Primary thyroid lymphoma with Hashimoto's thyroiditis: A case report and literature review

Primary thyroid diffuse large B-cell lymphoma (DLBCL) represents a rare and diagnostically challenging malignancy, particularly when arising in the setting of pre-existing Hashimoto's thyroiditis (HT). The present case report describes the case of an 86-year-old female patient with primary thyroid lymphoma (PTL) who presented with life-threatening tracheal compression. The aim of this report is to emphasize the diagnostic challenges due to overlapping clinical features with thyroid carcinoma and the absence of consensus management guidelines. Following ultrasound-guided biopsy and immunohistochemical analysis, germinal center-originated DLBCL was confirmed. The patient received four cycles of zuberitamab (a novel anti-CD20 monoclonal antibody) plus mini-CHOP therapy, with CT imaging demonstrating notable tracheal re-expansion after the first cycle. Successful disease control and quality of life were maintained throughout the follow-up. Furthermore, a comprehensive literature review was performed to elucidate the clinical manifestations and therapeutic approaches of PTL. In conclusion, the present case exemplifies that elderly patients with rapidly enlarging neck masses require urgent evaluation to distinguish between thyroid lymphoma and carcinoma. While individual case results cannot be generalized to all clinical scenarios, prompt diagnosis followed by appropriate treatment remains critical for favorable outcomes.