Thyroid lymphoma

A comprehensive update of extracutaneous involvement of mycosis fungoides: A narrative review of literature

Mycosis fungoides, the most prevalent subtype of cutaneous T-cell lymphoma, primarily targets areas of the skin that of not exposed to sunlight. Nevertheless, it can involve extracutaneous tissues at any disease stage, especially during its advanced phases. Research suggests that all extracutaneous organs might be susceptible, though such cases are more commonly reported in autopsy studies and less so in clinical setting. The most recent comprehensive review of such extracutaneous manifestations in mycosis fungoides occurred almost a decade ago. With the aim of enhancing clinicians' understanding of these extracutaneous manifestations to improve diagnostic accuracy and patient outcomes, this updated review provides a current synthesis of the rare instances of extracutaneous involvement in mycosis fungoides.

[Secondary thyroid lymphoma: a misleading pathology]

INTRODUCTION

The thyroid gland frequently presents malignant lesions, usually of follicular origin. Thyroid lymphoma, primary or secondary, is an extremely rare disease.

ABSTRACT AND CONCLUSIONS

Secondary thyroid lymphoma poses a diagnostic challenge, which includes in its differential diagnosis thyroid carcinoma and other rare entities, such as primary lymphoma (history of Hashimoto's thyroiditis) or intrathyroidal metastases (history of oncology), the diagnostic key being the anatomopathological study.

RESULTS

A patient with involvement of the gland by a secondary lymphoma with erroneous orientation in the initial diagnosis is presented, with resolution of the same after anatomopathological confirmation.

Developing a prognostic nomogram for primary thyroid lymphoma: insights from a large retrospective study

BACKGROUND

Primary thyroid lymphoma (PTL) is a rare and aggressive malignancy with a need for more precise prognostication tools due to the limitations of existing staging systems. This study aims to develop a nomogram to predict overall survival (OS) rates in PTL patients, addressing the gap in personalized treatment protocols.

METHODS

We analyzed 1469 PTL cases. Cox regression analyses were used to identify key prognostic factors and construct a survival prognostic nomogram. The nomogram's performance was evaluated using receiver operating characteristic (ROC) curves and decision curve analysis. Additionally, a web-based dynamic nomogram was developed to estimate mortality risk for PTL patients.

RESULTS

The nomogram exhibited high clinical utility and precision as determined by decision curve analysis and ROC curves. Furthermore, a novel risk stratification system was introduced. Kaplan-Meier survival curves illustrated significant differences among various risk groups, reinforcing the nomogram's substantial clinical value in predicting OS for PTL patients (P < 0.0001). SHAP value analysis clarified each variable's specific impact on the outcome.

CONCLUSIONS

The nomogram provides a valuable instrument for clinicians to individualize OS predictions for PTL patients, addressing the unmet need for personalized prognostication in this rare malignancy.

Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach

We aimed to analyze the management of the ectopic mediastinal thyroid (EMT) with respect to EMT-related cancer and non-malignant findings related to the pathological report, clinical presentation, imaging traits, endocrine profile, connective tissue to the cervical (eutopic) thyroid gland, biopsy or fine needle aspiration (FNA) results, surgical techniques and post-operatory outcome. This was a comprehensive review based on revising any type of freely PubMed-accessible English, full-length original papers including the keywords "ectopic thyroid" and "mediastinum" from inception until March 2024. We included 89 original articles that specified EMTs data. We classified them into four main groups: (I) studies/case series (n = 10; N = 36 EMT patients); (II) malignant EMTs (N = 22 subjects; except for one newborn with immature teratoma in the EMT, only adults were reported; mean age of 62.94 years; ranges: 34 to 90 years; female to male ratio of 0.9). Histological analysis in adults showed the following: papillary (N = 11/21); follicular variant of the papillary type (N = 2/21); Hürthle cell thyroid follicular malignancy (N = 1/21); poorly differentiated (N = 1/21); anaplastic (N = 2/21); medullary (N = 1/21); lymphoma (N = 2/21); and MALT (mucosa-associated lymphoid tissue) (N = 1/21); (III) benign EMTs with no thyroid anomalies (N = 37 subjects; mean age of 56.32 years; ranges: 30 to 80 years; female to male ratio of 1.8); (IV) benign EMTs with thyroid anomalies (N = 23; female to male ratio of 5.6; average age of 52.1 years). This panel involved clinical/subclinical hypothyroidism (iatrogenic, congenital, thyroiditis-induced, and transitory type upon EMT removal); thyrotoxicosis (including autonomous activity in EMTs that suppressed eutopic gland); autoimmune thyroiditis/Graves's disease; nodules/multinodular goiter and cancer in eutopic thyroid or prior thyroidectomy (before EMT detection). We propose a 10-item algorithm that might help navigate through the EMT domain. To conclude, across this focused-sample analysis (to our knowledge, the largest of its kind) of EMTs, the EMT clinical index of suspicion remains low; a higher rate of cancer is reported than prior data (18.8%), incident imagery-based detection was found in 10-14% of the EMTs; surgery offered an overall good outcome. A wide range of imagery, biopsy/FNA and surgical procedures is part of an otherwise complex personalized management.

