Hodgkin's lymphoma of the thyroid: a clinicopathologic study of five cases and review of the literature

Variability in primary thyroid lymphoma: A clinicopathological exploration of diffuse large B-cell, marginal zone, and follicular lymphoma

Primary thyroid lymphoma (PTL) is a rare condition, posing significant diagnostic challenges due to limited incidence and data. However timely and accurate diagnosis is crucial for effective management. This study aims to analyze the clinicopathological features of PTL cases observed over 15 years at a tertiary national referral hospital. PTL cases from 2009 to 2023 at Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital archives were retrospectively analyzed, with an assessment of clinical data, histopathological, and immunohistochemistry analysis. Statistical analysis was conducted using Chi-Square and Kruskal Wallis. Women constituted the majority of cases (male-to-female ratio was 1: 2.6), with a median patient age of 55 years. Of the 40 identified PTL cases, only one was a T-cell lymphoma among the non-Hodgkin lymphomas (NHL). The NHL subtypes included diffuse large B-cell lymphoma (DLBCL [72.5 %]), marginal zone lymphoma (15.0 %), and follicular lymphoma (FL [10.0 %]). An enlarged neck mass (94.7 %) was the most frequent symptom, and 42.1 % had a history of Hashimoto's thyroiditis. The overall surviving proportion in the present study is 80.7 %, with the median survival duration of 14.5 months, ranging from 1 to 54 months. The longest duration of survival documented in FL case and the shortest in DLBCL case. Lymphoepithelial lesions could be found in all lymphoma types. The main diagnostic and treatment modality used was surgery. Prompt diagnosis and personalized treatment approaches are important to improve survival outcomes. PTL should be anticipated in middle-aged women with rapid enlarged neck mass and a history of Hashimoto's thyroiditis.

Comparison of Fine-Needle Aspiration Cytopathology with Histopathological Examination of the Thyroid Gland in Patients Undergoing Elective Thyroid Surgery: Do We Still Need Fine-Needle Aspiration Cytopathology?

BACKGROUND

The thyroid gland is responsible for various functions, but it is susceptible to pathologies. The gold standard for preliminarily diagnosing thyroid abnormalities is fine-needle aspiration cytology (FNAC), although it has some limitations; thus, postoperative histopathological examination confirms the diagnosis. The aim of the present study was to compare preoperative FNAC results with postoperative histopathological examination.

METHODS

This study is a retrospective study based on FNAC and postoperative histopathology examination, which were compared and analyzed.

RESULTS

This study included 344 patients between 18 and 86 years old (mean age: 53.06 ± 13.89), comprising 274 females and 70 males (mean ages 52.72 ± 13.86 and 54.39 ± 14.05, respectively) with a 3.9:1 female-to-male ratio. Statistical significance between the FNAC and histopathology results was observed (p = 0.0000), and 86 (25.00%) patients were found to have been diagnosed incorrectly based on FNAC. The sensitivity of FNAC was 92.31%, and its specificity was 82.08%, with positive and negative predictive values of 68.57% and 96.08%, respectively.

CONCLUSIONS

Due to many factors, FNAC may lead to over- or under-diagnosis, increasing the chances of complications associated with the selected treatment. However, we do not have any other more accurate tools; therefore, FNAC should still remain as the gold standard of preliminary examination.

Utility of F-18 Fluorodeoxyglucose Positron Emission Tomography - Computed Tomography in Primary Thyroid Lymphoma

Primary thyroid lymphoma (PTL) is an uncommon malignancy. The majority of PTLs are non-Hodgkin's lymphoma. Fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) is the state-of-the-art imaging in lymphoma and plays a pivotal role in staging, follow-up, and treatment decisions. There is good evidence that it performs well in a wide variety of nodal and extranodal lymphomas (ENL). However, the data are scarce on its usefulness in rare ENL. Herein, we describe four cases of PTLs and a brief review of the literature. FDG PET/CT was performed at baseline to assess the disease status and response to treatment. This case series highlights the varied appearance of PTL and response to treatment. It establishes the importance of FDG PET/CT in the personalized management of PTL.

