominance (M: F = 1:3).
Typically, it presents as a rapidly enlarging goiter with compressive symptoms and cervical lymphadenopathy common. B-type symptoms are uncommon (20%) and approximately half of patients are euthyroid.
The etiology of thyroid lymphoma is unclear. Hashimoto thyroiditis is a major risk factor (~60 times increased risk) but the development of thyroid lymphoma is still rare in this group.
The histological subtype of thyroid lymphoma is heterogeneous with diffuse large B cell lymphoma being the most common in one series. Hodgkin lymphoma affects the thyroid very rarely, non-Hodgkin lymphoma accounts for the vast majority of thyroid lymphoma cases 2 .
The radiographic features of thyroid lymphoma are nonspecific and similar to other primary thyroid malignancies and Hashimoto thyroiditis.
Three patterns have been described: nodular (hypoechoic mass), diffuse (mixed echotexture), or mixed 1,3. Calcifications are uncommon 4.
- goiter, which is hypodense to adjacent muscle
- heterogeneous enhancement but still less than adjacent muscle 3
- T1/T2: iso- to hyperintense
- pseudocapsule may be present 3
Treatment and prognosis
Prognosis is generally considered "excellent" for disease limited to the thyroid. Combination chemotherapy and radiation therapy is generally used with surgical excision less common 1,2,4.
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