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Non Hodgkin’s Lymphoma And Thyroid Nodules

What Are The Causes Of Lymphoma Of Thyroid Gland

Hodgkinâs lymphoma | Hodgkinâs Disease | Reed-Sternberg Cell

Lymphocytes are a type of white blood cells that are responsible for providing immunity in the human body. B-cells and T-cells are the two different types of lymphocytes. When under certain circumstances, the lymphocytes grow and multiply abnormally, it leads to a condition called as lymphoma, which is a most common type of cancer. There are 2 types of lymphoma:

  • Hodgkin lymphoma
  • Non-Hodgkin lymphoma

The cause of Lymphoma of Thyroid Gland is unknown. There may be certain genetic defects, such as translocation, which is a juxtaposition of regions of the chromosomes, associated with the condition. This may result in:

  • Change of regulatory elements of certain cancer-causing genes called as oncogenes, which can lead to increased production of their mRNA , thus increasing their protein levels
  • Exchange of protein coding regions of gene, giving rise to new proteins that can stimulate the inappropriate growth of cells

It is believed that the abnormal development of lymphocytes gives rise to cancerous cells leading to the formation of this condition. Nevertheless, how this occurs and the factors that cause it remain under investigation.

What Causes Primary Thyroid Lymphoma

Primary thyroid lymphoma is more likely to occur in people who have Hashimotos thyroiditis , which is an autoimmune condition where the thyroid gland is infiltrated by lymphocytes. However, it is important to understand that, while Hashimotos thyroiditis is a common condition, thyroid lymphoma is rare, representing less than 5% of thyroid malignancies and less than2% of all lymphomas occurring outside of the lymph nodes. No other risk factors have been identified that cause thyroid lymphoma. Unlike other forms of thyroid cancer, exposure to radiation has not been clearly associated with thyroid lymphoma.

Thyroid lymphoma affects women more than men, and most commonly occurs between the ages of 65 to 75 years.

Symptoms From Lymphoma In The Abdomen

Lymphomas that start or grow in the abdomen can cause swelling or pain in the abdomen. This could be from lymph nodes or organs such as the spleen or liver enlarging, but it can also be caused by the build-up of large amounts of fluid.

An enlarged spleen might press on the stomach, which can cause a loss of appetite and feeling full after only a small meal.

Lymphomas in the stomach or intestines can cause abdominal pain, nausea, or vomiting.

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Q: What Is The Treatment And Prognosis Of This Condition

Non-Hodgkin’s lymphoma of the thyroid gland usually responds well to a combination of radiotherapy and chemotherapy or radiotherapy alone in localised stage 1 disease. The treatment of choice, however, is total thyroidectomy plus radiotherapy in patients where radical surgery is possible. Prognosis of this uncommon malignancy is usually good and much better than anaplastic thyroid carcinoma and hence every effort must be made to distinguish the two forms of malignancy.

Learning points

  • Primary non-Hodgkin’s lymphoma is an uncommon malignancy of the thyroid gland and is usually, although not invariably, preceded by Hashimoto’s thyroiditis.

  • It is very easily mistaken for anaplastic thyroid carcinoma on histology.

  • Immunohistochemical stains are very important in distinguishing between the two conditions as treatment and prognosis is entirely different.

  • Prognosis of this form of lymphoma is usually good as it responds well to radiotherapy and chemotherapy.

Symptoms From Lymphoma Affecting The Brain

Spectrum of CT Findings in Thoracic Extranodal Non

Lymphomas of the brain, called primary brain lymphomas, can cause headache, trouble thinking, weakness in parts of the body, personality changes, and sometimes seizures.

Other types of lymphoma can spread to the area around the brain and spinal cord. This can cause problems such as double vision, facial numbness, and trouble speaking.

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Signs And Symptoms Of Non

Non-Hodgkin lymphoma can cause many different signs and symptoms, depending on the type of lymphoma and where it is in the body. Sometimes it might not cause any symptoms until it grows quite large.

Having one or more symptoms doesnt mean you definitely have lymphoma. In fact, many of the symptoms listed here are more likely to be caused by other conditions, such as an infection. Still, if you have any of these symptoms, have them checked by a doctor so that the cause can be found and treated, if needed.