A diffuse large B-cell thyroid lymphoma presented as a compressive goiter in a young woman with no evidence of Hashimoto's thyroiditis

Thyroid lymphoma should be suspected in case of rapid enlargement of the thyroid gland even in a young patient with no history of Hashimoto thyroiditis. The confirmation is based on histopathology and immunohistochemistry.

Hodgkin lymphoma involving extranodal sites in head and neck: report of twenty-nine cases and review of three-hundred and fifty-seven cases

INTRODUCTION

Hodgkin lymphoma (HL) involving the Waldeyer's ring (WR) and other extranodal head and neck sites are rare. We report our experience and PubMed literature review.

METHODS

Retrospective single institution cohort study using lymphoma data base and PubMed literature search using twenty-six various search terms.

RESULTS

Twenty-nine patients were treated in our institution (1975-2018). Male:Female 22:7, median age at diagnosis 33 years (15-64), stages I-II:III-IV 25:4. Sites were nasopharynx (10), tonsil (9), parotid (5), mandible (2) and others (3). 20/29 patients received radiation therapy, 22/29 received chemotherapy. Ten years overall-survival and progression-free survival are 92% and 66% respectively. PubMed search showed 8766 citations and identified 357 patients including our patients. Male:Female 199:131, median age 45 years (5-89). Stages I-II in 286 (80%). Involvement was nasopharynx 109 (30.5%), tonsil 67 (18.8%), parotid 58 (16.2%), thyroid 45 (12.6%), adenoid 10 (2.8%), mandible 10 (2.8%) and others in 58 (16.2%). Pathology: mixed cellularity 99 (27.7%), nodular sclerosis 88 (24.6%), nodular lymphocyte-predominant 56 (15.7%), lymphocyte rich 25 (7%), classical-HL-not otherwise specified 16 (4.5%) and lymphocyte depleted 7 (2%) patients. Treatment details are available for 233 patients; 165 (46%) received radiation therapy, 137 (38%) chemotherapy. Complete remission in 208 (58%), progressive disease 14 (4%), no information 135 (38%). Overall, treatment failure in 54 (15%). Thirty (8.4%) have died; 21 disease related. KM overall-survival at 5 and 10 years was 88.5% and 77.6% respectively.

CONCLUSION

This largest report showed that HL involving extranodal head and neck sites is not very uncommon and has excellent prognosis.

Non-Hodgkin lymphoma of the thyroid in a patient with hyperthyroidism

Primary thyroid lymphoma is incredibly rare with an annual incidence of approximately 2.1 per million persons, accounting for 2% of thyroid malignancies. One of the only known risk factors is autoimmune thyroid disease, specifically Hashimoto’s, although there have been a few cases of thyroid lymphoma associated with Graves’ disease.

Here, we present one such case of a patient with pre-existing hyperthyroidism who developed non-Hodgkin’s lymphoma of the thyroid. The patient initially presented with rapidly progressing right-sided neck swelling. He was clinically and biochemically euthyroid with negative thyroid stimulating immunoglobulin, maintained on methimazole. Biopsy of the thyroid nodule with flow cytometry revealed non-Hodgkin lymphoma. Intervention included radiation therapy.

The diagnosis of primary thyroid lymphoma by fine-needle aspiration, cell block, and immunohistochemistry technique

AIM

Primary thyroid lymphoma (PTL) is a rare malignant disease. Its prognosis depends on early diagnosis. The role of fine-needle aspiration (FNA), including smear cytology, cell block (CB) techniques, and immunohistochemistry (IHC) sections in the diagnosis of PTL is still unclear. Here we reported 19 cases of PTL and literature review to evaluate the diagnostic accuracy for lymphoma by cytology.

METHODS

Our study retrospectively reviewed 19 patients diagnosed with PTL at the affiliated hospital of Southwest Medical University in China from June 2011 to May 2019. According to the Bethesda system for reporting thyroid cytopathology, the CB sections were evaluated for the presence of single tumor cells. IHC was performed on CB.

