Primary Thyroid Lymphoma: Two different presentations of a rare disease

Primary thyroid lymphoma
Vol. 5 No. 2 : 2010 (114-119)

Azlin I Azlin I
Leong CF Leong CF
NH Hamidah NH Hamidah
Sharifah NA Sharifah NA
Isa MR Isa MR
Rohaizak M Rohaizak M

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.
Keywords : malignant lymphoma, primary thyroid lymphoma, thyroid malignancies,
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.
Kata Kunci : kanser tiroid, limfoma malignan, limfoma tiroid primer,

Correspondance Address
Dr Azlin Ithnin, Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur. Tel: 603-9145 5837. Fax: 603-9173 6676. Email: nazlin@ppukm.ukm.my