MANAGEMENT OF TWICE RECURRENT THYROID LYMPHOMA—3/15/2017

 

 MANaGEMENT OF TWICE RECURRENT THYROID LYMPHOMA---3/15/2017

QUESTION--AO, Female, 57 years old

In 2006, she was referred to the doctor with a complaint of sudden swelling in the right side of the neck. In the physical examination, a fixed tumoral mass to the surrounding tissues was detected in the isthmus and right thyroid lobe.

14/02/2006 The thyroid ultrasound reported that 35x65x45 mm nodular mass in the right thyroid lobe.

10/03/2006 Thyroid Tc-99m scan showed a hypoactive nodule in the right thyroid lobe.

15/03/2006 The FDG/PET CT scan showed a diffuse pathologic FDG uptake was observed in PET images, which was large enough to fill the upper and middle parts of the right lobe of the thyroid gland, invading the subcutaneous tissues, and compressing the trachea.

2006 TSH: 0.837 (0.27-4.20), FT4:1.33 (0.93-1.7), FT3:2.88 (2.57-4.43), Anti-TPO:560 (˂12), Anti-Tg:508 (˂40)

16/03/2006: Incisional biopsy was done and pathology report was “Diffuse Large B-cell Non-Hodgkin's lymphoma”

Hematologic chemotherapy was performed.

The FDG/PET CT scan (15/09/2006) showed no pathologic FDG uptake was observed in PET images.

The FDG/PET CT scan (18/12/2006) showed no pathologic FDG uptake was observed in PET images.

22/10/2010 Thyroid USG: Thyroid paranchyme is heterogenous. No nodule was observed.

There were no complaints until 1/2016

07/01/2016 The thyroid ultrasound reported 40x36x30 mm nodular mass in the right thyroid lobe. There is no pathologic LAP.

08/1/2016   A thyroid true cut biopsy was performed.

13/01/2016 pathology report was “B-cell Non-Hodgkin's lymphoma”

15/01/2016 The FDG/PET CT scan showed a diffuse pathologic FDG uptake was observed in thyroid right lobe PET images.

Hematologic chemotherapy was performed.

02/05/2016 The FDG/PET CT scan showed no pathologic FDG uptake was observed in PET images.

11/02/2017  TSH: 0.88 (0.35-4.94), FT4:1.07 (0.7-1.48), FT3:3.34 (1.71-3.71), Anti-TPO:25.58 (˂5.6), Anti-Tg:1.94 (˂4.11)

11/02/2017  thyroid USG: Thyroid paranchyme is heterogenous. There are two hypoechoic nodules 4.8 mm in the right and 2.5 mm in the left lobe.

What would you recommend to this patient ?

1) Follow 6 months periods

2) Thyroidectomy and Radiotherapy (RT) to prevent future relapses?

3) Do recommend I-131 ablation after thyroidectomy before RT

Ali Saklamaz,  Turkey

 RESPONSE-In this case both total thyroidectomy and/or radiotherapy are good option. However, I woud go for adjuvant external radiotherapy, once other localization outside the thyroid gland has been ruled out by total body CT scan (PET CT is not enough). Sincerely, F. Pacini MD