Correspondence
γ/δ T-Cell Lymphoma of the Thyroid Gland
N Engl J Med 1997; 336:1391-1392May 8, 1997
- Article
To the Editor:
Lymphomas of the thyroid are almost exclusively of B-cell origin.1 We report a case of thyroid lymphoma with a γ/δ T-cell phenotype.
A 59-year-old Japanese woman was seen because of marked goiter. Chronic thyroiditis had been diagnosed one year before admission. Neither peripheral lymphadenopathy nor a rash was detected. Laboratory values were normal except for an elevated serum level of thyroglobulin. Serum antibodies against human T-cell lymphotropic virus type I and human immunodeficiency virus were not found. A few small bilateral lymph nodes were detected deep in the cervical region. Open biopsy of the thyroid tumor revealed diffuse replacement by atypical large lymphoid cells (Figure 1AFigure 1
Histologic Findings in a Patient with a Thyroid Tumor. and Figure 1B). Reactive lymphoid follicles with hypocellular germinal centers were found in and around the neoplastic area. The phenotype of lymphoma cells was CD3+CD4-CD8-CD19-CD20-CD56-. These cells reacted with a monoclonal antibody against T-cell receptor δ but not with a monoclonal antibody against T-cell receptor β. DNA analysis of the thyroid mass revealed a clonal rearrangement of the T-cell receptor δ-chain gene.The patient was given a diagnosis of γ/δ T-cell lymphoma (clinical stage IIA) and was treated with five courses of combination therapy with cyclophosphamide, doxorubicin, vincristine, and prednisone and three courses of therapy with carboplatin, etoposide, ifosfamide, and dexamethasone, followed by 40 Gy of local irradiation. The size of the goiter was reduced by half, and no uptake of gallium was detected on scanning. Twenty-two months after diagnosis, the patient remains well, with no evidence of recurrence.
Thyroid B-cell lymphomas occur predominantly in elderly women. They are associated with chronic thyroiditis and have a relatively good prognosis.1,2 This type of lymphoma is thought to be a mucosa-associated lymphoma derived from lymphoid tissue.2 In our patient, the clinical and histopathological features closely resembled those of the usual thyroid B-cell lymphoma.
Peripheral γ/δ T-cell lymphoma has been reported in a limited number of anatomical sites, such as hepatosplenic, cutaneous, and nasopharyngeal regions.3,4 Our patient did not present with any of these features, but with diffuse enlargement of the thyroid gland. Although “hepatosplenic γ/δ T-cell lymphoma” is included as a provisional entity in a recently proposed revised European–American classification of lymphoid neoplasms5 and is well recognized, not all the characteristics of γ/δ T-cell lymphoma are known. Our case report demonstrates that γ/δ T-cell lymphomas can involve unusual extranodal sites.
5 ReferencesMotoko Yamaguchi, M.D.
Toshiyuki Ohno, M.D., Ph.D.
Kenkichi Kita, M.D., Ph.D.
Mie University School of Medicine, Tsu 514, Japan1
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2
Hyjek E ,Isaacson PG . Primary B cell lymphoma of the thyroid and its relationship to Hashimoto's thyroiditis. Hum Pathol 1988;19:1315-1326
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Gaulard P ,Bourquelot P ,Kanavaros P , et al. Expression of the alpha/beta and gamma/delta T-cell receptors in 57 cases of peripheral T-cell lymphomas: identification of a subset of γ/δ T-cell lymphomas. Am J Pathol 1990;137:617-628
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Wong KF ,Chan JK ,Matutes E , et al. Hepatosplenic γδ T-cell lymphoma: a distinctive aggressive lymphoma type. Am J Surg Pathol 1995;19:718-726
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Harris NL ,Jaffe ES ,Stein H , et al. A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood 1994;84:1361-1392
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A. Bossowski, B. Czarnocka, K. Bardadin, A. Moniuszko, A. Łyczkowska, J. Czerwinska, J Dadan, A. Bossowska. (2010) Identification of chosen apoptotic (TIAR and TIA-1) markers expression in thyroid tissues from adolescents with immune and non-immune thyroid diseases. Folia Histochemica et Cytobiologica 48:2, 178-184
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Na Rae Kim, Young-Hyeh Ko, Young-Don Lee. (2010) Primary T-cell Lymphoma of the Thyroid Associated with Hashimoto's Thyroiditis, Histologically Mimicking MALT-Lymphoma. Journal of Korean Medical Science 25:3, 481
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K. Miyazaki, M. Yamaguchi, H. Imai, T. Kobayashi, S. Tamaru, K. Nishii, M. Yuda, H. Shiku, N. Katayama. (2008) Gene expression profiling of peripheral T-cell lymphoma including T-cell lymphoma. Blood 113:5, 1071-1074
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