Primary Thyroid Lymphoma, Non-Hodgkins lymphoma, Diffuse B-Cell Lymphoma, Hashimoto’s Thyroiditis, neck mass
Medicine and Health Sciences
Patients with neck masses typically present to primary care providers, but most are unfamiliar with the management of aggressively expanding neck masses. With so many varied structures in the cervical region, a rapidly growing neck mass can be a diagnostic dilemma. The broad initial differential includes infectious, inflammatory, vascular, and malignant causes. When the clinical course points to an aggressive malignancy, the location of the mass helps provide the clues to the likely etiology. Potential sites of involvement include the musculature, bone, larynx, trachea, esophagus, lymph tissue and thyroid tissue. Anterior neck masses at the level the thyroid should prompt a differential of primary thyroid lymphomas. Diffuse large B-cell lymphoma is most common, followed by mucosa-associated lymphoid tissue lymphoma, follicular lymphoma, and small lymphocytic lymphoma. Anaplastic thyroid carcinoma should be considered as well. A history of Hashimoto’s thyroiditis should lead the clinician toward the large B-cell lymphoma.Prompt diagnosis via fine-needle aspiration biopsy is essential, because compressive symptoms and airway collapse may rapidly ensue. A correct clinical and histopathologic diagnosis is essential. Primary thyroid lymphoma can often be treated with chemoimmunotherapy and radiation has a mean overall survival of 9.0 years. Anaplastic thyroid carcinoma is often locally aggressive with advanced metastatic disease at presentation, and treatment options are more limited. Primary care physicians need to be familiar with these relatively rare etiologies for an aggressively expanding neck mass in order to recognize and rapidly coordinate diagnostic and treatment options in a timely fashion.
Bakhshi TJ, Hendricks E, McClanahan E,
B-Cell Non-Hodgkin’s Lymphoma: viewing an aggressive neck mass in an older adult from a primary care perspective.
Marshall J Med.