Int J Thyroidol.  2023 Nov;16(2):209-213. 10.11106/ijt.2023.16.2.209.

Primary Thyroid Lymphoma with Vocal Fold Paralysis

• Jeong JY
• Song CM
• Ji YB
• Tae K

• KMID: 2548751
• DOI: http://doi.org/10.11106/ijt.2023.16.2.209

Abstract

Primary thyroid lymphoma is defined as a lymphoma involving either the thyroid gland alone or both the thyroid gland and neck lymph nodes, without contiguous spread or distant metastases from other areas of involvement at the time of diagnosis. Despite its rarity, prompt recognition of primary thyroid lymphoma is essential due to its distinct management, which differs significantly from the treatment approaches for other neoplasms of the thyroid gland. Herein, we report a 64 years old female patient who complained of hoarseness, and was diagnosed as thyroid lymphoma with unilateral vocal fold paralysis. After chemotherapy, vocal fold paralysis was relieved and the patient’s hoarseness improved.

Keyword

Thyroid cancer; Thyroid lymphoma; Vocal fold paralysis; Chemotherapy

Figure

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  Fig. 1 Fiberoptic laryngoscopy shows right vocal fold paralysis. Right vocal fold is fixed in paramedian position.

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  Fig. 2 Thyroid ultrasound of the right thyroid gland shows diffuse enlargement and severe heterogeneity with mass-like contour compressing trachea compared with the left thyroid gland. Tumor protrusion into the tracheoesophageal groove indicates suspicious invasion of the recurrent laryngeal nerve (arrow).

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  Fig. 3 Axial contrast-enhanced CT image of neck. The arrow indicates the location of the thyroid lymphoma, presenting heterogeneously enhancing mass with extra-capsular invasion abutting trachea and tracheoesophageal groove.

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  Fig. 4 Diffuse infiltration by large atypical lymphoid cells (Hematoxylin & Eosin staining, ×400).

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  Fig. 5 Diffuse large B cell lymphoma. (A) Immunohistochemistry of the biopsied tissue shows CD20 positivity (CD20, ×400). (B) BCL-6 positivity (BCL-6, ×400).

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  Fig. 6 CT image of neck 1 month after the initiation of combination chemotherapy revealed the mass dramatically decrease in size (white arrow).

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  Fig. 7 CT image of neck 5 year after combination chemotherapy shows heterogenous enhancement of shrunken thyroid gland and no evidence of tumor recurrence.

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  Fig. 8 Fiberscopic laryngoscopy that is examined 5 years after combination chemotherapy shows complete recovery of right vocal fold paralysis and complete glottic closure.

Reference

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