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Xu T, Wu L, Ye H, Luo S, Wang J. Thyroid papillary carcinoma combined with primary follicular lymphoma: a case report. Diagn Pathol 2024; 19:69. [PMID: 38773600 PMCID: PMC11107012 DOI: 10.1186/s13000-024-01495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/11/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) stands out as the most prevalent epithelial malignant thyroid tumor. Thyroid primary follicular lymphoma (PFL) represents a rare malignant tumor originating from mesenchymal tissues. The concurrent occurrence of PTC and PFL is exceptionally rare, particularly in the context of Hashimoto's thyroiditis, presenting significant challenges in clinical diagnosis and treatment. CASE DEMONSTRATION A 44-year-old female patient presented with a neck mass persisting for over 1 month. The patient underwent surgery, and the incised tissues were subjected to pathology examinations, along with immunohistochemistry and next-generation sequencing tests suggestive of an EZH2 gene mutation in the tumor cells. The final pathological diagnosis confirmed the presence of PTC combined with PFL. Following a 27-month follow-up, the patient displayed no signs of recurrence or metastasis. CONCLUSIONS The concurrent occurrence of PTC and PFL poses notable challenges in clinical practice, requiring careful consideration in diagnosis and treatment. Herein, we present a rare case of PTC combined with PFL featuring an EZH2 gene mutation, which can be easily overlooked in the context of Hashimoto's thyroiditis. The patient's favorable response to surgical and radiotherapeutic interventions underscores the importance of accurate diagnosis and tailored treatment strategies in similar cases.
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Affiliation(s)
- Ting Xu
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, P.R. China
- Department of Pathology, Zhejiang Provincial People's Hospital Bijie Hospital, Bijie City, Guizhou Province, China
| | - Li Wu
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, P.R. China
| | - Hua Ye
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, P.R. China
| | - Shuai Luo
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, P.R. China
| | - Jinjing Wang
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, P.R. China.
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Lincango EP, Serrano LF, Vallejo S, Solis-Pazmino P, Garcia-Bautista A, Acosta W, Ponce OJ, Salazar-Vega J, Garcia C. Diffuse large B-cell lymphoma associated with papillary thyroid carcinoma: a case report and systematic review on management and outcomes. J Surg Case Rep 2024; 2024:rjad658. [PMID: 38803841 PMCID: PMC11128766 DOI: 10.1093/jscr/rjad658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/17/2023] [Indexed: 05/29/2024] Open
Abstract
Primary thyroid lymphoma is a rare thyroid cancer, comprising ˂5% of thyroid neoplasms. Most cases are diffuse large B-cell lymphoma (DLBCL). Coexistence with papillary thyroid cancer (PTC) is extremely rare. This study presents a case of a 55-year-old woman with DLBCL and micropapillary thyroid cancer who underwent lobectomy, chemotherapy, and radiotherapy. Additionally, we performed a systematic review of 10 cases, including the reported case. The risk of bias in case reports varied. DLBCL diagnoses were mainly made after surgery, with total thyroidectomy being the most common surgical procedure. Chemotherapy was administered in most cases, and radiotherapy was used in some cases. Long-term outcomes indicated a low recurrence rate. While some debate the role of surgery in thyroid lymphoma, this study suggests that surgery should be considered in selected cases. Further research is needed to determine optimal treatment strategies for DLBCL with PTC.