RESULTS

The diagnostic accuracy for PTL of FNA, CB with smears, and the joint application of the three methods (FNA + CB + IHC) of our study with 19 cases was 68.4% (13/19), 83.3% (15/18), and 100% (17/17), respectively.

CONCLUSION

The present study demonstrates that FNA has low sensitivity in diagnosing PTL, but the joint application of FNA, CB, and IHC might provide high diagnostic accuracy for lymphoma and should be applied in all cases where the clinical suspicion is high regardless of the FNA findings.

Thyroid lymphoproliferative lesions in Asia

Primary thyroid lymphomas (PTLs) are rare and most commonly present as rapidly enlarging thyroid mass causing obstructive symptoms. Due to worldwide differences in clinical practices related to thyroid malignancy, this review was conducted to compare the clinicopathological and diagnostic modalities related to PTL and their similarities and differences between the Asian and Western countries. Using the search engine PubMed, published data on thyroid lymphomas was collected and reviewed. A total of 18 Asian and 22 Western studies were included. Most of PTLs were B-cell Non-Hodgkin lymphomas (NHL). While mucosa-associated lymphoid tissue (MALT) lymphoma was the commonest (41.1%) among Asians, diffuse large B cell lymphoma (DLBCL) (71.9%) predominated in the Western population. Some rare subtypes of PTL were also identified. Majority of all patients in Asian as well as Western studies presented with early stage (stage I/II) disease. Interestingly, when compared with Asian patients, a larger proportion of patients from the West presented with higher stage (stage III/IV) disease (12.2% vs. 3%). Ultrasonography (USG) and fine needle aspiration cytology (FNAC) in addition to histological examination usually by core needle biopsy and in some by open procedures were used for the diagnosis of PTL in both the cohorts. The various ancillary techniques used were immunocytochemistry (ICC), flowcytometry (FC), immunohistochemistry (IHC), and molecular testing. The use of ancillary techniques for PTL diagnosis was more common in the West compared to Asia and markedly increased the sensitivity of cytology to diagnose PTL. Treatment and prognosis largely depend upon the subtype of PTL and stage at presentation. To conclude, from the available published literature, there is an apparent difference between Asian and Western cohorts in the histological type and stage of presentation of PTL, but the results may be affected by publication and selection bias. Also, advanced ancillary techniques are more commonly adopted in the West.

Ultrasonography in the Diagnosis and Monitoring of Therapy for Primary Thyroid Lymphoma

This study aims to evaluate the value of ultrasonography in the diagnosis, treatment, and follow-up of primary thyroid lymphoma. The clinical data of 12 patients, who were pathologically confirmed with thyroid lymphoma and treated in our hospital, were retrospectively analyzed. Ultrasonography was performed on the thyroid and neck lymph nodes, and the sonographic features of the lesions were recorded. During the course of the diagnosis and treatment of lymphoma, the patients were monitored and followed up by ultrasonography. The sonographic features of 12 patients with 20 lesions revealed hypoechoic masses, within which "strip-shaped" and "grid-shaped" high echoes were observed, and echoes behind masses were not attenuated. Furthermore, a small amount of blood flow signals were observed. Six patients received thyroidectomy. Among these patients, one patient relapsed. Six patients underwent chemotherapy. Among these patients, 2 patients relapsed and received chemotherapy again. Ultrasound can guide the biopsy of suspicious lymphoma lesions and provide accurate information on treatment effects and tumor recurrence for patients with thyroid lymphoma after treatment, especially after chemotherapy.