Surgery is a Viable Treatment Option for Stage IE Primary Thyroid Lymphoma

BACKGROUND

Stage IE primary thyroid lymphoma (PTL) has been diagnosed in approximately half of patients with PTL; however, the optimal treatment for stage IE PTL has not yet been established.

METHODS

Stage IE PTL patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2019. Thereafter, the disease-specific survival (DSS) and treatment modalities (surgery alone, surgery + radiotherapy (RT) and/or chemotherapy (CT), and RT and/or CT) of these patients were compared by Kaplan-Meier curves and log-rank test after propensity score matching (PSM). Additionally, patients with PTL from the Affiliated Sixth People's Hospital of the Shanghai Jiao Tong University and School of Medicine (Shanghai, China) between 2007 and 2022 were retrospectively analyzed as an external cohort.

RESULTS

Among the 1596 patients with PTL from the SEER database, 842 were identified as patients with stage IE PTL, with an average follow-up period of 7.8 years. Pairwise analysis after PSM revealed no significant difference between the DSS of the three treatment groups. A total of 38 patients with PTL were identified in the external cohort, with an average follow-up period of 3.4 years. Compared with the RT and/or CT group, the surgery-alone group showed no significant difference in the incidence of hypothyroidism (p = 0.161) but had significantly fewer treatment-related complications (p = 0.021), shorter treatment duration (p < 0.001), and lower treatment costs (p = 0.025).

CONCLUSIONS

The results of our study demonstrate that surgery is a viable treatment option for patients with stage IE PTL.

Fast Track Management of Primary Thyroid Lymphoma in the Very Elderly Patient

A rapid growing cervical mass mobile while swallowing is the most common clinical presentation of severe thyroid malignancy. A 91-year-old female patient with a history of Hashimoto thyroiditis presented with clinical compressive neck symptoms. The patient had gastric Maltoma diagnosed that was surgically resected thirty years ago. A straightforward process was needed to reach full histological diagnosis and initiate prompt therapy. Ultrasound (US) showed a 67 mm hypoechoic left thyroid mass with reticulated pattern without signs of locoregional invasion. Percutaneous trans isthmic US-guided 18G core needle biopsy (CNB) disclosed diffuse large B cell lymphoma of the thyroid gland. FDG PET revealed two distinct thyroid and gastric foci (both SUVmax 39.1). Therapy was initiated rapidly to decrease clinical symptoms in this aggressive stage III primitive malignant thyroid lymphoma. The prognostic nomogram was calculated by using a seven-item scale, which disclosed a one-year overall survival rate of 52%. The patient underwent three R-CVP chemotherapy courses, then refused further treatment and died within five months. Real-time US-guided CNB approach led to rapid patient's management that was tailored to patient's characteristics. Transformation of Maltoma into diffuse large B cell lymphoma (DLBCL) into two body areas is deemed to be extremely rare.