Diagnostic and therapeutic strategies for primary thyroid lymphoma

HUANG Jing; ZHANG Pan; LIU Jia-ye; SHEN Bing-bing; LI Zhi-hui

doi:10.19538/j.cjps.issn1005-2208.2025.09.21

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.