Clinical features associated with high pathological grade in primary thyroid lymphoma

This study aimed to identify clinical features associated with high pathological grade (HG) in primary thyroid lymphoma (PTL), through a systematic review and meta-analysis. Electronic databases were searched for studies assessing PTL. Extracted data were age, sex, lymph node involvement, symptoms, lymphocytic thyroiditis, serum tumor markers; the association with HG was assessed by using odds ratio (OR), with a significant p-value<0.05. Twenty-four studies with 1916 PTLs were included. HG was significantly associated with age≤55 (OR = 0.54; p < 0.0001); female sex (OR = 1.31; p = 0.02), lymph node involvement (OR = 2.23; p < 0.00001), compressive symptoms (OR = 2.61; p < 0.0001), absence of lymphocytic thyroiditis (OR = 0.45; p = 0.0002), and increased LDH levels (OR = 4.90; p < 0.00001), but not with age>60 (OR = 0.74; p = 0.24), age>70 (OR = 1.16; p = 0.66), and B symptoms (OR = 1.30; p = 0.54). In conclusion, Age≤55, female sex, lymph node involvement, compressive symptoms and absence of lymphocytic thyroiditis may be predictive factors for HG in PTL. On the other hand, B symptoms does not seem to be associated with pathological grade.

[A retrospective analysis of 12 cases of primary thyroid lymphoma]

OBJECTIVE

To discuss the clinical characteristics and diagnostic and therapeutic considerations of primary thyroid lymphoma (PTL) by reviewing PTL cases.

METHODS

In the study, 12 cases of PTL diagnosed and treated in Peking University First Hospital between January 1995 and September 2015 were identified. The clinical characteristics, management experiences and prognosis of these cases were reviewed retrospectively.

RESULTS

A total of 12 PTL patients (four males and eight females) were collected, with an average age of 63 years (42 to 81 years) at the time of diagnosis. The average time to clarify diagnosis was 5 months (0.5 to 24 months). Eleven patients presented with a rapidly growing neck mass and visited surgical department, except one complained of coughing and suffocated. Seven patients were hypothyroid, and four were euthyroid at the time of diagnosis. In sonography of 11 cases, nine showed bilateral nodules, with an average diameter of 3.87 cm. Pathologic diagnosis of non-Hodgkin's lymphoma was confirmed in all the 12 cases by means of partial thyroidectomy (four) or core needle biopsy (eight). The pathological subtypes were diffuse large B cell lymphoma in nine patients, mucosa-associated lymphoid tissue lymphoma (MALToma) in two, and small B cell lymphoma in the other one patient. Five patients were concomitant with Hashimoto's thyroiditis. Eleven patients received chemotherapy. Only one patient did not have any further treatment after operation due to an inertia type of tumor. The median overall survival time was 24 months (1-117 months), three patients died. Among the patients who survived, seven completed chemotherapy without disease progression, one MALToma case did not receive chemotherapy after thyroidectomy but was still alive with PTL, and one patient just finished his second course of chemotherapy.

CONCLUSION

The diagnosis of PTL should be considered when dealing with rapidly growing goiters in elder female Hashimoto's thyroiditis patients whose B ultrasound indicates hypoechogenicity in thyroid nodules or parenchyma, especially with lymphadenopathy and tracheal compressions. Timely use of coreneedle biopsy on suspicious cases can avoid unnecessary surgical trauma, and chemotherapy is the main treatment.

A review on the dosimetrical and radiobiological prediction of radiation-induced hypothyroidism in radiation therapy of head-and-neck cancer, breast cancer, and Hodgkin’s lymphoma survivors

A review on the radiobiological modeling of radiation-induced hypothyroidism after radiation therapy of head-and-neck cancers, breast cancer, and Hodgkin’s lymphoma is presented. The current review is based on data relating to dose-volume constrains and normal tissue complication probability (NTCP) as a function of either radiobiological or (pre)treatment-clinical parameters. Also, these data were explored in order to provide more helpful criteria for radiobiological optimization of treatment plans involving thyroid gland as a critical normal organ.

