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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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Peng C, Yang C, Yao J, Xu J, Wu J, Zhao J, Xu D. Multimodal Sonographic Appearance and Survival Outcomes of 69 Cases of Primary Thyroid Lymphoma Over 10 Years. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3031-3040. [PMID: 35673932 DOI: 10.1002/jum.16032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/08/2022] [Accepted: 05/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To investigate ultrasound appearance and the survival outcomes for patients with primary thyroid lymphoma (PTL). METHODS Ultrasonic images and clinical characteristics from pathologically confirmed 69 PTL patients (2008-2019) were retrospectively analyzed. The clinical characteristics, ultrasonic characters, and prognostic factors were analyzed. Survival curves were plotted using the Kaplan-Meier method. Univariate and multivariate analyses were performed. RESULTS Of the 69 study patients, 23 were indolent PTL and 46 were aggressive PTL. Age (>70 years old) and elevated lactate dehydrogenase levels were statistically different clinical features between aggressive and indolent PTL. From ultrasonic images, 34 cases were nodular, 11 diffuse, and 24 mixed pattern. Mixed types displayed high invasiveness (45.7%) while diffuse types displayed higher inertness (39.1%), with statistically significant differences (P = .000). Invaded thyroid capsule and increased chaotic vascularity also showed significant differences between aggressive and indolent PTL. We also observed statistical difference in overall survival rates between aggressive and indolent PTL (P = .032). Single factor K-M analyses showed that age >70 years, aggressive pathology, and Ki67 >30% were positively correlated with the risk of poor PTL survival (P < .05). CONCLUSIONS Multimodal ultrasound provides accurate ultrasonographic information and facilitates PTL invasiveness diagnostics for improved clinical treatment. In addition, PTL patients aged >70 years, with aggressive pathology, and Ki67 >30% were more likely to have a poor survival outcome.
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Affiliation(s)
- Chanjuan Peng
- Department of Ultrasound Medicine, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy Of Sciences, Hangzhou, China
| | - Chen Yang
- Department of Ultrasound Medicine, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy Of Sciences, Hangzhou, China
| | - Jincao Yao
- Department of Ultrasound Medicine, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy Of Sciences, Hangzhou, China
| | - Jingjing Xu
- Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy Of Sciences, Hangzhou, China
| | - Junzhou Wu
- Core Facility Service, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy Of Sciences, Hangzhou, China
| | - Jiazheng Zhao
- Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy Of Sciences, Hangzhou, China
| | - Dong Xu
- Department of Ultrasound Medicine, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy Of Sciences, Hangzhou, China
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Liu XM, Ma DL, Yuan G, Xie JH. Progressively Enlarging Goiter: Case Reports of Primary Thyroid Lymphoma and Literature Review. Curr Med Sci 2020; 40:518-522. [PMID: 32474859 DOI: 10.1007/s11596-020-2204-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/03/2020] [Indexed: 12/23/2022]
Abstract
Primary thyroid lymphoma (PTL) is an exceptionally rare and highly aggressive potentially curable malignant disease. We report three typical cases of PTL referred to our hospital. All three cases had long history of Hashimoto's thyroiditis, and presented with progressively enlarging neck mass. The first two cases were confirmed by surgical biopsy to be diffuse large B cell lymphoma, and received radiotherapy combined with chemotherapy, or received only chemotherapy. The third case was confirmed by core needle biopsy to be mucosa-associated lymphoid tissue lymphoma, and received radiotherapy. In summary, confirmation of PTL diagnosis is essential for further clinical decisions. Core biopsy should be one of the most important methods to make the diagnosis of PTL, while the use of fine needle aspiration cytology alone is still limited in diagnosing PTL.
