When a Goitre is a Thyroid Lymphoma

Area of Science:

• Oncology
• Endocrinology

Background:

• Primary thyroid lymphoma is a rare malignancy, constituting <5% of thyroid cancers and <2% of extra-nodal lymphomas.
• It typically manifests as a rapidly enlarging goitre, often presenting with compressive symptoms like superior vena cava syndrome.

Purpose of the Study:

• To highlight the importance of recognizing primary thyroid lymphoma.
• To present a case study for early diagnosis and treatment strategies.

Main Methods:

• Case report of a 55-year-old man with a 3-month history of cervical enlargement.
• Diagnostic workup included cervical ultrasound, neck CT scan, and open thyroid biopsy.
• Treatment involved rituximab therapy.

Main Results:

• Ultrasound revealed asymmetrical thyroid enlargement with abnormal texture.
• CT scan indicated superior vena cava compression.
• Open biopsy confirmed primary thyroid lymphoma, leading to clinical improvement with rituximab.

Conclusions:

• Primary thyroid lymphoma requires a high index of suspicion, especially with rapidly growing goitres.
• While fine needle aspiration biopsy is initial, core or open biopsy may be needed for definitive diagnosis.
• Histological classification guides treatment and prognosis, with chemotherapy often successful.