[Primary hodgkin lymphoma of thyroid: case report]

Les lymphomes thyroïdiens primitifs sont une entité clinique rare, qui ne dépassent pas 5% des lymphomes diagnostiqués, se produisent plus fréquemment chez les femmes que chez les hommes, avec un pic d'incidence à la sixième décennie de la vie. La relation avec une thyroïdite chronique est bien connue. Le sous type hodgkinien, encore plus rare, peu décrit dans la littérature; posant un problème diagnostique. La confirmation diagnostique est portée le plus souvent sur la pièce opératoire. Pour mieux comprendre cette entité, nous rapportons le cas d'un patient de 64 ans, sans notion de thyroïdite chronique, admis pour un lymphome de Hodgkin de la thyroïde, diagnostiqué sur une masse cervicale antérieure. La thyroïdectomie avec études histopathologique et d'immunohistochimique avaient confirmé le diagnostic. Le patient avait reçu une chimiothérapie de type ABVD (Adriblastine-Bléomycine-Vinblastine-Dacarbazine) et programmé pour une radiothérapie.

Primary and isolated thyroid Hodgkin's lymphoma: A case report

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Hodgkin’s lymphoma rarely involves the thyroid gland.

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We report a case of primary and isolated Hodgkin’s thyroid lymphoma.

Introduction

Hodgkin’s lymphoma rarely involves the thyroid gland. It is typically presented as a fast growing neck mass that is sometimes accompanied by respiratory compression symptoms.

Case report

We report one of the few (the seventeenth) case of primary and isolated Hodgkin’s thyroid lymphoma presented by a 65 years old man, consulting for a fast growing neck mass with Hodgkin’s symptoms. The patient had total thyroidectomy and short courses of chemotherapy, then total resolution of symptomatology.

Conclusion

Most thyroid Hodgkin’s lymphoma are presented by women, rarely man, isolated and primary. Since 1962, we only found sixteen cases described in the literature. Hodgkin’s lymphoma should be considered in the differential diagnosis of patients with a thyroid mass for rapid management.

Nodular Lymphocyte Predominant Hodgkin Lymphoma of the Thyroid

Thyroid lymphomas are rare clinical entities that may result from either the primary intrathyroid de novo or secondary thyroid gland involvement of a lymphoma. Among these, the Hodgkin's subtype is quite uncommon, accounting for 0.6-5% of all thyroid malignancies. The authors report on a 76-year-old female presenting with a thyroid nodule that, upon surgical excision, was found to be a nodular lymphocyte predominant Hodgkin lymphoma of the thyroid. So far, thyroid involvement by this variant has never been reported. Upon reporting on this clinical case, the authors emphasize the difficulties usually found in establishing the diagnosis and in defining the best management strategy. A thorough review of the available literature is done.

Multi-institutional study of fine-needle aspiration for thyroid lymphoma

INTRODUCTION

Primary thyroid lymphoma is a rare neoplasm accounting for 1% to 5% of thyroid malignancies. We study the efficacy of fine-needle aspiration (FNA) in diagnosing thyroid lymphoma.

METHODS

Pathology databases from our three institutions were searched for thyroid FNA biopsies having a diagnosis of lymphoma or atypical lymphoproliferative cells, or a corresponding tissue diagnosis of thyroid lymphoma having a prior FNA biopsy.

RESULTS

Sixty-eight cases were retrieved from 64 patients; 67 cases with histologic confirmation. Forty-six specimens were from women (68%), ages 21 to 87 years (mean = 60). Forty-seven aspirates were diagnosed as lymphoma (n = 29) or suspicious (n = 18) for lymphoma (sensitivity = 73%), 11 atypical, 7 benign, 2 unsatisfactory, and 1 suspicious for carcinoma. Follow-up surgical diagnoses included diffuse large B-cell lymphoma (n = 43), classical Hodgkin lymphoma (5), chronic lymphocytic leukemia (5), and other cases (11). Only 12 of 64 patients (13 specimens) had a known diagnosis of lymphoma prior to FNA. Light chain restriction was detected in 34 specimens (by flow cytometry [FCM] in 32 cases or polymerase chain reaction, in 2 cases). FCM was polyclonal (n = 7) or inconclusive (2) with 25 cases not having FCM performed or not having enough viable cells for evaluation. Four cases showed lymphocytic thyroiditis on surgical follow-up with 2 of these cases having a small monoclonal lymphoid population detected by FCM.

CONCLUSIONS

Diffuse large B-cell lymphoma was the most common lymphoma in this series (63%). The sensitivity of FNA with the optional use of FCM was 71% with a specificity of 99%.

