Primary Thyroid Lymphoma: Multi-Slice Computed Tomography Findings

  • Li, Xu-Bin (Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy) ;
  • Ye, Zhao-Xiang (Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy)
  • Published : 2015.03.04


Background: The objective of this study was to investigate the MSCT characteristics of PTL in order to enhance the awareness of this uncommon entity among both clinicians and radiologists. Materials and Methods: The clinicopathological data and MSCT images of 27 patients with PTL were retrospectively reviewed. The MSCT appearances were classified into three types: type 1, solitary nodule surrounded by normal thyroid tissue; type 2, multiple nodules in the thyroid, and type 3, enlarged thyroid glands with a reduced attenuation with or without peripheral thin hyperattenuating thyroid tissue. Results: The patients were enrolled in the study with a mean age of 68 years (range, 51-86years) and compression symptoms or enlarged cervical lymph nodes at diagnosis. Hashimoto's thyroiditis was in 20 patients. All patients had non-Hodgkin lymphoma of B-cell in origin, including 22 cases of diffuse large B-cell lymphoma (DLBCL) and 5 of low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). For MSCT appearance, type 1 pattern was observed in 2 patients, type 2 in 8, and seventeen type 3 in 17. The lesions occurred in more than one lobe with a mean maximal transverse diameter of 6.9 cm and an ill-defined margin. Most tumors showed a homogeneous attenuation equal to that of surrounding muscles before contrast and obvious enhancement after contrast. Cervical lymph node involvement and invasion of the trahea and (or) esophagus were mainly observed in patients with DLBCL. Conclusions: PTL should be clinically considered in elder patients presenting with a history of Hashimoto's thyroiditis and cervical lymphadenopathy. The MSCT characteristics of PTL includes a mass diffusely affecting more than one thyroid lobe, isointense to muscle and obvious enhancement before and after contrast. DLBCL, the most common histological subtype of PTL, is associated with a higher invasive tendency.


Supported by : Natural Science Foundation of China


  1. Aiken AH, Glastonbury C (2008). Imaging Hodgkin and non- Hodgkin lymphoma in the head and neck. Radiol Clin North Am, 46, 363-78.
  2. Ansell SM, Grant CS, Habermann TM (1999). Primary thyroid lymphoma. Semin Oncol, 26, 316-23.
  3. Arabi M, Dvorak R, Smith LB, Kujawski L, Gross MD (2011). Fluorodeoxyglucose positron emission tomography in primary lymphoma with coexisting lymphocyticthyroiditis. Thyroid, 21, 1153-6.
  4. Kim HC, Han MH, Kim KH, et al (2003). Primary thyroid lymphoma: CT findings. Eur J Radiol, 46, 233-9.
  5. King AD, Ahuja AT, King W, Metreweli C (1997). The role of ultrasound in the diagnosis of a large, rapidly growing thyroid mass. Postgrad Med J, 73, 412-4.
  6. Loevner LA, Kaplan SL, Cunnane ME, Moonis G (2008). Crosssectional imaging of the thyroid gland. Neuroimaging Clin N Am, 18, 445-61.
  7. Matsuzuka F, Miyauchi A, Katayama S, et al (1993). Clinical aspects of primary thyroid lymphoma: diagnosis and treatment based on our experience of 119 cases. Thyroid, 3, 93-9.
  8. Nam M, Shin JH, Han BK, et al (2012). Thyroid lymphoma: correlation of radiological and pathologic feature. J Ultrasound Med, 31, 589-94.
  9. Pedersen RK, Pedersen NT (1996). Primary non-Hodgkin's lymphoma of the thyroid gland: a population based study. Histopathology, 28, 25-32.
  10. Sakorafas GH, Kokkoris P, et al (2010). Primary thyroid lymphoma: diagnostic and therapeutic dilemmas. Surg Oncol, 19, e124-129.
  11. Soler ZM, Hamilton BE, Schuff KG, Samuels MH, Cohen JI (2008). Utility of computed tomography in the detection of subclinical nodal disease in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg, 134, 973-8.
  12. Stein SA, Wartofsky L (2013). Primary thyroid lymphoma: a clinical review. J Clin Endocrinol Metab, 98, 3131-8.
  13. Sumi M, Ohki M, Nakamura T (2001). Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. Am J Roentgenol, 176, 1019-24.
  14. Takashima S, Morimoto S, Ikezoe J, et al (1990). CT evaluation of anaplastic thyroid carcinoma. Am J Neuroradiol, 11, 361-7.
  15. Takashima S, Nomura N, Noguchi Y, Matsuzuka F, Inoue T (1995). Primary thyroid lymphoma evaluation with US, CT, and MRI. J Comput Assist Tomogr, 19, 282-8.
  16. Takashima S, Sone S, Horii A, Honjho Y, Yoshida J (1997). Subacute thyroiditis in Hashimoto's thyroiditis which mimicked primary thyroid lymphoma. J Clin Ultrasound, 25, 279-81.<279::AID-JCU11>3.0.CO;2-E
  17. Thieblemont C, Mayer A, Dumontet C, et al (2002). Primary thyroid lymphoma is a heterogeneous disease. J Clin Endocrinol Metab, 87, 105-11.
  18. Widder S, Pasieka JL (2005). Primary thyroid lymphomas. Curr Treat Options Oncol, 5, 307-13.

Cited by

  1. Automatic Electronic Cleansing in Computed Tomography Colonography Images using Domain Knowledge vol.16, pp.18, 2016,
  2. Ultrasonographic features of aggressive primary thyroid diffuse B-cell lymphoma: A report of two cases vol.11, pp.4, 2016,
  3. Lymphomas and thyroid: Bridging the gap vol.36, pp.3, 2018,