Some common signs and symptoms include:

  • Enlarged lymph nodes
  • Feeling full after only a small amount of food
  • Chest pain or pressure
  • Shortness of breath or cough
  • Severe or frequent infections

Some people with Non-Hodgkin lymphoma have what are known as B symptoms:

  • Fever without an infection
  • Drenching night sweats
  • Weight loss without trying

What Are The Signs And Symptoms Of Lymphoma Of Thyroid Gland

The signs and symptoms of Lymphoma of Thyroid Gland depend on whether it is a primary condition or a secondary condition. In a majority of primary lymphomas, if the tumor is small, it may be usually asymptomatic and the individuals will not have any significant symptoms. The symptoms also depend upon the extent of lymphoma involvement in other parts of the body.

The signs and symptoms of Lymphoma of Thyroid Gland may include:

  • Presence of a lump in the neck/throat that may be accompanied by pain
  • Hoarseness of voice voice fatigue
  • Tickling sensation in throat
  • Frequent infections
  • Low blood pressure

In case the condition spreads from the thyroid gland with the involvement of other organs, then the signs and symptoms may be based on the specific organs that are affected.

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How Is Lymphoma Of Thyroid Gland Treated

A combination of measures may be used to treat Lymphoma of Thyroid Gland. The treatment also depends upon the stage, overall health, age, and subtype of lymphoma.

  • Chemotherapy: This approach uses a combination of drugs to kill the cancerous cells and can be used in patients, for all stages of the tumor
  • There can be severe side effects including fatigue, nausea, hair loss, anemia, high risk of infection, and drug-specific reactions
  • Many lymphomas can be resistant to chemotherapy. It can also damage healthy cells
  • Chemotherapy can be administered as a pill, liquid, shot, or intravenously

Note: Men and women in child-bearing age would greatly benefit from counseling regarding fertility issues. Some chemotherapy agents can cause infertility in both men and women. There can be permanent damage to the testicles and ovaries, harming their ability to produce sperms or ova. In men, sperm banking can be considered before initiating therapy. In women, in many cases, due to urgency of starting chemotherapy, it is often difficult to perform ovum banking. However, if there is sufficient time prior to chemotherapy, ovum banking may be performed. The healthcare provider may help assess the risk-benefit analysis, depending upon each individualâs specific circumstances.

  • Undertaking treatment of underlying conditions/disorders, as warranted
  • Nowadays targeted therapies are being developed that can selectively kill the cancer cells. Many of them are in the stage of clinical trials
  • Histology Cytology And Cytogenetic Analysis

    Histopathology – Nodular Lymphocyte Predominant Hodgkin Lymphoma

    Tissue biopsies were submitted to routine histopathological evaluation, immunohistochemistry, and cytochemistry using a panel of monoclonal Ab and flow cytometry. The diagnosis of lymphoma was based on the more recent lymphoma classification . After 1993, tissue cytogenetic studies were systematically performed.

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    How Can Lymphoma Of Thyroid Gland Be Prevented

    Currently, it is not possible to prevent Lymphoma of Thyroid Gland. However, controlling certain factors may help lower oneâs risk for the condition.

    • Healthy diet and exercise, as well as avoidance of unnecessary exposure to chemicals, may help decrease its risk
    • Avoiding smoking
    • Undertaking appropriate and early treatment of any condition that affects the thyroid gland
    • Using appropriate protective gear while working with x-rays and other radioactive source
    • In order to avoid a relapse, or be prepared for a recurrence, the entire diagnosis, treatment process, drugs administered, etc. should be well-documented and follow-up measures initiated

    Regular medical screening at periodic intervals with blood tests, scans, and physical examinations, are mandatory. Often several years of active vigilance are crucial and necessary.

    What Are The Symptoms Of Primary Thyroid Lymphoma

    In thyroid lymphoma, the thyroid gland becomes enlarged and firm, which often causes difficulty swallowing, shortness of breath, and/or a hoarse voice. Patients often notice a rapidly enlarging mass in their neck, which may be tender. If the enlarged gland presses on the veins through which blood drains from the head, this can cause puffiness or swelling of the face. A minority of patients may also experience more generalized symptoms associated with lymphoma, such as fever, night sweats, and unintentional weight loss.

    Thyroid lymphoma can also cause hypothyroidism , or decreased production of thyroid hormone, due to infiltration of the normal thyroid gland. The symptoms of hypothyroidism include feeling slow or tired, feeling cold, dry skin, and constipation.

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    What Are The Risk Factors For Lymphoma Of Thyroid Gland

    No specific risk factors have been identified for Lymphoma of Thyroid Gland. However, the condition is known to be associated with the following factors:

    • Autoimmune disorders
    • Advanced age older individuals commonly have a higher risk
    • Individuals with weak immune system

    Besides the above, the following general factors may contribute towards lymphoma formation and development:

    • Family history of immune disease
    • The presence of any systemic disease
    • Profession involving radiation exposure, which may include nuclear plant workers, pilots, astronauts, etc.
    • Certain medications and drugs

    International Prognostic Index: According to some scientists, the International Prognostic Index may not be very helpful in evaluating Lymphoma of Thyroid Gland. However, some scientists believe that it is helpful in some cases, to determine the prognosis.

