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Primary Thyroid Lymphoma: Two different presentations of a rare disease

Case report

Abstrak

Limfoma tiroid primer merupakan penyakit kanser yang jarang berlaku. Ia merangkumi 2% daripada keseluruhan limfoma malignan dan kurang daripada 5% daripada lim­foma tiroid. Ia adalah penyakit yang sangat agresif dan merbahaya. Kebanyakan lim­foma ti­roid terdiri daripada limfoma ‘non-Hodgkin’ yang berasal dari sel limfoid B. Majo­riti kes-kes berlaku dikalangan wanita enam puluhan. Kami melaporkan dua kes lim­foma tiroid primer dengan memberi penekanan terhadap isu-isu klinikal dan kesulitan menangani penyakit ini. Kedua-dua pesakit datang ke hospital dengan kesukaran per­nafasan yang memerlukan pembedahan. Keberkesanan radioterapi, kemoterapi, pem­bedahan dan penggunaan antibodi monoklonal masih lagi didebatkan. Peranan pem­bedahan di dalam menangani kes limfoma tiroid primer sudah banyak berubah namun peranannya yang penting di dalam kes-kes kecemasan tidak boleh diketepikan. Ke­dua-dua pesakit yang dilaporkan perlu menjalani pembedahan kecemasan tetapi hanya seorang sahaja yang telah menerima rawatan tambahan kemoterapi dan ra­dioterapi. Kedua-dua kes ini me­maparkan kesukaran di dalam pengurusan kes lim­foma tiroid primer.

Abstract

Primary thyroid lymphoma is a rare disorder accounting for about 2% of all malignant lymphomas and less than 5% of thyroid malignancies. It is an aggressive disease with poor outcome. The majority of thyroid lymphomas are non-Hodgkin lymphomas of B-cell origin. Majority of cases occur in women in the sixth decade. We report two cases of pri­mary thyroid lymphoma and highlight the clinical issues and challenges posed by this rare disease. Both cases presented with respiratory obstructive symptoms that required surgical intervention. The optimal management for a primary thyroid lym­phoma be it chemotherapy, radiotherapy, surgery or monoclonal antibodies is still de­batable. The role for surgery has evolved through the years but its importance in emergency situations should not be overlooked. Both our patients had to undergo sur­gery but only one patient received additional chemotherapy and radiotherapy. These two case reports illustrated the difficulties in managing this rare disorder.