Prognostic evaluation models for primary thyroid lymphoma, based on the SEER database and an external validation cohort

Purpose Primary thyroid lymphoma (PTL) is a rare malignancy, and the literature is limited to small case series and case reports. This study aimed to assess the epidemiologic characteristics, survival, and prognostic factors of patients with PTL. Methods We analyzed 2215 PTL patients from the Surveillance, Epidemiology, and End Results database medical records, between 1983 and 2015, as the training cohort. We enrolled 105 patients from the Cancer Hospital, Chinese Academy of Medical Sciences, for the external validation cohort. The nomograms for predicting the 1-, 5-, and 10-year overall survival (OS) and lymphoma-specific survival (LSS) were constructed. Results PTL incidence steadily increased from 1977 to 1994, with an annual percentage change of 3.2% (95% confidence interval [CI]: 1.2–5.2, P < 0.05). The 1-, 5-, and 10-year OS and LSS rates were 84.66%, 71.61%, and 55.95%; and 90.5%, 85.7%, and 82.2%, respectively. Multivariate Cox regression analysis revealed that shorter OS association with age ≥ 60 years (hazard ratio [HR], 3.94; 95% CI 3.31–4.69; P < 0.001), unmarried status (HR, 1.55; 95% CI 1.37–1.75; P < 0.001), Ann Arbor stage III-IV (HR, 1.55; 95% CI 1.37–1.75; P = 0.020), diffuse large B-cell lymphoma (HR, 2.60; 95% CI 1.15–5.87; P = 0.022), and T cell non–Hodgkin lymphoma (HR, 3.53; 95% CI 1.12–11.10; P = 0.031). In the multivariate competing-risk analyzes, age, stages III-IV, year of diagnosis, surgery, radiation, chemotherapy, and histology were strongly predictive of PTL-specific risk of death. To estimate the 1-, 5-, and 10-year LSS and OS rates, respectively, nomograms were built. In the validation cohort, the results also confirmed the utility. Conclusions This study presents the first prognostic model with an external validation that could help clinicians identify patients with high-risk PTL to improve their prognosis.

Comparison of the clinical characteristics of primary thyroid lymphoma and diffuse sclerosing variant of papillary thyroid carcinoma

Objective: Both primary thyroid lymphoma (PTL) and diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC) are two rare malignant tumours with different therapies and prognoses. This study compared their clinical features. Methods: From a retrospective review of the pathologic database at our institute between January 2015 and August 2020, 52 PTL patients and 40 DSVPTC patients were included. Demographic, clinical, laboratory and ultrasound data were extracted from electronic medical records. Statistical analyses were performed using GraphPad Prism 5.0. Results: Both PTL and DSVPTC were more likely to occur in women (83.7% and 67.5%), but DSVPTC patients were younger (median age: 36 vs 64.5), had fewer compressive symptoms, and more frequently had neck lymph node metastasis than PTL patients. The prevalence of Hashimoto’s thyroiditis (HT) and hypothyroidism was significantly higher in PTL patients than in DSVPTC patients (31% vs 17.5%). Hyperthyroidism could only be found in DSVPTC patients, which accounted for 7.5%. Heterogeneous echogenicity and irregular edges were frequently observed in both PTL and DSVPTC. However, compared with PTL, DSVPTC exhibited smaller lesion sizes, higher frequencies of diffuse sonographic patterns and calcification, and lower frequencies of hypoechoic features and internal blood flow signal. The overall survival rate with PTL was 77.23%, which was lower than that with DSVPTC (90.91%), but this difference was not significant (p=0.096). Conclusion: Clinical characteristics such as age, compression symptoms, and sonographic features such as a large mass with heterogeneous echogenicity, hypoechoic, irregular edges, and calcification are helpful for impression diagnosis of PTL and DSVPTC before surgery.

Association of Hashimoto’s Thyroiditis and Burkitt Lymphoma: A Rare Condition to Be Considered

We present the case of a 72-year-old woman who was diagnosed with Hashimoto’s thyroiditis and who developed a low-grade fever, fatigue, and weight loss that prompted to perform a thyroid biopsy to rule out an underlying primary thyroid lymphoma. This case report offers the opportunity to review the association between Hashimoto’s thyroiditis and primary thyroid lymphoma. Furthermore, it underlines the importance of considering the diagnosis of lymphoma when a thyroid mass is found in patients with an underlying Hashimoto’s disease, as the timely management is essential for survival with this rare thyroid condition.

Multi-modal Ultrasonic Diagnosis and Prognosis for Primary Thyroid Lymphoma Invasiveness

Objective Sixty-nine patients with primary thyroid lymphoma (PTL) were evaluated for diagnostic value and prognosis for PTL invasiveness. Methods We retrospectively (2008–2019) analyzed multi-modal ultrasonic images and clinical characteristics from pathologically confirmed PTL patients. These patients were divided into aggressive PTL(n=46) and indolent PTL(n=23). Results Age(>70 years old) and elevated LDH (lactase dehydrogenase) were statistically different clinical features between aggressive and indolent PTL. From ultrasonic images, 34 cases were nodular, 11 diffused, and 24 mixed. Mixed types displayed high invasiveness (45.7%) while diffuse types displayed higher inertness (39.1%), and differences were statistically significant (P = 0.000). Elastography, invaded thyroid capsule and increased chaotic vascularity also showed significant differences between aggressive and indolent PTL. We observed statistical difference in OS(overall survival rates) between aggressive and indolent PTL(p=0.032). Single factor Kaplan-Meier (K-M) analysis showed that: age > 70 years old, aggressive pathology, Ki67>30%, elastography scored >3 were positively correlated with the risk of poor prognosis of PTL (P < 0.05).Conclusions Multi-modal ultrasound provides accurate ultrasonographic information, e.g., ultrasound patterns, elastography, invaded thyroid capsules, and hypervascularity, which facilitates PTL invasiveness diagnostics for improved clinical treatment. In addition, PTL patients with age > 70 years old, aggressive pathology, Ki67>30%, elastography scored >3 are more likely to have poor prognosis.

Burkitt’s Thyroid Lymphoma Revealed in a Pregnant Woman With Acute Dyspnea

Extraganglionic Burkitt’s lymphoma is rare. Primary thyroid localization accounts for 1% to 5% of malignant tumors of the thyroid gland. The association of Burkitt’s lymphoma and pregnancy is even rarer. Our patient was pregnant at 36 weeks. She was brought to the emergency department with anterior cervical swelling, rapidly increasing in volume and becoming compressive for 15 days, in addition to dysphonia and inspiratory dyspnea. Cervical ultrasound and computed tomography scan revealed a compressive and plunging goiter. Surgery attempted after fetal extraction proved impossible due to massive tumor infiltration into adjacent structures shielding the cervical region. Accordingly, the act was limited to a glandular biopsy. The newborn was healthy. Histological examination confirmed the diagnosis of Burkitt’s lymphoma. Given the poor general condition of the patient, chemotherapy was not administered and the patient died after 15 days of stay in intensive care unit.