SMALL-CELL MALIGNANT LESIONS OF THE THYROID GLAND*†

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Abstract
IN ALL the varied classifications of malignant thyroid neoplasms, about 20 per cent of the cases are relegated to a subdivision termed “anaplastic” or “undifferentiated.” These have perhaps been accorded less detailed study than the other more common groups. This, no doubt, stems partly from the prevailing impression that these lesions are uniformly fatal, and it has resulted in undeserved neglect of certain interesting and important entities. The anaplastic tumors may be broadly divided, on a histologic basis, into large-cell and small-cell types. The reported incidence of the latter varies in different series from 3 to 18 per cent (1, 2). Although previous studies have confirmed the view that no patients with large-cell carcinomas survive any appreciable length of time, several observers have noted the presence of occasional long-term survivors among the small-cell group. There has long been controversy over the possible existence of primary malignant lymphoma within this group. More recently, speculation has been revived as to a possible association of small-cell malignant lesions with struma lymphomatosa (Hashimoto's disease). Many pathologists, notably Ewing (3), have virtually refused to recognize the existence of primary lymphoma of the thyroid, electing to regard all small-cell lesions as carcinomas. Others have considered malignant lymphoma to be a rarity. In more recent years, in keeping with findings in bone and in the stomach, there has been more general acceptance of localized malignant lymphoma as an entity. In 1953 Brewer and Orr (4), in a comprehensive review of the literature, found 34 acceptable “reticulo-sarcomata” of the thyroid and added 13 new cases. Since then at least 15 other cases of primary malignant lymphoma have been reported in the literature. The widely divergent views as to the proper classification of these lesions effectively prevent any accurate statistical assessment of various series by observers unfamiliar with the material under review.

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