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Affiliation(s)
- Eddy P Lincango
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, United States
- Deparment of Surgery, CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
| | - Luis F Serrano
- Department of Surgery, University of Central Florida, Orlando, United States
| | - Sebastian Vallejo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, United States
- Department of Internal Medicine, University of Miami, Florida, United States
| | - Paola Solis-Pazmino
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, United States
- Deparment of Surgery, CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Deparment of Surgery, Instituto de la Tiroides y Enfermedades de Cabeza y Cuello (ITECC), Quito, Ecuador
| | - Andrea Garcia-Bautista
- Internal Medicine, Doctors Hospital at Renaissance Health System, Edinburg, TX, United States
| | - William Acosta
- Medical School, Pontifica Universidad Católica del Ecuador, Quito, Ecuador
| | - Oscar J Ponce
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, United States
- Deparment of Surgery, CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Department of Internal Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Jorge Salazar-Vega
- Deparment of Surgery, CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Medical School, Pontifica Universidad Católica del Ecuador, Quito, Ecuador
| | - Cristhian Garcia
- Deparment of Surgery, CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Deparment of Surgery, Instituto de la Tiroides y Enfermedades de Cabeza y Cuello (ITECC), Quito, Ecuador
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Iskra I, Tomaš MI, Crnčić TB, Kukić E, Hadžisejdić I, Avirović M, Girotto N. Two lymphoma histotypes and papillary thyroid carcinoma coexisting on Hashimoto ground: a case report and review of the literature. Diagn Pathol 2024; 19:52. [PMID: 38461341 PMCID: PMC10924984 DOI: 10.1186/s13000-024-01472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 02/25/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Papillary carcinoma is the most frequent type of thyroid carcinoma, while primary thyroid lymphoma is uncommon disease. The coexistence of these entities has already been described, and the common risk factor is considered Hashimoto thyroiditis. The two most frequent histotypes of primary thyroid lymphoma are diffuse large B-cell and mucosa-associated lymphoid tissue lymphoma, but the coexistence of both with papillary carcinoma is rarely reported. METHODS We present a case of a previously healthy 57-years old male with rapidly growing lump on the right side of the neck. Ultrasonography revealed nodules in both thyroid lobes. Fine needle aspiration cytology and pertechnetate scintigraphy were performed. Due to the Bethesda T-5 in the "cold" nodule of the right lobe, surgery with histopathological and immunohistochemistry analysis was indicated. RESULTS Histopathological and immunohistochemistry methods confirmed concomitant malignancies in the thyroid gland: diffuse large B-cell lymphoma and papillary carcinoma in the right, and mucosa-associated lymphoid tissue lymphoma in the left lobe with Hashimoto thyroiditis in the remaining tissue. Patient underwent therapy procedures and was without signs of local recurrence or metastatic spread on subsequent follow-up. CONCLUSIONS Sudden appearance of the neck mass in patients with Hashimoto thyroiditis should raise suspicion on primary thyroid lymphoma and be promptly taken in the diagnostic workup, including fine needle aspiration cytology. Pathology with immunohistochemistry is crucial for further clinical decision making. Since the standardized protocol in management of these complex patients is missing, personal approach and close collaboration between cytologist, pathologist, surgeon, haematologist and nuclear medicine specialist is essential.
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Affiliation(s)
- Igor Iskra
- Clinical Department of Nuclear Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Maja Ilić Tomaš
- Clinical Department of Nuclear Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Tatjana Bogović Crnčić
- Clinical Department of Nuclear Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia.
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
| | - Edvin Kukić
- Clinical Department of Nuclear Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Ita Hadžisejdić
- Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Manuela Avirović
- Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Neva Girotto
- Clinical Department of Nuclear Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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Li J, He S, Xu J, Xue G. Coexistence of primary thyroid diffuse large B cell lymphoma and papillary thyroid carcinoma in a patient with Hashimoto's thyroiditis: a case report and literature review. Front Oncol 2023; 13:1248830. [PMID: 37869091 PMCID: PMC10585257 DOI: 10.3389/fonc.2023.1248830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common pathological type of thyroid malignancy and also has an excellent prognosis. Primary thyroid lymphoma (PTL) is rare and has a poor prognosis. The co-occurrence of both malignancies is extremely rare, and the preoperative diagnosis is rather difficult. We report the case of a patient with both PTC and PTL in the setting of Hashimoto's thyroiditis (HT). A 59-year-old female patient was referred to our department for progressive enlargement of the thyroid gland over a few months. The imaging results demonstrated an enlarged thyroid and a mass in the thyroid. Total thyroidectomy and bilateral central neck node dissection were conducted. The final diagnosis of the coexistence of thyroid diffuse large B cell lymphoma and PTC was confirmed by histopathology and immunohistochemistry. The patient received radiation therapy and six cycles of chemotherapy combined with targeted therapy, including rituximab, cyclophosphamide, doxorubicin, vindesine, and prednisone (R-CHOP). After 6 months of follow-up, neither tumor has recurred. It is important for physicians to keep PTL in mind for differential diagnosis in HT patients with sudden thyroid enlargement.
