title: Clinical Presentation and Diagnostic Challenges of Thyroid Lymphoma: A Cohort Study.
abstract: Thyroid lymphoma is a relatively rare disease often posing a diagnostic challenge. Reaching the final diagnosis can be delayed if insufficient biopsy material is obtained for immunohistochemistry analysis. The aim of this study was to evaluate the clinical, biochemical, and radiological features of thyroid lymphoma.
  
  
  
  A retrospective analysis was conducted of all Mayo Clinic patients evaluated between 2000 and 2014 who had a tissue biopsy positive for thyroid lymphoma.
  
  
  
  Seventy-five subjects had biopsy-proven thyroid lymphoma, and 62.7% were primary thyroid lymphomas. The median age at diagnosis was 67 years (range 20-90 years). A total of 50.7% were male, and 54.7% had a history of Hashimoto's thyroiditis. Presenting symptoms included neck mass (88%), dysphagia (45.3%), and hoarseness (37.3%). The typical ultrasound appearance consisted of a solid, hypoechoic mass with increased vascularity and variable edge characteristics. Fine-needle aspiration (FNA) biopsies were abnormal in 70.7% of cases, and 42% indicated a specific lymphoma subtype. The diagnosis was confirmed in 53.3% by core biopsy, in 21.3% by thyroidectomy (partial or total), in 12% through incisional biopsy, and in 12% by lymph node biopsy. Core biopsy had a higher sensitivity compared with FNA (93% vs. 71%, p = 0.006).
  
  
  
  A rapidly enlarging neck mass in the setting of Hashimoto's thyroiditis should raise suspicion for thyroid lymphoma. Radiologically, this usually presents as a large, unilateral, thyroid-centered mass, hypoechoic by ultrasound, and expanding into adjacent soft tissues. Core-needle biopsy should be the first diagnostic test to expedite reaching the final diagnosis and decrease patient burden of additional tests and interventions.
authors.affiliation: 1 Department of Endocrinology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Anu
authors.initials: A
authors.lastname: Sharma
authors.affiliation: 1 Department of Endocrinology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Sina
authors.initials: S
authors.lastname: Jasim
authors.affiliation: 2 Department of Radiology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Carl C
authors.initials: CC
authors.lastname: Reading
authors.affiliation: 3 Department of Oncology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Kay M
authors.initials: KM
authors.lastname: Ristow
authors.affiliation: 3 Department of Oncology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Villasboas Bisneto
authors.affiliation: 3 Department of Oncology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.affiliation: 1 Department of Endocrinology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Vahab
authors.initials: V
authors.lastname: Fatourechi
authors.affiliation: 1 Department of Endocrinology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Marius
authors.initials: M
authors.lastname: Stan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography; D055815:Young Adult