Clinical presentation and treatment of non-Hodgkin's lymphoma of the thyroid gland

Background: Non-Hodgkin's lymphoma (NHL) of the thyroid is a rare malignanc y. The traditional approach to curative treatment of localized (stages I an d II) NHL of the thyroid gland is surgical resection. The recent success of multimodality chemoradiotherapy suggests that surgery should be reserved f or providing a tissue diagnosis or relief from acute airway obstruction. It is questionable whether this has made an impact on treatment approaches. Methods: Retrospective chart review was conducted for all cases of localize d NHL of the thyroid gland treated at Roswell Park Cancer Institute between January 1970 and January 1999. Results: Ten patients (8 women, 2 men) with a mean age of 56.8 years were i dentified. Nine patients (90%) presented with a neck mass; seven patients ( 70%) had a history of Hashimoto's disease. Nine patients (90%) had extensiv e investigations to rule out extrathyroidal disease. All patients were trea ted with either a total thyroidectomy (eight patients) or a thyroid lobecto my (two patients). Nine (90%) were initially treated outside of Roswell Par k Cancer Institute and referred secondarily for consideration of further th erapy. Adjuvant therapy consisting of cyclophosphamide-based chemoradiother apy was administered to nine patients. Overall survival was 80% at a mean f ollow-up of 8.6 years with a disease-specific survival rate of 100%. Conclusions: A review of the literature suggests that fine needle aspiratio n (FNA) with flow cytometry and immunohistochemistry can be used to accurat ely diagnose NHL of the thyroid gland. Open biopsy should be reserved for c ases where this technique is not available or where the diagnosis can not b e confirmed by FNA alone. Extrathyroidal NHL should be ruled out by chest x -ray, CT scan of the abdomen, and bone marrow biopsy. Further review sugges ts that the most efficacious therapy is systemic chemotherapy in combinatio n with radiation for local control. Debulking surgery should be used only t o provide relief from acute airway obstruction.