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Affiliation(s)
| | | | | | - Gang Xue
- Department of Thyroid and Breast Surgery, General Hospital of Western Theater Command of Chinese People’s Liberation Army, Chengdu, China
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The Risk of Developing Lymphoma among Autoimmune Thyroid Disorder Patients: A Cross-Section Study. DISEASE MARKERS 2022; 2022:4354595. [PMID: 35692889 PMCID: PMC9187447 DOI: 10.1155/2022/4354595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/06/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022]
Abstract
Background Graves' disease (GD) and Hashimoto's thyroiditis (HT) are the most common types of autoimmune thyroid diseases (AITD), and both are characterized by the infiltration of lymphocytes into the thyroid gland. Moreover, autoimmune diseases like HT have a higher risk of developing lymphoma. This study is aimed at assessing the prevalence and association of lymphoma in patients with AITD. Methods This cross-sectional study was conducted in King Abdulaziz Medical City, Jeddah, Saudi Arabia. Data were gathered from the medical records of patients aged 18 years or older who developed AITD. A total number of 140 medical records were collected, and 72 patients were included after applying in exclusion criteria. Data on the subtype, clinical-stage, treatment modality, patient status, remission, and relapse were collected for patients who developed lymphoma. Results Among 72 patients who developed AITD, HT was diagnosed in 58 (80.6%) patients and GD in 14 (19.4%). Five (7%) patients were diagnosed with lymphoma all of whom had a history of HT. The subtypes of lymphoma were diffuse large B-cell lymphoma (DLBCL 3; 4.2%), follicular lymphoma 1 (1.4%), and Hodgkin's lymphoma 1 (1.4%). Conclusion The prevalence of PTL in patients with AITD, specifically HT, was 7%. Most patients developed NHL, with DLBCL being the most common subtype. The onset of lymphoma in this study was lower than reported in the literature. All patients with PTL had HT in their backgrounds. Further national studies are warranted to explore the relationship between the two diseases to provide more insight into the comprehension of this association.
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Li Q, Zhu F, Xiao Y, Liu T, Liu X, Zhang L, Wu G. Synchronous double primary lymphoma and thyroid cancer: A single-institution retrospective study. Medicine (Baltimore) 2021; 100:e27061. [PMID: 34596109 PMCID: PMC8483851 DOI: 10.1097/md.0000000000027061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/13/2021] [Accepted: 08/05/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Synchronous double primary malignancies of lymphoma and thyroid cancer are rare. In this retrospective study, we investigated the pathology, clinical characteristics, and treatment outcomes of patients with synchronous lymphoma and thyroid cancer.Of the 1156 newly diagnosed lymphoma patients treated in our hospital between January 1, 2016 and February 1, 2021, 8 cases had lymphoma complicated with thyroid cancer. The clinical data and treatment strategies of 8 cases with synchronous lymphoma and thyroid cancer were retrospectively analyzed.The median age of patients was 56 (25-64) years. All the 8 patients were female and papillary thyroid cancer. Only 1 patient had peripheral T-cell lymphoma, and the other 7 were B-cell lymphoma. Seven of 8 patients had normal free triiodothyronine and free thyroxine at the time of diagnosis. Seven thyroid cancer patients received total thyroidectomy and levothyroxine and the remaining 1 patient has a plan for surgery. At the last follow-up, 7 patients with B-cell lymphoma are alive; the patient with peripheral T-cell lymphoma complicated with thyroid cancer died due to lymphoma progression.Synchronous lymphoma and thyroid cancer are more predominant in women. Histologically, B-cell lymphomas and papillary thyroid cancer subtypes are more common. Attention should be paid to the presence of thyroid nodules in the diagnosis of lymphoma. Biopsy or ultrasound-guided fine needle aspiration of the suspicious thyroid nodule should be performed to exclude thyroid malignancy.
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