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Affiliation(s)
- Xia-Ming Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - De-Lin Ma
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Gang Yuan
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jun-Hui Xie
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Kir G, Sarbay BC, Ozpek A. Cytodiagnosis of Primary Thyroid Lymphoma Coincident with Unnoticed Papillary Thyroid Carcinoma: A Case Report and Review of the Literature. J Cytol 2018; 35:187-189. [PMID: 30089952 PMCID: PMC6060575 DOI: 10.4103/joc.joc_180_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, whereas primary thyroid lymphoma is very rare. Here, we report a case in which a right-sided nodule measuring 4.3 × 2.2 cm was examined using fine-needle aspiration biopsy. This revealed abundant monomorphic non-cohesive large lymphoid cells without thyroid follicular cells, on which basis acytodiagnosis of lymphoma coincident with lymphocytic thyroiditis was made. Subsequent histologic examination revealed CD45−, CD20+, and Bcl-6 + and cytokeratin-, CD3-, CD5-, and CD30-negative tumor cells arranged diffusely in the whole thyroid coexisting with a separate PTC nodule sized 1.3 × 1.0 cm in the right lobe. The key point exemplified by this case is that a cytodiagnosis of this extremely rare coexistence of PTC and lymphoma can be made by adequate sampling of both nodules preoperatively. In our case, only one nodule formation was sampled, and therefore the coexisting PTC was not detected with cytology preoperatively.
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Affiliation(s)
- Gozde Kir
- Department of Pathology, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Billur Cosan Sarbay
- Department of Pathology, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Adnan Ozpek
- Department of General Surgery, Umraniye Education and Research Hospital, Istanbul, Turkey
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Ahmed OI, Salih ZT. Dual malignancy in a thyroid; papillary thyroid carcinoma and small lymphocytic lymphoma; a report of a case with a cyto-histologic correlation. Diagn Cytopathol 2017; 45:851-856. [DOI: 10.1002/dc.23748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/30/2017] [Accepted: 05/08/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Omar I. Ahmed
- Department of Pathology; Wake Forest School of Medicine; Winston-Salem North Carolina
| | - Ziyan T. Salih
- Department of Pathology; Wake Forest School of Medicine; Winston-Salem North Carolina
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Coexistence of papillary thyroid microcarcinoma and mucosa-associated lymphoid tissue lymphoma in a context of Hashimoto's thyroiditis. ASIAN PAC J TROP MED 2016; 9:812-4. [DOI: 10.1016/j.apjtm.2016.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/16/2016] [Accepted: 06/21/2016] [Indexed: 11/21/2022] Open
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Marcy PY, Thariat J, Chevenet C, Lacout A. Jugular Vein Invasion Diagnosis and Prognosis in Thyroid Carcinomas. Pol J Radiol 2016; 81:268-9. [PMID: 27354880 PMCID: PMC4907401 DOI: 10.12659/pjr.896757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/25/2015] [Indexed: 01/05/2023] Open
Abstract
Diagnosis of venous jugular invasion by means of traditional imaging is very rarely reported in the literature. Doppler ultrasound definitively helps to diagnose the tumor thrombus, the extent, and helps in redefining the TNM stage of such an aggressive thyroid tumor.
