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. 2025 Aug 16;16(1):1568.
doi: 10.1007/s12672-025-03218-3.

Diagnosis and treatment outcomes of primary lymphoma of the thyroid gland

Omar Hamdy  1 , Gehad A Saleh  2 , Ramadan Ayman Selim  3 , Radwa M Abdelsattar  3 , Maryam M Dawood  3 , Youssef Y Abbas  4 , Rana Abdo  3 , Yousef M Mansour  4 , Jana M AbuZahra  4 , Mohamed Elsayed  5 , Ahmed E Eladl  6 , Shaimaa El-Ashwah  7 , Mohamed Ezat  8
Affiliations

Diagnosis and treatment outcomes of primary lymphoma of the thyroid gland

Omar Hamdy et al. Discov Oncol. .

Abstract

Introduction: Primary thyroid lymphoma (PTL) is a rare extranodal malignancy accounting for less than 5% of thyroid cancer, with a unique algorithm of management in contrast to other types of thyroid cancer, where surgery is the cornerstone of management. PTL usually shows female predominance, and diffuse large B-cell lymphoma (DLBCL) is the most prevalent pathological subtype. In this study, we aimed to assess thyroid lymphoma's epidemiology, patterns of relapse, diagnostic approaches, and prognostic features, presenting a 16.5-year experience at a tertiary referral oncology center.

Methods: This retrospective study assessed PTL patients managed between January 2008 and June 2024 at a tertiary referral center. All the clinical, diagnostic, therapeutic, and follow-up data were analyzed.

Results: Sixteen patients were included, with a mean age of 59.34 years and a female-to-male ratio of 1.7. Most cases (68.8%) were diagnosed at stage II, with DLBCL identified in 93.8% of patients. Remission was achieved in half of the patients after first-line therapy, with no cures following second-line treatments. All the patients who died were stage II at the time of diagnosis. The median disease-free survival (DFS) was 35 months, and the overall survival (OS) was 37.5 months.

Conclusion: Being aware of PTL can facilitate the timely initiation of treatment. Chemotherapy is the definitive treatment, used alone or with surgery, if done for diagnostic purposes. PTL has a good prognosis, however, late-stage disease can be linked to worse outcomes. This study underscores the importance of multimodal diagnostic and therapeutic strategies while highlighting the need for further research into this rare malignancy.

Keywords: Chemotherapy; Thyroid lymphoma; Thyroid tumors; Thyroidectomy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The authors received IRB approval for the study from the medical research ethics committee at Mansoura University Faculty of Medicine under the number R.24.12.2962.This is a retrospective study. Consent for participation in the study is not applicable. All procedures performed in the study involving human participants followed the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent for publication: waived as per the policy of the medical research ethics committee at Mansoura University Faculty of Medicine. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CT scan of a case of PTL: A 66-year-old male with non-Hodgkin lymphoma (DLBC type) in the right thyroid lobe. Post-contrast CT neck axial (A & B) and reconstructed coronal (C) images revealed infiltrative hypo-enhancing right thyroid lobe mass (arrows) measures 5.5 × 3 × 9 cm, it’s seen inseparable from Rt sternomastoid muscle laterally, contacting both right common carotid artery (CCA), right internal jugular vein (IJV) without caliber changes and extending into post cricoid region posteromedially. No detected tracheal deviation. A small left thyroid hypodense nodule (asterisk) measures 1 cm. No detected suspicious cervical LNs
Fig. 2
Fig. 2
Baseline PET-CT of a patient PTL Axial post-contrast CT (A) and axial fused PET-CT (B&C) revealed metabolically avid diffuse left thyroid and isthmic lesion (stars) displacing left CCA and internal jugular vein laterally without vascular invasion (SUVmax 25). Small right thyroid lobe nodule with similar metabolic activity (long arrow). Few left level III cervical LNs, the largest of SUV max about 21 (short arrows). Coronal reformatted maximum intensity projection (MIP) image (D) confirms the absence of other metabolically active lesions
Fig. 3
Fig. 3
Follow-up PET-CT of the same patient with PTL Axial post-contrast CT (A), axial fused PET-CT (B) and coronal reformatted MIP image (C): complete metabolic remission mad morphologic resolution of all thyroid lesions and left cervical LNs with restoration of normal CT appearance and size of left thyroid lobe. Symmetrical intense FDG uptake in the paravertebral regions (short arrows), corresponding to fat areas without CT abnormalities compatible with activated brown adipose fat
Fig. 4
Fig. 4
Microscopic examination of a case of PTL (A) Effacement of thyroid architecture by diffuse infiltration of large transformed lymphocytic cells. Noted remnants of small, atrophied thyroid follicles at the side. (B) Atypical lymphocytic cells with large hyperchromatic nuclei and scanty cytoplasm, exhibiting a moderate degree of atypia. (C) Diffuse positive CD20 IHC reaction highlighting the large, atypical B-cell lymphocytes. (D) Negative CD3 IHC reaction in the large atypical lymphocytic cells, with scattered positive small reactive T-cell lymphocytes in the background. (E) Ki-67 IHC showing a high proliferation index
Fig. 5
Fig. 5
Kaplan-Meier curve of DFS
Fig. 6
Fig. 6
Kaplan-Meier curve of OS
See this image and copyright information in PMC

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