MALT Type Lymphoma Demonstrating Prominent Plasma Cell Differentiation Resembling Fibrous Variant of Hashimoto’s Thyroiditis: a Three Case Report

Department of Pathology and Clinical Laboratories, Gunma Cancer Center Hospital, 617-1, Takabayashinishi-cho, Ohta 373-8550, Japan.
Pathology & Oncology Research (Impact Factor: 1.86). 11/2008; 15(2):285-9. DOI: 10.1007/s12253-008-9108-y
Source: PubMed


Fibrous variant of Hashimoto's thyroiditis (HT) is characterized by marked fibrous replacement of one third or more of the thyroid parenchyma. We present here three cases of mucosa associated lymphoid tissue (MALT) type lymphoma demonstrating prominent plasma cell differentiation resembling fibrous variant of HT. Histologically, thyroid structures were disturbed by a diffuse and focally nodular infiltration by mature plasma cells and cells with plasma cell differentiation against a background of prominent hyalinosis. In addition, scattered centrocyte-like (CCL) cells and lymphoepithelial lesions were observed in all three lesions. A portion of the resected specimens in all three cases exhibited HT. However, immunohistochemical study demonstrated that the plasma cells and CCL-cells of these three lesions had monotypic intracytoplasmic kappa light chain. Moreover, these three lesions demonstrated a clonal band on polymerase chain reaction assay for the immunoglobulin heavy chain gene. To avoid underdiagnosis, we emphasize that careful attention should be paid to these immunological features as well as to morphological findings.

2 Reads
  • Source
    • "Other sites where MALT lymphomas can occur include the orbit, lung, salivary glands, thyroid, skin, intestine, and liver [3]. Salivary gland and thyroid MALT lymphomas are associated with autoimmune disorders such as Sjogren's syndrome and Hashimoto disease, respectively [4,5]. Primary MALT lymphomas can also occur in the oral cavity, although their appearance in this location is rare [6]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Mucosa-associated lymphoid tissue (MALT) lymphoma is a type of extranodal marginal zone B-cell lymphoma and is a distinct subtype of non-Hodgkin's lymphoma. Primary MALT lymphomas can also occur in the oral cavity, although their appearance in this location is rare. The neoplastic cells of which MALT lymphomas are composed express B-cell antigens and show monotypic immunoglobulin expression with light-chain restriction. Although neoplastic MALT lymphoma cells do not express CD5, previous studies have shown that CD5 positive MALT lymphomas are more prone to dissemination than those that do not express CD5. Moreover, there are some reports that describe kappa- and lambda- dual light chain expression in B cell malignant neoplasms. A 66-year-old Japanese woman with swelling of the right buccal mucosa was referred to our hospital. The lesion was excised and was pathologically diagnosed as a MALT lymphoma tumor with a t(11;18)(q21;q21) chromosome translocation. Swelling of the right buccal mucosa recurred 2 years later. The recurrent tumor was then excised and pathologically diagnosed as MALT lymphoma. Immunohistochemical examination of CD5, lambda, and kappa expressions revealed that the primary tumor was positive for CD5, kappa, and lambda, but the recurrent tumor was weakly positive for CD5 and kappa. With respect to lambda positivity, the recurrent tumor showed negativity. Our study suggests that immunohistochemical expression of CD5, kappa, and lambda in oral MALT lymphoma have the risk of recurrence. We first described the recurrence of CD5 positive MALT lymphoma in the oral cavity and compared the immunohistochemical expressions of CD5, lambda, and kappa between the primary and recurrent tumors.
    Diagnostic Pathology 09/2011; 6(1):82. DOI:10.1186/1746-1596-6-82 · 2.60 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Primary thyroid lymphoma (PTL) is a rare but clinically important malignancy of the thyroid. This article reviews the diagnosis, histologic subtypes, pathogenesis, and treatment of PTL, with the objective of optimizing diagnosis and management of the disease. Recent studies have shed light on the clinicopathologic features of the histologic subtypes of PTL. Analysis of the pathogenesis of PTL indicates that both antigenic stimulation in the setting of Hashimoto's thyroiditis and aberrant somatic hypermutation may play a role. The first large, population-based study of PTL indicated that age, stage, histologic subtype, and treatment modality have prognostic implications. The U.S. Food and Drug Administration approval of rituximab for non-Hodgkin's lymphoma has improved standard chemotherapeutic options, as data on efficacy in nodal and other extranodal lymphomas have been extrapolated to PTL. Advances in the understanding of the histologic subtypes of PTL have led to more accurate diagnosis and tailored treatments. The introduction of a new chemotherapeutic agent has expanded the treatment paradigm for PTL. Important prognostic indicators of survival for patients with PTL have been confirmed in the first population-based study. This article emphasizes current diagnostic and treatment approaches and discusses the potential for future developments.
    Current opinion in oncology 10/2009; 22(1):17-22. DOI:10.1097/CCO.0b013e3283330848 · 4.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study reports a case of plasma cell granuloma of the thyroid gland in a 47-year-old woman, presenting with a right subhyoid mass and a previous diagnosis of Hashimoto thyroiditis dating back to 1988, which was made on a subtotal thyroidectomy. Plasma cell granuloma preferentially involves the lung, with only 18 cases of thyroid gland involvement having been reported to date in the English literature. Thyroid plasma cell granuloma preferentially affects women and classically shows a prominent plasma cell infiltrate embedded in a variable degree of fibrous stroma: only 2 of the reported cases exhibited the morphologic features of inflammatory myofibroblastic tumor. These morphologic features may raise problems in the differential diagnosis with other plasma cell-rich disorders, including infectious diseases and auto(dys)immune conditions, including the recently described "IgG4-related sclerosing disease." In view of these considerations, a contemporary diagnostic approach to thyroid plasma cell granuloma is therefore discussed here.
    International Journal of Surgical Pathology 12/2011; 20(5):500-6. DOI:10.1177/1066896911431453 · 0.95 Impact Factor
Show more