    The International Prognostic Index, for aggressive non-Hodgkin lymphoma, lists a few factors that determine the overall risk:

    • Age over 60 years
    • Elevated level of serum lactate dehydrogenase – LDH
    • Performance status, i.e. the overall health condition of the individual, which could range from being fully active to being completely disabled
    • Individual, who have already suffered from lymphoma, or other types of blood cancers, may have a relapse or a recurrence
    • Presence of an immunodeficiency syndrome, like AIDS, is a high risk factor
    • Those infected with Epstein-Barr virus are also prone to this lymphoma type

    How Is Lymphoma Of Thyroid Gland Diagnosed

    Thyroid Lymphoma as a Cause of Dysphagia and Dyspnea in a Patient ...

    Lymphoma of Thyroid Gland diagnosis is generally performed by obtaining biopsy samples from the affected region and examining them under a microscope to detect the cancerous cells. There are other tests and procedures that could help in the diagnosis and these include:

    • A thorough physical examination and a complete medical history, which is very important
    • Examination by an ENT specialist
    • Blood tests that may include:
    • Complete blood cell count blood test
    • Absolute lymphocyte count on peripheral blood
    • Liver function blood test
    • Lactate dehydrogenase blood test
  • Tissue biopsy from the thyroid gland:
  • A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
  • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
  • Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, flow cytometric analysis and very rarely, electron microscopic studies, to assist in the diagnosis
  • The biopsy may be performed through any of the following procedures:
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    Clinical Characteristics Of The Patients

    The clinical characteristics of the patients are shown in . The median follow-up for patients was 4.6 yr . Twenty-three patients were female. The median age at diagnosis was 59 yr . Eighty-seven percent of the patients presented with a rapidly growing nodular goiter , with clinical consequences such as pressure symptoms in the neck or pain and, rarely, dysphagia and/or dyspnea. Two thirds of the patients were hypothyroid with a high level of TSH . At diagnosis, 81% of the patients had a performance status less than 2 and did not have any clinical symptoms related to lymphoma. Half of the patients had localized disease. Levels of LDH and 2-microglobulin were elevated in only four and five patients, respectively. A monoclonal component was detected in two patients, one with an IgG and the other with an IgG .

    Response To Treatment And Progression Of The Disease

    Complete remission in response to treatment was achieved in 19 of the 25 available patients. Three of them, 1 with a follicular lymphoma, 1 with a DLCL, and 1 with Hodgkins disease, relapsed at 10 yr, 6 months, and 22 yr, respectively. None of the patients with MALT lymphoma treated with surgery alone relapsed after complete remission. Partial remission was obtained in 6 patients, 5 with DLCL and 1 with follicular lymphoma. Progression of the disease occurred in all of these patients in a median time of 5 months .

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    Neck Lumps With Enlarged Lymph Nodes: Papillary Thyroid Cancer And Hodgkin Lymphoma

    Shitong Su, RuijieLiu, Yongbin Hu, Guanghui Gong, Wei Zhu, Kuansong Wang

    Departmentof Pathology, Xiangya Hospital, Central South University, China

    *Corresponding author: Kuansong Wang,Department of Pathology, Xiangya Hospital, Central South University, #87,Xiangya Road, Changsha, Hunan, China. Email:

    ReceivedDate: 15December, 2018 Accepted Date: 04January, 2019 11January, 2019

    Citation: Su S, Liu R, Hu Y, Gong G, Zhu W, Wang K Neck Lumps with Enlarged Lymph Nodes: Papillary Thyroid Cancer and Hodgkin Lymphoma. Ann Case Rep: ACRT-211. DOI: 10.29011/2574-7754/100211

    1. Abstract

    We describe a clinical commonsymptom, as the title suggest, growing rapidly neck lumps and multiple enlargedlymph nodes in a patient. The neck ultrasound and computed tomography revealedthyroid solid nodules with neck multiple enlarged lymph nodes. Bycytopathology, right papillary thyroid cancer and left nodular goiter werediagnosed, lymphatic metastasis was considered, because some atypical cellswere found. Which is your first consideration for it? We report a very rarecase: synchronous papillary thyroid cancer and Hodgkin lymphoma that is achallenging case for clinical diagnosis before surgical pathology practice.

