Korean Journal of Head & Neck Oncology (대한두경부종양학회지)

The Korean Society for Head and Neck Oncology (대한두경부종양학회)
권호 표지
DOI QR코드

DOI QR Code

A Case of Diffuse Large B-cell Lymphoma transformed from Primary Thyroid MALT Lymphoma

갑상선 MALT 림프종으로부터 전환된 미만성 거대 B세포 림프종 1예

  • Young Rok Jo (Department of Otorhinolaryngology-Head and Neck Surgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine) ;
  • Youn Jin Cho (Department of Otorhinolaryngology-Head and Neck Surgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine) ;
  • Ju Yeon Pyo (Department of Pathology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine) ;
  • Hye Ran Lee (Department of Otorhinolaryngology-Head and Neck Surgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine)
  • 조영록 (가톨릭관동대학교 의과대학 국제성모병원 이비인후-두경부외과학교실) ;
  • 조윤진 (가톨릭관동대학교 의과대학 국제성모병원 이비인후-두경부외과학교실) ;
  • 표주연 (가톨릭관동대학교 의과대학 국제성모병원 병리과교실) ;
  • 이혜란 (가톨릭관동대학교 의과대학 국제성모병원 이비인후-두경부외과학교실)
  • Received : 2023.04.13
  • Accepted : 2023.05.15
  • Published : 2023.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Diffuse large B cell lymphoma (DLBCL) is main subtype of primary thyroid lymphoma and can be histologically transformed from a low-grade B-cell lymphoma. The characteristics and treatment guidelines of these particular DLBCL have not been fully established. The mainstay of treatment of primary thyroid DLBCL is multimodality treatment with chemotherapy and radiotherapy. Meanwhile, surgery can be considered only for diagnosis or alleviation of airway compressive symptoms. A 57-year-old female visited our outpatient clinic for recently enlarged long-held anterior neck mass. A thyroid mass compressing the airway and esophagus was identified on imaging, which was diagnosed as MALT lymphoma by excisional biopsy. After staging, the patient underwent total thyroidectomy with regional lymph node dissection for treatment of stage IIE MALT lymphoma and relieving airway compromise symptoms. The final diagnosis was DLBCL transformed from MALT Lymphoma, and chemotherapy was additionally performed. We report this rare experience with a review of literature.

아직까지 원발성 갑상선 림프종은 대규모 전향적 임상 연구가 부족하여 각 증례에서의 적절한 치료 계획에 대해 의논의 여지가 많고, 관련 임상과들의 다학제적 접근이 요구된다. 비교적 저등급 림프종으로 분류되는 MALT 림프종 역시 조직학적 형질전환을 포함한 다양한 임상 경과를 보이고, 부분적인 생검만으로는 림프종의 정확한 진단에 어려움이 있는 만큼, 환자의 증상과 상황에 맞는 최선의 의사 결정이 요구된다. 아울러 갑상선의 기관 특성을 고려한 림프종의 각 아형별 표준 치료의 정립이 지속적으로 논의되어야 할 것으로 사료된다.

Keywords

References

  1. Alaggio R, Amador C, Anagnostopoulos I, Attygalle AD, Araujo IBO, Berti E, et al. The 5th edition of the world health organization classification of haematolymphoid tumours: Lymphoid neoplasms. Leukemia. 2022;36:1720-1748.  https://doi.org/10.1038/s41375-022-01620-2
  2. Karvounis E, Kappas I, Angelousi A, Makris GM, Kassi E. Mucosa-associated lymphoid tissue lymphoma of the thyroid gland: A systematic review of the literature. Eur Thyroid J. 2020;9:11-18.  https://doi.org/10.1159/000502204
  3. Colovic M, Matic S, Kryeziu E, Tomin D, Colovic N, Atkinson HD. Outcomes of primary thyroid non-Hodgkin's lymphoma: A series of nine consecutive cases. Med Oncol. 2007;24:203-208.  https://doi.org/10.1007/BF02698041
  4. Stein SA, Wartofsky L. Primary thyroid lymphoma: A clinical review. J Clin Endocrinol Metab 2013;98:3131-3138.  https://doi.org/10.1210/jc.2013-1428
  5. Defrancesco I, Arcaini L. Overview on the management of non-gastric MALT lymphomas. Best Pract Res Clin Haematol. 2018;31:57-64.  https://doi.org/10.1016/j.beha.2017.11.001
  6. Maeshima AM, Taniguchi H, Toyoda K, Yamauchi N, Makita S, Fukuhara S, et al. Clinicopathological features of histological transformation from extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue to diffuse large B-cell lymphoma: An analysis of 467 patients. Br J Haematol. 2016;174:923-931.  https://doi.org/10.1111/bjh.14153
  7. Derringer GA, Thompson LD, Frommelt RA, Bijwaard KE, Heffess CS, Abbondanzo SL. Malignant lymphoma of the thyroid gland: A clinicopathologic study of 108 cases. Am J Surg Patho.l 2000;24:623-639.  https://doi.org/10.1097/00000478-200005000-00001
  8. Lee SC, Hong SW, Lee YS, Jeong JJ, Nam KH, Chung WY, et al. Primary thyroid mucosa-associated lymphoid tissue lymphoma; a clinicopathological study of seven cases. J Korean Surg Soc. 2011;81:374-379.  https://doi.org/10.4174/jkss.2011.81.6.374
  9. Mancuso S, Carlisi M, Napolitano M, Siragusa S. Lymphomas and thyroid: Bridging the gap. Hematol Oncol. 2018. [cited 2018 Feb 27] Available from URL: https://doi.org/10.1002/hon.2504 
  10. Montoto S, Fitzgibbon J. Transformation of indolent B-cell lymphomas. J Clin Oncol. 2011;29:1827-1834.  https://doi.org/10.1200/JCO.2010.32.7577
  11. Witte H, Biersack H, Kopelke S, Rades D, Merz H, Bernard V, et al. Indolent lymphoma with composite histology and simultaneous transformation at initial diagnosis exhibit clinical features similar to de novo diffuse large B-cell lymphoma. Oncotarget. 2018;9:19613-19622.  https://doi.org/10.18632/oncotarget.24701
  12. Network NCC. B-Cell Lymphomas (Version 5.2022). [cited July 12, 2022]; Available from: https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf 
  13. Sippel RS, Gauger PG, Angelos P, Thompson NW, Mack E, Chen H. Palliative thyroidectomy for malignant lymphoma of the thyroid. Ann Surg Oncol 2002;9:907-911.  https://doi.org/10.1007/BF02557529
  14. Flossbach L, Antoneag E, Buck M, Siebert R, Mattfeldt T, Moller P, et al. BCL6 gene rearrangement and protein expression are associated with large cell presentation of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue. Int J Cancer. 2011;129:70-77.  https://doi.org/10.1002/ijc.25663
  15. Ghesquieres H, Berger F, Felman P, Callet-Bauchu E, Bryon PA, Traverse-Glehen A, et al. Clinicopathologic characteristics and outcome of diffuse large B-cell lymphomas presenting with an associated low-grade component at diagnosis. J Clin Oncol. 2006;24:5234-5241. https://doi.org/10.1200/JCO.2006.07.5671