Early cytological diagnosis of extranodal stage I, primary thyroid Non-Hodgkin lymphoma in elderly patients. Report of two cases and review of the literature

Background

Primary thyroid lymphomas (PTLs) account for 5% of thyroid malignant tumors and often develop in patients with Hashimoto Thyroiditis (HT). Fine-needle cytology (FNC) is widely used in the diagnosis of thyroid nodules, including those arising in HT. Two PTL cases in HT elderly patients are here described and discussed.

Methods

FNC was performed in rapidly enlarged thyroid nodules of 2 elderly patients under ultrasound (US) control. FNC was used to prepare conventional cytologic smears, immunocytochemistry (ICC) and flow cytometry (FC) assessment of cell populations.

Results

The above cases were diagnosed as well differentiated, small B-cell and diffuse large B-cell thyroid lymphomas, respectively, by means of FNC. The histological diagnoses were mucosa-associated non Hodgkin lymphoma (MALT) and diffuse large B-cell lymphoma (DLBCL), confirming FNC diagnoses, and patients were treated accordingly.

Conclusions

FNC diagnosis of PTL is reliable and accurate; it may be conveniently used in the clinical practice since it provides indications for appropriate therapeutic procedures or diagnostic surgery, and avoids to treat benign nodules.

Thyroid lymphoma: recent advances in diagnosis and optimal management strategies

Primary thyroid lymphoma is rare, composing approximately 5% of all thyroid malignancies and less than 3% of all extranodal lymphomas. It typically presents as a rapidly enlarging goiter with associated compressive symptoms. Thyroid ultrasound and fine needle aspiration cytology, using flow cytometry and immunohistochemistry, remain the main modalities used to confirm the presence of lymphoma. The increasing use of an ultrasound-guided core biopsy to achieve an accurate diagnosis has further limited the role of surgery. An open surgical biopsy may still be required not only for definitive diagnosis but also to confirm the subtype of lymphoma. There are limited numbers of randomized or prospective trials to guide management, and controversy remains over optimal treatment. Treatment and prognosis of this disease can be dichotomized into two separate groups: pure mucosa-associated lymphoid tissue (MALT) lymphoma and diffuse large B-cell lymphoma (DLBCL) or mixed subtypes. Early stage (stage IE) intrathyroidal MALT lymphomas typically have an indolent course and may be treated with single-modality surgery, radiotherapy, or a combination of both. DLBCLs are more aggressive, and survival outcomes are highest with multimodal therapy incorporating monoclonal antibodies, chemotherapy, and radiotherapy. The prognosis is generally excellent but can be varied because of the heterogeneous nature of thyroid lymphomas. The aim of this paper is to discuss the changes in diagnostic modalities and to focus on the recent alterations in the management of this rare disease, including targeted therapies as well as the more limited role of the endocrine surgeon.

Thyroid nodule as a first manifestation of Hodgkin lymphoma-report of two cases and literature review

Lymphomas account for less than 5% of thyroid malignant lesions. Vast majority of them are B-cell non-Hodgkin lymphomas (NHL), while Hodgkin lymphoma (HL) is extremely rare. Here we present two cases of HL, at baseline manifesting as a thyroid lesion. First patient, 29-year-old pregnant female, initially suspected for metastatic medullary thyroid cancer, was eventually diagnosed with mixed cellularity type of thyroid HL. Second patient, 22-year-old woman with suspicion of advanced thyroid cancer, was in the end diagnosed with an extra-lymphatic classical HL of the thyroid. In both cases, despite repeated fine-needle aspiration biopsy, cytological examination gave inconclusive or misleading results. On histopathological examination, thyroid tumor cells were positive for CD15 and CD30 antigen, which is typical for Reed-Sternberg cells. In the report authors also discuss difficulties in management as well as potential importance of novel methods such as FISH, PCR and other molecular techniques in diagnostics of thyroid lymphomas.

VIRTUAL SLIDES

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2896947559559648.

