A current analysis of primary lymphoma of the thyroid
E. D. Skarsgard, J. M. Connors and R. E. Robins
Department of Surgery, University of British Columbia, Vancouver, Canada.
Over a 9-year period ending in May 1990, 27 patients with histologically
proved thyroid lymphoma were assessed and treated. There were 24 female and
three male patients with a median age of 67 years at the time of diagnosis
(age range, 39 to 85 years). The usual presentation was that of a rapidly
enlarging neck mass. Incisional biopsy was the diagnostic procedure of
choice; however, nine of 27 patients underwent diagnostic partial or total
thyroidectomy based on a preoperative impression of thyroid carcinoma. All
27 patients had non-Hodgkin's lymphomas of intermediate (77%) or high (23%)
grade. Detailed staging was carried out in 25 patients; seven patients
(28%) had disease confined to the thyroid gland (stage I), while 18 (73%)
had accompanying disease in cervical lymph nodes or the mediastinum (stage
II). Combined multiagent chemotherapy and irradiation was given to 19 of 25
staged patients (76%). Actuarial, overall 5-year survival for all patients
was 70% with 48 months being the median follow-up for living patients
(follow-up range, 3 to 102 months). Of a number of factors evaluated using
log-rank survival tests, only the absence of dysphagia at the time of
hospital admission, a primary tumor mass not greater than 10 cm,
restriction of disease to the thyroid gland, and the absence of mediastinal
lymph node involvement were statistically significant predictors of
improved survival. Surgery should usually be restricted to diagnostic
biopsy, as there is infrequently a role for resection in the management of
thyroid lymphoma, given the effectiveness of combined multiagent
chemotherapy and radiotherapy.
