doi:10.19538/j.cjps.issn1005-2208.2025.09.21

Chinese Journal of Practical Surgery ›› 2025, Vol. 45 ›› Issue (09) : 1071-1075. DOI: 10.19538/j.cjps.issn1005-2208.2025.09.21

Author information +

History +

Abstract

Primary thyroid lymphoma (PTL) is a rare form of extranodal lymphoma of the thyroid, accounting for 1%-5% of thyroid malignancies. It occurs predominantly in middle-aged and elderly women, with more than 80% of cases associated with Hashimoto’s thyroiditis. Patients typically present with a rapidly enlarging thyroid mass within a short period, often accompanied by compressive symptoms or B symptoms. Its clinical manifestations resemble those of anaplastic thyroid carcinoma or thyroiditis, leading to frequent misdiagnosis. Histologically, diffuse large B-cell lymphoma (DLBCL) is the most common subtype, followed by mucosa-associated lymphoid tissue (MALT) lymphoma, with significant differences in aggressiveness and prognosis between subtypes. Ultrasound-guided core needle biopsy combined with immunohistochemistry (e.g., CD20, Ki-67) and fluorescence in situ hybridization (FISH) for MYC, BCL2, and BCL6 constitutes the diagnostic gold standard. Treatment strategies are based on pathological subtype and disease stage. DLBCL is usually managed with R-CHOP chemotherapy combined with radiotherapy, while localized MALT lymphoma confined to the thyroid may be cured with definitive radiotherapy. Surgery is mainly reserved for urgent airway management or diagnostically challenging cases. Prognostic assessment relies on the International Prognostic Index (IPI), serum lactate dehydrogenase (LDH) levels, and positron emission tomography-computed tomography (PET/CT). Advanced age, DLBCL subtype, high IPI score, and TP53 mutation are adverse prognostic factors. Overall, PTL is highly sensitive to radiotherapy and chemotherapy; early-stage MALT lymphoma has an excellent prognosis, whereas aggressive DLBCL carries a poorer outcome. Multidisciplinary collaboration is essential to improve therapeutic efficacy and enhance patient survival and quality of life.

Key words

primary thyroid lymphoma / diffuse large b-cell lymphoma / needle core biopsy / multi-disciplinary treatment

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

References

［1］ Pavlidis ET，Pavlidis TE.A review of primary thyroid lymphoma: molecular factors, diagnosis and management［J］.J Invest Surg，2019，32（2）：137-142.DOI:10.1080/08941939.2017.1383536.

［2］ Stein SA，Wartofsky L.Primary thyroid lymphoma: a clinical review［J］.J Clin Endocrinol Metab，2013，98（8）：3131-3138.DOI:10.1210/jc.2013-1428.

［3］ Tzioni MM，Wotherspoon A，Chen Z，et al.Divergent evolution of metachronous follicular lymphoma and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue from a common precursor［J］.J Pathol，2023，261（1）：11-18.DOI:10.1002/path.6143.

［4］ Arber DA，Orazi A，Hasserjian RP，et al.International Consensus Classification of Myeloid Neoplasms and Acute Leukemias: integrating morphologic, clinical, and genomic data［J］.Blood，2022，140（11）：1200-1228.DOI:10.1182/blood.2022015850.

［5］ Tzioni MM，Watanabe N，Chen Z，et al.Primary thyroid B-cell lymphoma: molecular insights into its clonal evolution and relapse［J］.J Pathol，2025，265（2）：123-131.DOI:10.1002/path.6380.

［6］ Niitsu N，Okamoto M，Nakamura N，et al.Clinicopathologic correlations of stage IE/IIE primary thyroid diffuse large B-cell lymphoma［J］.Ann Oncol，2007，18（7）：1203-1208.DOI:10.1093/annonc/mdm094.

［7］ Ting CY，Chang KM，Kuan JW，et al.Clinical significance of BCL2, C-MYC, and BCL6 genetic abnormalities, epstein-barr virus infection, CD5 protein expression, germinal center B cell/non-germinal center B-cell subtypes, co-expression of myc/bcl2 proteins and co-expression of MYC/BCL2/BCL6 proteins in diffuse large b-cell lymphoma: a clinical and pathological correlation study of 120 patients［J］.Int J Med Sci，2019，16（4）：556-566.DOI:10.7150/ijms.27610.

［8］冯奇器, 施良, 黄品同. 超声诊断原发性甲状腺淋巴瘤及其误诊分析［J］. 实用肿瘤杂志, 2025, 40(3): 265-269. DOI:10.13267/j.cnki.syzlzz.2025.041.

［9］ Zhang L，Castellana M，Virili C，et al.Fine-needle aspiration to diagnose primary thyroid lymphomas: a systematic review and meta-analysis［J］.Eur J Endocrinol，2019，180（3）：177-187.DOI:10.1530/EJE-18-0672.

［10］ Walsh S，Lowery AJ，Evoy D，et al.Thyroid lymphoma: recent advances in diagnosis and optimal management strategies［J］.Oncologist，2013，18（9）：994-1003.DOI:10.1634/theoncologist.2013-0036.