Concomitant thyroid Malt lymphoma and papillary thyroid carcinoma

The objective of this study was to describe the rare thyroid MALT lymphoma concomitant with papillary thyroid carcinoma in a male patient who was submitted to total thyroidectomy. Treatment and follow-up issues are addressed. Male patient complains of fast thyroid enlargement without lymphadenophaty and normal clinical exams. Total thyroidectomy was indicated and performed without any complications. The pathology showed multicentric papillary thyroid carcinoma, concomitant thyroid MALT lymphoma and Hashimoto's thyroiditis. The immunohistochemistry assay was positive for CD 20, CD 43, CD 79, AE1/AE3. The staging studies showed no evidence of both metastasis, Ann Harbor stage IE, without B symptoms. After RIT no further radiotherapy or chemotherapy was indicated. Nowadays the thyroglobulin is undetectable, without recurrences at two years of follow-up. It was concluded that primary thyroid MALT lymphoma is uncommon being the papillary thyroid carcinoma more frequent. Both occurring concomitantly is very rare and the treatment has to prioritize the tumor of worst prognosis at the discovery moment.

Profile of Hashimoto's Thyroiditis in Sri Lankans: Is There an Increased Risk of Ancillary Pathologies in Hashimoto's Thyroiditis?

Hashimoto's thyroiditis has been reported to be associated with many neoplastic and nonneoplastic thyroid pathologies. This retrospective study aims to determine the demographic profile of Hashimoto's thyroiditis in Sri Lankans, document ancillary pathologies in Hashimoto's thyroiditis, and determine whether there is an increased risk of occurrence of malignancies, benign neoplasms, and nonneoplastic benign lesions in Hashimoto's thyroiditis by comparing with thyroids showing multinodular goiters, follicular adenomas, and colloid nodules. The mean age of Hashimoto's thyroiditis is 43.3 years with the majority in the 41 to 60 year age group and a female to male ratio of 10.3 : 1. This study revealed a statistically significant increase of thyroid malignancies in association with Hashimoto's thyroiditis. The association of Papillary carcinoma, Non-Hodgkin's lymphoma, and Hurthle cell adenoma with Hashimoto's thyroiditis was statistically significant.

Contribution of the 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography to the diagnosis of primary osseous Hodgkin lymphoma

Hodgkin lymphoma typically presents as a nodal lesion and infrequently involves extra nodal sites. Although cases of primary extra-nodal Hodgkin lymphoma have been reported previously, the reality of the primitive nature of the disease was difficult to authenticate with traditional high resolution imaging techniques, such as computed tomography or magnetic resonance imaging, because they cannot evaluate the spread of the disease throughout the whole body. We report here a case of primary osseous Hodgkin lymphoma, regarded as stage I extranodal IE thanks to the important contribution of a new imaging technique, the 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography/ computed tomography (18F-FDG-PET/CT). PET enables systemic Hodgkin lymphoma with secondary bone invasion to be distinguished from primitive osseous Hodgkin lymphoma. This technique is highly specific in demonstrating the isolated osseous localisation of the tumour and should be recommended in all patients with putative osseous lymphoma.

Dermatologic aspects of thyroid disease

Thyroid disorders commonly have dermatologic manifestations. The purpose of the present chapter is to review and emphasize potential clinical dermatologic findings that can occur with Graves' disease, hypothyroidism and thyroid cancer. In autoimmune diseases such as Graves' disease and Hashimoto's thyroiditis the skin manifestations may be related to either thyroid hormone levels themselves or to the associated T and/or B cell abnormalities. Thyroid cancer may be associated with various syndromes that could have significant skin manifestations.

Anaplastic Thyroid Carcinoma, Thyroid Lymphoma, and Metastasis to Thyroid

Anaplastic thyroid carcinoma, thyroid lymphoma, and secondary metastasis to the thyroid gland are uncommon thyroid malignancies. They represent significant challenges for the surgeon owing to difficulties in diagnosis, aggressive biology, and the infrequency of their presentation. An awareness and appreciation of multimodality treatment strategies is essential for their management.