    2. Keywords:Hodgkin Lymphoma LymphaticMetastasis Neck Lumps Neck Enlarged Lymph Nodes,Papillary Thyroid Cancer

    1. Introduction

    2. CaseReport

    3. Discussion

    5. FinancialDisclosure: The authors have no funding or financial support to disclose.

    What Are The Possible Complications Of Lymphoma Of Thyroid Gland

    My Cancer Story- Thyroid and Hodgkins Lymphoma

    The complications due to Lymphoma of Thyroid Gland may include:

    • Involvement of local and distant organs: It can lead to systemic or disseminated disease in some cases
    • Loss of function of the organ/area to which cancer has spread due to systemic involvement
    • Changes in oneâs voice
    • Respiratory distress in rare cases
    • Weakened immune system can be a complication, which can become more severe during treatment. Due to this, individuals are more vulnerable to infections there is an increased risk of developing serious complications from such infections
    • Occasionally, the tumor can transform into a more aggressive form or subtype of lymphoma

    There may be complications related to chemotherapy used in treating the condition, which may include:

    • Side effects such as dizziness, vomiting, appetite loss, mouth ulcers, and hair loss
    • The treatment can also cause infertility in men and women. Hence, measures to protect the individualâs fertility must be considered, before starting chemotherapy

    The treatment measures can also give rise to secondary cancers, such as skin cancer.

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    The Risk Of Developing Lymphoma Among Autoimmune Thyroid Disorder Patients: A Cross

    Mubarak Al-MansourSyed Sameer Aga


    1. Introduction

    The thyroid gland is an essential endocrine organ that produces triiodothyronine and thyroxine or thyroid hormones . These hormones regulate basal metabolic rate, cardiac output, normal growth, and nerve development . Thus, any disorder affecting the thyroid gland can have major effects on the human system, such as autoimmune thyroid disease . Graves disease and Hashimotos thyroiditis are the two most frequent types of AITD, and both diseases are characterized by lymphocyte infiltration in the thyroid gland .

    In HT, an autoreactive T helper cell initiates the disease by activating cytotoxic T and B cells . Thyroid peroxidase and thyroglobulin antibodies are produced by this activation, resulting in the destruction of follicular cells and hypothyroidism . In GD, CD4+ cells activate B lymphocytes, causing them to produce self-antibodies known as thyroid-stimulating immunoglobulin , which mimics the effect of thyroid-stimulating hormone, increasing the production of thyroid hormones, leading to hyperthyroidism .

    Most studies on the association between AITD and PLT involve case series and case reports however, large-scale retrospective or cross-sectional studies are limited. To the best of our knowledge, no study from Saudi Arabia has explored or assessed the prevalence and association between the two diseases.

    2. Materials and Methods

    2.1. Statistical Analysis

    3. Results

    3.1. Patients Characteristics


    Q: What Other Investigations Would You Consider

    Peak expiratory flow measurement would give an objective assessment of tracheal stenosis by demonstrating extrathoracic airways obstruction.

    Computed tomography of the neck was also carried out and revealed a heterogenous mass lesion arising from the left lobe of the thyroid gland surrounding the trachea, left common carotid artery, and extending retrosternally with patchy contrast enhancement. There was no evidence of lymphadenopathy. The tumour was far too advanced for a thyroidectomy and hence only an open biopsy and tracheostomy could be performed .

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    Types Of Thyroid Nodules & Cancers

    The thyroid is a small, butterfly-shaped gland located in the neck, in front of the trachea, or windpipe, the tube through which air passes to the lungs. The thyroid consists of two lobes connected by a thin tissue called the isthmus. The gland produces thyroid hormones, which regulate metabolismthe conversion of food to energy.

    The thyroid takes the mineral iodinefound in table salt, seafood, and dairy productsfrom the bloodstream and uses it to produce the thyroid hormones thyroxine and triiodothyronine .

    T3 helps regulate your heart rate. It also controls your metabolismthe speed with which food is digested and glucose, or sugar, is produced and used in the body. T4 plays the same role, but its more powerful and acts more rapidly.

    The thyroid produces T4 and T3 after the pituitary gland, a small organ at the base of the brain, releases a hormone called thyroid-stimulating hormone, or TSH. When thyroid hormone levels are low, the pituitary releases more TSH. When thyroid hormone levels are high, TSH levels are suppressed.

    NYU Langone doctors treat many types of conditions affecting the thyroid and can identify benign thyroid tumors, known as nodules, and thyroid cancers.

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