Prompt diagnosis and airway management for primary thyroid lymphoma with compromised upper airway: a single-institution case series.

Abstract

Objectives: Primary thyroid lymphoma (PTL) is a rare malignant tumour. Prompt and accurate diagnosis and optimal airway management are crucial for PTL, especially when complicated with dyspnoea.

Methods: Eight patients with PTL and dyspnoea treated in Beijing Friendship Hospital from January 2015 to December 2021 were retrospectively reviewed.

Results: Three of four patients complicated with mild to moderate dyspnoea underwent chemotherapy after prompt diagnosis by fine needle aspiration cytology (FNAC) combined with cell block immunocytochemistry (CB-ICC) and flow cytometric immunophenotyping (FCI) or core needle biopsy (CNB) combined with immunohistochemistry (IHC) without open surgery. Total thyroidectomy was performed in one patient without other diagnostic methods because the FNAC result was inconclusive. Four patients with moderate to severe dyspnoea underwent tracheostomy and incisional biopsy without severe complications after tracheal intubation under the guidance of a fibreoptic bronchoscope performed without general anaesthesia.

Conclusions: For patients with mild to moderate dyspnoea suspected of PTL, FNAC along with FCI and CB-ICC or CNB along with IHC are recommended, in addition to prompt chemotherapy to avoid prophylactic tracheostomy. Patients with moderate to severe dyspnoea suspected of PTL should undergo tracheal intubation under the guidance of a fibreoptic bronchoscope without general anaesthesia, followed by tracheostomy with simultaneous thyroid incisional biopsy to reduce the risk of asphyxia during treatment.