［11］ Ando T，Kato H，Matsuo M.Different CT imaging findings between histological subtypes in patients with primary thyroid lymphoma［J］.Radiol Med，2022，127（2）：191-198.DOI:10.1007/s11547-022-01447-y.

［12］ Kesim S，Ozguven S.Primary thyroid MALT lymphoma and treatment response demonstrated on FDG PET/CT［J］.Rev Esp Med Nucl Imagen Mol (Engl Ed)，2021，40(6):372-373.DOI:10.1016/j.remn.2020.11.005.

［13］ Balikó A，Szakács Z，Kajtár B，et al.Clinicopathological analysis of diffuse large B-cell lymphoma using molecular biomarkers: a retrospective analysis from 7 Hungarian centers［J］.Front Oncol，2023，13：1224733.DOI:10.3389/fonc.2023.1224733.

［14］ Bellas C，García D，Vicente Y，et al.Immunohistochemical and molecular characteristics with prognostic significance in diffuse large B-cell lymphoma［J］.PLoS One，2014，9（6）：e98169.DOI:10.1371/journal.pone.0098169.

［15］ Goda JS，Gospodarowicz M，Pintilie M，et al.Long-term outcome in localized extranodal mucosa-associated lymphoid tissue lymphomas treated with radiotherapy［J］.Cancer，2010，116（16）：3815-3824.DOI:10.1002/cncr.25226.

［16］ Watanabe N，Noh JY，Narimatsu H，et al.Clinicopathological features of 171 cases of primary thyroid lymphoma: a long-term study involving 24553 patients with Hashimoto's disease［J］.Br J Haematol，2011，153（2）：236-243.DOI:10.1111/j.1365-2141.2011.08606.x.

［17］ Jin S，Xie L，You Y，et al.Development and validation of a nomogram to predict B-cell primary thyroid malignant lymphoma-specific survival: A population-based analysis［J］.Front Endocrinol (Lausanne)，2022，13：965448.DOI:10.3389/fendo.2022.965448.

［18］彭俊, 习羽, 郭恒, 等. 原发性甲状腺淋巴瘤多种治疗方案疗效Meta分析［J］. 农垦医学, 2023, 45(6): 506-515.

［19］ Sdayoor I，Shouval R，Fried S，et al.Pretreatment pulmonary function testing has limited utility in B-cell lymphoma treated with CD19 CAR T cells［J］.Blood Adv，2025，9（7）：1720-1725.DOI:10.1182/bloodadvances.2024014488.

［20］ Ernst M, Oeser A, Besiroglu B, et al. Chimeric antigen receptor (CAR) T-cell therapy for people with relapsed or refractory diffuse large B-cell lymphoma［J］. Cochrane Database Syst Rev, 2021, 9(9): CD013365. DOI:10.1002/14651858.CD013365.pub2.

［21］ Crump M，Neelapu SS，Farooq U，et al.Outcomes in refractory diffuse large B-cell lymphoma: results from the international SCHOLAR-1 study［J］.Blood，2017，130（16）：1800-1808.DOI:10.1182/blood-2017-03-769620.

［22］ Basro S, Abdullah-Noor H. Primary lymphoma of the thyroid: diagnostic and therapeutic considerations［J］. Asian J Surg, 2010, 33(1): 20-24. DOI:10.1016/S1015-9584(10)60004-7.

［23］ Marie WS, Tim NB, Jill K, et al. Primary thyroid lymphoma: a multi-center retrospective review［J］. Am J Surg, 2024, 237(1): 122-128. DOI:10.1016/j.amjsurg.2023.05.003.

［24］赵海鑫, 耿祖仕, 卢秀波, 等. 原发性甲状腺淋巴瘤临床预后相关因素及生存研究［J］. 中国实用外科杂志, 2023, 43(12): 1422-1428. DOI:10.19538/j.cjps.issn1005-2208.2023.12.18.

［25］ Yang X, Gong W, Chen Y. (68)Ga-FAPI PET/CT imaging in a patient with primary thyroid lymphoma［J］. Endocrine, 2021, 73(1): 230-231. DOI:10.1007/s12020-021-02679-2.

［26］ Xin L, Yan Z, Zhang X, et al. Parameters for contrast-enhanced ultrasound (CEUS) of enlarged superficial lymph nodes for the evaluation of therapeutic response in lymphoma: a preliminary study［J］. Med Sci Monit, 2017, 23: 5430-5438. DOI:10.12659/MSM.905040.

［27］ Liu S, Fu Y, Cui L, et al. Role of ultrasonography in monitoring chemotherapeutic effects on primary thyroid lymphoma: a single-center retrospective study［J］. Medicina (Kaunas), 2024, 61(1): 15. DOI:10.3390/medicina61010015.

［28］ Meriranta L, Alkodsi A, Pasanen A, et al. Molecular features encoded in the ctDNA reveal heterogeneity and predict outcome in high-risk aggressive B-cell lymphoma［J］. Blood, 2022, 139(12): 1863-1877. DOI:10.1182/blood.2021013320.

［29］ Hristozov K, Dimitrova R, Shishkov S, et al. Primary intrathyroidal non-Hodgkin lymphoma: a case report［J］. Cureus, 2023, 15(10): e47096. DOI:10.7759/cureus.47096.