Objective: We examined cytological findings for the diagnosis of primary thyroid mucosa-associated lymphoid tissue (MALT) lymphoma by fine needle aspiration. Study Design: During the study period of 4 years, a total of 101 cases including 51 MALT lymphomas, 20 Hashimoto's thyroiditis (HT), and 30 diffuse large-cell B-cell lymphomas were cytologically examined. MALT lymphomas were divided into 44 common MALT and 7 MALT lymphomas with extreme plasmacytic differentiation (MALT-EPCD). Results: (1) Small- to medium-sized cells displaying irregularly shaped nuclei with prominent nucleoli (ISN-PN) were neoplastic cells. (2) In the case of a frequency of plasma cells (PC) below 15%, the accuracy rate for distinguishing common MALT from HT was 97% for ISN-PN cell frequencies above 20% in combination with the presence of lymphoepithelial lesion clusters (LELC) and mountain range-like clusters (MRLC). The frequency of large-sized cells was below 15% in common MALT. (3) In the case of a frequency of PC above 15%, cases with a sum of PC and ISN-PN cells above 30% were MALT-EPCD. (4) MRLC were cell clusters derived from regions of follicular colonization, and LELC were cell clusters from lymphoepithelial lesions of MALT lymphomas. Conclusion: Useful cytological criteria for the diagnosis of thyroid primary MALT lymphoma, such as neoplastic cells and cell clusters, were defined.

Keywords:
Fine needle aspiration cytology, Thyroid, Mucosa-associated lymphoid tissue lymphoma, Lymphoepithelial lesion, Follicular colonization, Plasma cells
1.
Isaacson PG, Wright D: Malignant lymphoma of mucosa-associated lymphoid tissue. Cancer 1983;52:1410-1416.
2.
Jaffe ES, Harris NL, Stein H, Wardiman JW: WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, IARC Press, 2001 vol 1, pp 42-160, 172.
3.
Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Vardiman JW: WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, IARC Press, 2008, pp 200-217.
4.
The Japanese Society of Thyroid Surgery: General Rules for the Description of Thyroid Cancer, ed 6 (in Japanese). Tokyo, Kanehara Shuppan, 2005, pp 26-27.
5.
DeLellis RA, Lloyd RV, Heitz PU, Eng C: WHO Classification of Tumours: Pathology and Genetics - Tumours of Endocrine Organs. Lyon, IARC Press, 2004, p 110.
6.
Kaba S, Hirokawa M, Nobuoka Y, Higuchi M, Yamao N, Suzuki A, Takagi N, Kojima M, Miyauchi A: Findings and significance of mountain range-like clusters derived from follicular colonization for the diagnosis of MALT lymphoma (in Japanese with English summary). J Jpn Soc Clin Cytol 2013;52:428-436.
7.
Kaba S, Hirokawa M, Nobuoka Y, Higuchi M, Yamao N, Suzuki A, Takagi N, Kojima M, Miyauchi A: Cytological findings of primary thyroid MALT lymphoma with extreme plasma cell differentiation in fine needle aspiration specimens (in Japanese with an English summary). J Jpn Soc Clin Cytol 2013;52:507-517.
8.
Matsuda M, Sone H, Koyama H, Ishiguro S: Fine-needle aspiration cytology of malignant lymphoma of the thyroid. Diagn Cytopathol 1987;3:244-249.
9.
Tani E, Skoog L: Fine needle aspiration cytology and immunocytochemistry in the diagnosis of lymphoid lesions of the thyroid gland. Acta Cytol 1989;33:48-52.
10.
Detweiler RE, Katz RL, Alapat C, el-Naggar A, Ordonez N: Malignant lymphoma of the thyroid: a report of two cases diagnosed by fine-needle aspiration. Diagn Cytopathol 1991;7:163-171.
11.
Das DK, Gupta SK, Francis IM, Ahmed MS: Fine-needle aspiration cytology diagnosis of non-Hodgkin lymphoma of thyroid: a report of four cases. Diagn Cytopathol 1993;9:639-645.
12.
Hirokawa M, Hata S: Cytological comparisons of malignant lymphoma to non-neoplastic lympho-proliferative lesions of the thyroid (in Japanese with an English summary). J Jpn Soc Clin Cytol 1997;36:115-118.
13.
Kanzaki Y, Hashimoto K, Hosokawa K, Hayashi T, Nunomura M, Fujita Y, Kanbayashi T, Wakata Y: A case of mucosa-associated lymphoid tissue (MALT) lymphoma of thyroid (in Japanese with an English summary). J Jpn Soc Clin Cytol 1997;36:613-617.
14.
