Primary Thyroid Marginal Zone Lymphoma Revealed by a Compressive Goitre: A Rare Diagnostic Challenge
Youssef Ouazzani Touhami *
Department1 Visceral Surgery, Mohamed V Military Instruction Hospital, Rabat, Morocco.
Amine Maazouz
Department1 Visceral Surgery, Mohamed V Military Instruction Hospital, Rabat, Morocco.
Karima Sif Nasr
Department of Radiology, Mohamed V Military Instruction Hospital, Rabat, Morocco.
Mohamed Allaoui
Department of Histopathology, Mohamed V Military Instruction Hospital, Rabat, Morocco.
Mohamed Bouzroud
Department1 Visceral Surgery, Mohamed V Military Instruction Hospital, Rabat, Morocco.
Mountassir Moujahid
Department1 Visceral Surgery, Mohamed V Military Instruction Hospital, Rabat, Morocco.
Ahmed Bounaim
Department1 Visceral Surgery, Mohamed V Military Instruction Hospital, Rabat, Morocco.
Sidi Mohamed Bouchentouf
Department1 Visceral Surgery, Mohamed V Military Instruction Hospital, Rabat, Morocco.
Hakim El Kaoui
Department1 Visceral Surgery, Mohamed V Military Instruction Hospital, Rabat, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background: Primary thyroid lymphoma (PTL) is a rare extranodal lymphoma often associated with chronic autoimmune thyroiditis and may mimic other thyroid neoplasms, predominantly affecting elderly patients.
Aim: This report aims to highlight the diagnostic challenges, imaging features, and therapeutic considerations of this uncommon entity.
Case Presentation: We report the case of a 69-year-old patient presenting with a progressively enlarging cervical mass associated with compressive symptoms. Cervical ultrasound revealed a suspicious right thyroid nodule, and biopsy demonstrated a lymphoid infiltrate consistent with marginal zone lymphoma. Cross-sectional imaging showed a large infiltrative thyroid mass with regional lymphadenopathy, while FDG PET-CT confirmed localised disease. Thyroid function tests were normal. Following multidisciplinary discussion, a total thyroidectomy was performed. Histopathological and immunohistochemical analyses confirmed a primary thyroid marginal zone lymphoma arising in a background of chronic lymphocytic thyroiditis, with no lymph node involvement
Discussion: Primary thyroid marginal zone lymphoma is an indolent disease with non-specific clinical and radiological features, making histological confirmation essential. Imaging plays a key role in staging and excluding disseminated disease. Management remains controversial, and surgery may be justified in selected cases with compressive symptoms or diagnostic uncertainty.
Conclusion: Primary thyroid marginal zone lymphoma should be considered in elderly patients with a slowly enlarging goitre, particularly in the setting of autoimmune thyroiditis. A multidisciplinary approach is crucial to ensure accurate diagnosis and optimal management.
Keywords: Primary thyroid lymphoma, marginal zone lymphoma, Hashimoto’s thyroiditis, thyroidectomy