THYROID LYMPHOMA - IS THERE A ROLE FOR SURGERY

The role of surgery in the treatment ai: Stage I and II non-Hodgkin's thyroid lymphoma (NHTL) is nest well defined, At our institution, we h ave treated sever, patients (six women and one man) with NHTL during t he past 6 years. Three patients (43%) had a prior history of thyroid d isease, usually lymphocytic thyroiditis. Clinical symptoms included a rapidly enlarging neck mass (86%), dysphagia (71%), dyspnea (71%), and hoarseness (71%). Five patients (71%) had hypothyroidism; one patient , hyperthyroidism; and one patient, normal thyroid function, Five pati ents underwent fine-needle aspiration (FNA) at our institution. In thr ee instances, FNA results were indicative of NHTL; the remaining FNA t ests yielded no diagnosis. Surgical procedures were varied: incisional biopsy (n = 4), limited tumor debulking with tracheostomy (n = 25, an d thyroidectomy (n = 1). Each of the seven patients was found to have large cell lymphoma. Treatment consisted Elf combination chemotherapy with consolidative irradiation. All tumors dramatically decreased in s ize soon after the initiation of therapy. One patient refused radiothe rapy, All patients except one are still alive (median follow-up, 24 mo nths), In conclusion, 1) a diagnosis of NHTL, although rare, should be considered when patients have rapidly growing goiters; 2) FNA is a us eful first step, in diagnosing NHTL; 3) NHTL is exquisitely sensitive to both chemotherapy and radiation; 4) surgical intervention is genera lly confined to incisional biopsy with occasional limited pretracheal tumor debulking and 5) when a biopsy is obtained from a patient suspec ted of having NHTL, immediate processing by the pathologist is recomme nded so that material can be obtained for special studies as needed.