Sangalli G, Serio G, Zampatti C, Lomuscio G, Colombo L: Fine needle aspiration cytology of primary lymphoma of the thyroid: a report of 17 cases. Cytopathology 2001;12:257-263.
15.
Tsuruta S, Iijima M, Nomoto Y, Shinbo C, Negishi H, Hoshi K, Itho H, Oyama T, Johshita T, Suzuki Y: Cytological features of mucosa-associated lymphoid tissue (MALT) lymphoma arising from thyroid glands (in Japanese with an English summary). J Jpn Soc Clin Cytol 2002;41:327-334.
16.
Lerma E, Arguelles R, Rigla M, Otal C, Cubero J-M, Bagué S, Carreras AM, Eulalia E, Gonzalez-Campora R, Galera H, Prat J: Comparative findings of lymphocytic thyroiditis and thyroid lymphoma. Acta Cytol 2003;47:575-580.
17.
Gupta N, Nijhawan R, Srinivasan R, Nijhawan R, Srinivasan R, Rajwanshi A, Dutta P, Bhansaliy A, Sharma SC: Fine needle aspiration cytology of primary thyroid lymphoma: a report of ten cases. Cytojournal 2005;2:21.
18.
Morgen EK, Geddie W, Boerner S, Bailey D, Santos Gda C: The role of fine-needle aspiration in the diagnosis of thyroid lymphoma: a retrospective study of nine cases and review of published series. J Clin Pathol 2010;63:129-133.
19.
Kaba S, Hirokawa M, Kuma S, Maekawa M, Yanase Y, Kojima M, Miyauchi A: Cytologic findings of primary thyroid MALT lymphoma with extreme plasma cell differentiation: FNA cytology of two cases. Diagn Cytopathol 2009;37:815-819.
20.
Kaba S, Tokoro Y, Washiya K, Tokairin T, Ono I, Tsuchida S, Kojima M, Koshikawa T: Cytology of pulmonary marginal zone B-cell lymphoma of MALT type: lessons learned for intra-operative diagnosis. Cytopathology 2011;22:346-349.
21.
Isaacson PG, Androulakis-Papachristou A, Diss TC, Pan L, Wright DH: Follicular colonization in thyroid lymphoma. Am J Pathol 1992;141:43-52.
22.
Barton FE, Farmer DA: Plasmacytoma of the thyroid gland. Ann Surg 1950;132:304-309.
23.
Macpherson TA, Dekker A, Kapadia SB: Thyroid-gland plasma cell neoplasm (plasmacytoma). Arch Pathol Lab Med 1981;105:570-572.
24.
Chesyln-Curtis S, Akosa AB: Primary plasmacytoma of the thyroid. Postgrad Med J 1990;66:477-478.
25.
Kovacs CS, Mant MJ, Nguyen GK, Ginsberg J: Plasma cell lesions of the thyroid: report of a case of solitary plasmacytoma and a review of the literature. Thyroid 1994;4:65-71.
26.
Vailati A, Marena C, Milani F, Aristia L, Sozzé E, Galenda P, Breyer S, Bossolo PA, Ascari E: Cytological evidence of plasmacytoma of the thyroid. Haematologica 1995;80:91-92.
27.
Bourtsos EP, Bedrossi ANAW, De Frias DV, Nayar R: Thyroid plasmacytoma mimicking medullary carcinoma: a potential pitfall in aspiration cytology. Diagn Cytopathol 2000;23:354-358.
28.
Al-Marzooq YM, Chopra R, Younis M, Al-Mulhim AS, AL-Momatten MI, AL-Omran SH: Thyroid low-grade B-cell lymphoma (MALT type) with extreme plasmacytic differentiation: report of a case diagnosed by fine-needle aspiration and flow cytometric study. Diagn Cytopathol 2004;31:52-56.
29.
Avila A, Villalpando A, Montoya G, Luna MA: Clinical features and differential diagnoses of solitary extramedullary plasmacytoma of the thyroid: a case report. Ann Diagn Pathol 2009;13:119-123.
30.
Seegmiller AC, Xu Y, McKenna RW, Karandikar NJ: Immunophenotypic differentiation between neoplastic plasma cells in mature B-cell lymphoma vs plasma cell myeloma. Am J Clin Pathol 2007;127:176-181.
31.
Nobuoka Y, Hirokawa M, Kuma S, Takagi N, Higuchi M, Masuoka H, Miya A, Kubota S, Miyauchi A: Cytologic findings and differential diagnoses of primary thyroid MALT lymphoma with striking plasma cell differentiation and amyloid deposition. Diagn Cytopathol 2014;42:73-77.
32.
Barber WA, Fernando M, Chadwick DR: Plasma cell granuloma of the thyroid: a conservative approach to a rare condition and review of the Literature. J Thyroid Res 2010;2010:840469.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.