Journal of Cytology
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Year : 2007  |  Volume : 24  |  Issue : 3  |  Page : 140-141
Diagnostic fine needle aspiration cytology of primary thyroid lymphoma


1 Department of Pathology, T.N. Medical College and B.Y.L. Nair Hospital, Dr. A.L. Nair Road, Bombay Central, Mumbai- 400008, India
2 Tata Memorial Hospital, Mumbai, India

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   Abstract 

Primary thyroid lymphomas (PTL) are extremely uncommon neoplasms accounting for 5% of all thyroid malignancies. There are very few small series and occasional case reports of fine needle aspiration cytology (FNAC) of PTL in literature. We present an interesting and rare case of PTL diagnosed on FNAC. FNAC is an important tool in the diagnosis of thyroid lymphoma.

Keywords: Thyroid, lymphoma, FNAC.

How to cite this article:
Amonkar G, Jashnani K, Shet T, Naik L, Rege J. Diagnostic fine needle aspiration cytology of primary thyroid lymphoma. J Cytol 2007;24:140-1

How to cite this URL:
Amonkar G, Jashnani K, Shet T, Naik L, Rege J. Diagnostic fine needle aspiration cytology of primary thyroid lymphoma. J Cytol [serial online] 2007 [cited 2019 Sep 16];24:140-1. Available from: http://www.jcytol.org/text.asp?2007/24/3/140/41905



   Introduction Top


Primary thyroid lymphomas (PTL) are rare neoplasms accounting for 5% of all thyroid malignancies.[1] There are very few small series and occasional case reports of fine needle aspiration cytology (FNAC) of PTL in literature.[2],[3] We present an interesting and rare case of PTL diagnosed on FNAC. FNAC plays a very important role in the diagnosis of thyroid lymphoma. The two most important critical diagnoses in FNAC of thyroid are lymphoma and anaplastic carcinoma as these avoid unnecessary surgery.


   Case History Top


A 49 years old female presented with a thyroid swelling of 10 months duration. There was history of rapid increase in the size in the last 2 months. There was no history of previous radiation therapy. T 3 , T 4 and TSH levels were within normal limits. On local examination there was a 15x10 cm large firm, diffuse thyroid swelling. Ultrasonography showed picture suggestive of multinodular goitre. FNAC was carried out and wet fixed smears were stained by Papanicolaou (PAP) stain and air dried smear were stained by May­GrUnwald Giemsa stain. The smears showed sheets of atypical small and intermediate sized lymphoid cells [Figure 1]. Lymphoglandular bodies were also seen. There was absence of thyroid follicular cells, Hurthle cells and colloid. Patient had no lymphadenopathy clinically and on ultrasonography. Considering all these features the diagnosis of primary lymphoma of thyroid was made. Subsequently a gun biopsy of the thyroid mass was done for typing of the lymphoma [Figure 2]. The final diagnosis on histology and immunohistochemistry was high-grade non Hodgkin's B cell lymphoma (CD20 positive). The patient was started on chemotherapy. She responded to the therapy and there was regression of the thyroid mass. She was free of the tumour for 6 months after therapy.


   Discussion Top


Primary lymphomas of the thyroid gland are uncommon and comprise 5% of all thyroid malignancies. [1] They occur more commonly in the middle aged and elderly women. [1] Our case was a 49 years old female with a 15x10 cm neck mass which was rapidly growing in the last 2 months. They clinically present with a rapidly growing mass, dysphagia, stridor or change in voice. [1],[4] FNAC is a useful tool in the diagnosis of PTL. High grade lymphomas can be diagnosed easily on FNAC but the low grade lymphomas may be mistaken for chronic thyroiditis. [2],[4] In thyroiditis, a polymorphic mixed population of mature and transformed lymphocytes is seen. The presence of a monotonous population of large atypical lymphocytes or rarely small cells is seen in lymphoma. [5] In our case the  Pap smear More Detailss showed sheets of atypical small and intermediate sized lymphoid cells due to which we had difficulty but the Giemsa stained sections showed monotonous cell population. The changes in PAP smears could be attributed to fixation changes.

Most PTLs appear in the context of mucosal associated lymphoid tissue (MALT), and some of them are related to Hashimotos thyroiditis (HT). [1],[4],[5],[6]

The diagnostic difficulty on FNAC occurs when the aspirate consists of both neoplastic (lymphoma cells) and non-neoplastic (thyroiditis) elements. The other close differential diagnosis on FNAC is small cell analplastic carcinoma. Cell clustering, nuclear moulding and tear drop cells favour small cell anaplastic carcinoma. [4]

Most PTL are non Hodgkin's B cell lymphomas (small/large cells) or MALT lymphomas. [1],[4],[5],[6] T cell lymphomas are exceedingly rare. [1],[4],[5] Chemotherapy is the mainstay of treatment. Surgical debulking is done if the mass is very large and is causing mechanical discomfort. Radiotherapy is required in cases of recurrences and local spread. The 10 year survival rate is around 75%. [1],[4] They can show local recurrence, metastasis to soft tissue, lymph nodes and even to other MALT sites like GIT. [7]

FNAC plays an important role in the diagnosis of thyroid lymphoma, and it is imperative to use this as a diagnostic aid in these cases. The two most important critical diagnoses in FNAC of thyroid are lymphoma and anaplastic carcinoma. Proper evaluation of aspirates in these cases can avoid unnecessary surgery. As lymphoma of thyroid was diagnosed on FNAC in our case the patient received chemotherapy immediately and showed good response to the therapy. Surgical morbidity and mortality was prevented.

 
   References Top

1.Livolsi VA, Montone K, Sack M. Pathology of the thyroid gland. In: Sternberg SS, editor. Diagnostic surgical pathology. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 1999. p. 529-87.  Back to cited text no. 1    
2.Sangalli G, Serio G, Zampatli C, Lomuscio G, Columbo L. Fine needle aspiration cytology of primary lymphoma of the thyroid: a report of 17 cases. Cytopathology 2001; 12 : 257-63.  Back to cited text no. 2    
3.Venden Bruel A, Drijkoningen M, Oygen R, Vanflexteren E, Bouillon R. Diagnostic fine needle aspiration and immunohistochemistry analysis of a primary thyroid lymphoma presenting as an anatomic emergency. Thyroid 2002;12: 69-73.  Back to cited text no. 3    
4.Orell SR, Sterrett GF, Walters MN- I, Whitaker D. Manual and atlas of fine needle aspiration cytology. 3rd ed. Edinburgh: Churchill Livingstone; 1999. p. 109-44.  Back to cited text no. 4    
5.Lerma A, Arguplles R, Rigla M, et al. Comparative findings of lymphocytic thyroiditis and thyroid lymphoma. Acta Cytol 2003; 47 : 575-80.  Back to cited text no. 5    
6.Matsuzuka F, Mivauchi A, Katayama S, et al. Clinical aspects of primary thyroid lymphoma : diagnosis and treatment based on our experience of 19 cases. Thyroid 1993; 3 : 93-9.  Back to cited text no. 6    
7.Stone CW, Slease RB, Brubake D, Fabian C, Grozia PN. Thyroid lymphoma with gastrointestinal involvement: report of three cases. Am J Haematol 1996; 21: 357- 65.  Back to cited text no. 7    

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Correspondence Address:
G Amonkar
778, Homi Villa, Parsi Colony, Tilak Road, Dadar (E), Mumbai - 400 014, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.41905

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  [Figure 1], [Figure 2]

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