A c as e of MA LT ly m ph om a of the thy roid ac c om p any in g H as him ot o 's thy roiditis

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1 : MALT (MALT om a ) 1, * * =A b s t r a c t = A c as e of MA LT ly m ph om a of the thy roid ac c om p any in g H as him ot o 's thy roiditis T ae Young Lee, M.D., Eun Sang Ryoo, M.D., Il Song Nam, M.D., Gi Young Hong, M.D., Chan Hee Han, M.D., Suk Gi Yoon, M.D., Chul Hee Kim, M.D., Dong Won Byun, M.D., Young Sun Kim, M.D., Gyo Il Seo, M.D., Myung Hi Yoo, M.D. and So Young Jin, M.D. * Departments of Internal M edicine and A natom ical Pathology, Soonchunhyang University, College of M edicine, Seoul, K orea Primary thyroid lymphomas constitute of up to 5% of all thyroid malignancies. Recently, mucosa- associated lymphoid tissue (MALT ) lymphoma are relatively recognized as a B cell subset of non-hodgkin 's lymphoma. MALT -lymphomas are thought to develop from acquired lymphocytic tissue during the course of a chronic inflammatory or autoimmune process. In the thyroid, which is normally devoid of lymphocytic tissue, chronic autoimmune thyroiditis (Hashimoto's disease) has been associated with an increased risk of lymphoma, including MALT type. T he clinical presentations include the enlarging of the neck mass, dysphagia, hoarsenes and choking or cold thyroid nodule. We report a case of MALT oma of the thyroid accompanied by Hashimoto's thyroiditis with a review of the literature.(korean J Med 61: , 2001) Key W ords : Lymphoma; Mucosa-associated lymphoid tissue; Thyroiditis, Autoimmune 5% MALT B low grade (indolent). MALT MALT 1. : : :, 657, ( ) E -mail :

2 Korean Journal of Medicine : Vol. 61, No. 3, 2001 :, 54 :, : 1 3. : : 100/ 60 mmhg, 80 /min, 36.5, 20/ min 6 4 cm. : 4300/ mm 3, 12.4 g/ dl, 36.7%, 217,000/ mm 3 K 3.2 meq/ L. T SH 2.45 uu/ ml, T ng/ dl, T3 91 ng/ dl, thyroglobulin ng/ ml, antithyroglobulin antibody 1.88 U/ ml, calcitonin 3.0 pg/ ml antimicrosomal antibody 100 U/ ml,. :, (submandibular gland) cm 1 cm ( 1).. Tc-99 m thyroid scan 2.8% ( 2). :,.. centrocyte. B kappa chain lambda chain Fig ure 1. Neck CT shows 6 4 cm sized huge solid mass extended to submandibular gland, involving thyroid isthmus in the left thyroid 99 Fig ure 2. mt c thyroid uptake scan shows enlarged right lobe of the thyroid gland with photon defect in the left lobe and 2.8% uptake rate

3 T ae Young Lee, et al : A case of the thyroid MALT lymphoma accompanying Hashimoto' s thyroiditis Figure 3A Figure 3B Fig ure 3. A. Microscopic finding of the thyroid mass shows marked lymphocytic infiltration and a few remaining degenerated follicles. T he lymphocytes have irregular nucleic and clear cytoplasm, like centrocytes. (H & E, 100) B. Immunohistochemical findings disclose diffuse positive staining for the pan- B cell marker. (ABC, 400) light chain monoclonality MALT ( 3A, 3B).. : MALT, stage 1A, cgy. Mucosa- associated lymphoid tissue (MALT ) B cell NHL subset revised Europian- American lymphoma (REAL) extranodal marginal zone 1, 7, 8). non- MALT.,, 2, 7, 8 ). MALT type 3, 8 ). B 1 diffuse small and large cell type 4 ) 5 ). CHOP regimen 6 ). 7 ). MALT type.,, antimicrosomal antibody. 5% ). 3 Matsuzuka % 8 )

4 : Matsuzuka 119 review 6% 8 ) % 10 ). (euthyroid) antimicrosomal antibodies, Matsuzuka 58% euthyroid, 14% overt hypothyroidism, 27% subclinical hypothyroidism, 1% hyperthyroidism 68% antimicrosomal antibodies 8 ).. B cell monoclonality MALT. Matsuzuka 8).. Working fomulation MALT low grade 12, 14 ). Issacson (common embryonic antigen) mucosa associated lymphoid tissue (MALT ) 9 ). Sirota. monomorphic infiltration 11, 15 ). low grade malignant lymphoma B cell type of MALT origin Matsuzuka Sirota.,,, MALT type chlorambucil, cyclophosphamide, vincristine, prednisone 12, 13 ). Diffuse large cell CHOP regimen 12 ). Robert 13 ) MALT 1. R E F E R E N C E S 1) Harris NL, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML, Delsol G, De Wolf Peeters C, Falini B, Gatter KC. A revised E urop ian-american classif ication of lymphoid neoplasm: a p roposal from the international Lymphoma study group. B lood 84: , ) Thieblemont C, Berger F, Coiffier B. M ucosaassociated lymphoid tissue lymphomas. Curr Op in Oncol 7: , ) Hyjek E, Isaacson DM. P rimary B cell lymphoma of the thyroid and its relationship to Hashimoto's thyroiditis. H um Pathol 19: , ),,,,,. B 1. 40: , ),,,,,,,

5 9 : MALT (MALT oma) : , ),,,,,,,,,. ( 4E ) 1. 9: , ),,,,,,,,,, :97-102, ) Fumio M, Akira M, Shoichi K. Clinical asp ect of p rimary thyroid lymphoma: Diagnosis and treatment based on our exp erience of 119 cases. Thyroid 3:93-99,1993 9) Issacson P, Wright DH. Extranodal malignant lymphoma arising from mucosa-associated lymphoid tissue. Cancer 53: , ) Ansocombe AM, Wright DH. P rimary, malignant lymphoma of the thyroid-a tumor of mucosaassociated lymphoid tissue: review of seventy six cases. H istopathology 9:81-97, ) Sirota DK, Segal RL. P rimary lymphoma of the thyroid gland. J A m M ed A ssoc 242: , ) Ansell SM, Grant CS, Habermann TM. P rimary thyroid lymphoma. Seminars in oncology 26: , ) Robert W, Lee B, Howard R, Martin I. M altoma of thyroid in a man with Hashimoto's thyroiditis. J Clin Endoclinol M etab 84: , ) Pedersen RK, Pedersen NT. Primary non-h odgkin 's lymphoma of the thyroid gland: a p op ulation based study. H istopathology 28:25-32, ) Lovchik J, Lane MA, Clark DP. P olymerase chain reaction- based detection of B cell clonality in the f ine needle asp iration biopsy of a thyroid mucosa associated lymphoid tissue (M A L T) lymphoma. H um Pathol 28: ,