Abstract
Lymphocyte-only aspirates pose a significant diagnostic challenge in the interpretation of thyroid fine-needle aspiration specimens. Differential diagnosis includes Hashimoto thyroiditis, lymphoma, intrathyroidal lymph node, intrathyroidal thymoma, and thyroglossal duct cyst. Hashimoto thyroiditis especially in the florid lymphoid phase usually presents as lymphocyte-only aspirates. During this phase, numerous hyperplastic lymphoid follicles are seen throughout the gland, and they often replace the thyroid parenchyma. Lymphomas of the thyroid typically occur in older patients, almost always arise in a background of Hashimoto thyroiditis and are of B-cell lineage. Primary lymphomas of the thyroid gland are mainly diffuse large B-cell lymphoma (DLBCL) and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) and to a much lesser extent Hodgkin and small lymphocytic lymphoma. Given the limitations of establishing a lymphoma diagnosis with only cytomorphology, morphological evaluation is commonly augmented with flow cytometry or immunohistochemistry in the diagnostic workup of lymphocyte-only fine-needle aspirates from the thyroid.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Chistiakov DA. Immunogenetics of Hashimoto’s thyroiditis. J Autoimmune Dis. 2005;2:1.
Harris NL. Lymphoid proliferations of the salivary glands. Am J Clin Pathol. 1999;111:S94–103.
Shiono H, Fujii Y, Okumura M, Takeuchi Y, Inoue M, Matsuda H. Failure to down-regulate Bcl-2 protein in thymic germinal center B cells in myasthenia gravis. Eur J Immunol. 1997;27:805–9.
Abdou AG, Aiad HA. Intrathyroid lymph node tissue in multinodular goiter in an Egyptian female. Saudi Med J. 2009;30:558–60.
DeMay RM. The art and science of cytopathology: superficial aspiration cytology. Chicago: ASCP Press; 2012.
Gill M, Batra A, Sangwaiya A, Shakya S, Gupta S, Sen R. Small lymphocytic lymphoma of the thyroid mimicking plasmacytoma. Eur Thyroid J. 2014;3:202–5.
Vega F, Lin P, Medeiros LJ. Extranodal lymphomas of the head and neck. Ann Diagn Pathol. 2005;9:340–50.
Thakral B, Zhou J, Medeiros LJ. Extranodal hematopoietic neoplasms and mimics in the head and neck: an update. Hum Pathol. 2015;46:1079–100.
Derringer GA, Thompson LD, Frommelt RA, Bijwaard KE, Heffess CS, Abbondanzo SL. Malignant lymphoma of the thyroid gland: a clinicopathologic study of 108 cases. Am J Surg Pathol. 2000;24:623–39.
Thieblemont C, Mayer A, Dumontet C, et al. Primary thyroid lymphoma is a heterogeneous disease. J Clin Endocrinol Metab. 2002;87:105–11.
Ha CS, Shadle KM, Medeiros LJ, et al. Localized non-Hodgkin lymphoma involving the thyroid gland. Cancer. 2001;91:629–35.
Kini SR. Thyroid cytopathology: an Atlas and text. Philadelphia: Wolters Kluwer/ Lippincott Williams & Wilkins; 2008.
Katna R, Shet T, Sengar M, et al. Clinicopathologic study and outcome analysis of thyroid lymphomas: experience from a tertiary cancer center. Head Neck. 2013;35:165–71.
Aggarwal N, Swerdlow SH, Kelly LM, et al. Thyroid carcinoma-associated genetic mutations also occur in thyroid lymphomas. Mod Pathol. 2012;25:1203–11.
Gindin T, Murty V, Alobeid B, Bhagat G. MLL/KMT2A translocations in diffuse large B-cell lymphomas. Hematol Oncol. 2015;33:239–46.
Bacon CM, Diss TC, Ye H, et al. Follicular lymphoma of the thyroid gland. Am J Surg Pathol. 2009;33:22–34.
Jayaram G. Hodgkin’s disease beginning as a thyroid nodule. Acta Cytol. 1993;37:256–7.
Gupta N, Nijhawan R, Srinivasan R, Rajwanshi A, Dutta P, Bhansaliy A, et al. Fine needle aspiration cytology of primary thyroid lymphoma: a report of ten cases. Cytojournal. 2005;2:21.
Swart GJ, Wright C, Brundyn K, Mansvelt E, du Plessis M, ten Oever D, et al. Fine needle aspiration biopsy and flow cytometry in the diagnosis of lymphoma. Transfus Apher Sci. 2007;37:71–9.
Neill J. Intrathyroid thymoma. Am J Surg Pathol. 1986;10:660–1.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Adeniran, A.J., Chhieng, D. (2016). Lymphocyte-Only Aspirates. In: Common Diagnostic Pitfalls in Thyroid Cytopathology. Springer, Cham. https://doi.org/10.1007/978-3-319-31602-4_6
Download citation
DOI: https://doi.org/10.1007/978-3-319-31602-4_6
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-31600-0
Online ISBN: 978-3-319-31602-4
eBook Packages: MedicineMedicine (R0)