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Affiliation(s)
- Pierre Yves Marcy
- Department of Radiodiagnostics, PolyClinique Les Fleurs, Ollioules, France
| | - Juliette Thariat
- Department of Oncology & Radiation Therapy, Antoine Lacassagne Cancer Research Institute, Nice, France
| | - Carole Chevenet
- Department of Histopathology, Centre de Pathologie, Aurillac, France
| | - Alexis Lacout
- Department of Radiodiagnostics, Surgical Medical Center de Tronquières (CMC) Aurillac, Aurillac, France
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Wu Q, Jiang YX, Guo JC, Xiao Y, Yang X, Zhao RN, Lai XJ, Zhu SL, Zhang XY, Zhang B. Pathology Verified Concomitant Papillary Thyroid Carcinoma in the Sonographically Suspected Thyroid Lymphoma: A Case Report. ACTA ACUST UNITED AC 2016; 31:54-58. [PMID: 28031089 DOI: 10.1016/s1001-9294(16)30023-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Qiong Wu
- Department of Ultrasound,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yu-Xin Jiang
- Department of Ultrasound,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jun-Chao Guo
- Department of General Surgery,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xiao Yang
- Department of Ultrasound,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Rui-Na Zhao
- Department of Ultrasound,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xing-Jian Lai
- Department of Ultrasound,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Shen-Ling Zhu
- Department of Ultrasound,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xiao-Yan Zhang
- Department of Ultrasound,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Bo Zhang
- Department of Ultrasound,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Shen G, Ji T, Hu S, Liu B, Kuang A. Coexistence of Papillary Thyroid Carcinoma With Thyroid MALT Lymphoma in a Patient With Hashimoto's Thyroiditis: A Clinical Case Report. Medicine (Baltimore) 2015; 94:e2403. [PMID: 26717396 PMCID: PMC5291637 DOI: 10.1097/md.0000000000002403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common type of thyroid neoplasias; however, primary thyroid gland lymphoma (PTL) is uncommon and their simultaneous occurrence is very rare.Herein, we reported a 25-year-old female patient with Hashimoto's thyroiditis (HT), who developed a small goiter with a palpable 1.2-cm nodule in the right lobe. A fine-needle aspiration (FNA) biopsy revealed atypical follicular epithelial cells and lymphoid cells in a background of lymphocytic thyroiditis. A total thyroidectomy was performed. The pathology showed multicentric papillary thyroid carcinoma, concomitant thyroid mucosa-associated lymphoid tissue (MALT) lymphoma, and Hashimoto's thyroiditis. Postoperatively, he received chemotherapy and radioactive iodine ablation treatment. Nowadays the thyroglobulin of the patient is undetectable, without recurrences at 2 years of follow-up.It is concluded that the PTC and MALT lymphoma can exist concomitantly, especially in patients with HT. For the diagnostic workup and optional management of this rare coexistence, a multidisciplinary approach and close surveillance are needed.
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Affiliation(s)
- Guohua Shen
- From the Department of Nuclear Medicine, West China Hospital of Sichuan University, No.37, Guoxue Alley, Chengdu, Sichuan (GS, SH, BL, AK); and Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yan Ta Road, Xi'an, Shanxi, People's Republic of China (TJ)
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Xie S, Liu W, Xiang Y, Dai Y, Ren J. Primary thyroid diffuse large B-cell lymphoma coexistent with papillary thyroid carcinoma: A case report. Head Neck 2015; 37:E109-14. [PMID: 25352071 DOI: 10.1002/hed.23917] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/19/2022] Open
Affiliation(s)
- Shumin Xie
- Department of Otolaryngology Head and Neck Surgery; The Second Xiangya Hospital of Central South University; Changsha People's Republic of China
| | - Wei Liu
- Department of Otolaryngology Head and Neck Surgery; The Second Xiangya Hospital of Central South University; Changsha People's Republic of China
| | - Yuyan Xiang
- Department of Human Anatomy; University of South China; Hengyang People's Republic of China
| | - Yinghuan Dai
- Department of Pathology; The Second Xiangya Hospital of Central South University; People's Republic of China
| | - Jihao Ren
- Department of Otolaryngology Head and Neck Surgery; The Second Xiangya Hospital of Central South University; Changsha People's Republic of China
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11
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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. [PMID: 25538903 PMCID: PMC4224251 DOI: 10.1159/000363292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/19/2014] [Indexed: 12/05/2022] Open
Abstract
Primary thyroid gland lymphomas (PTLs) typically occur in middle-to older-aged individuals in the setting of lymphocytic thyroiditis with a predilection for females. Diffuse large B-cell lymphoma is the most frequent histologic subtype of thyroid lymphomas. Small lymphocytic lymphoma (SLL) belongs to the least common subtypes of thyroid lymphoma. It is often associated with the involvement of lymph nodes, bone marrow, spleen, liver and, extremely rarely, other organs. PTLs with plasmacytic differentiation or extensive infiltration by plasma cells have been observed in marginal zone B-cell lymphomas in the thyroid but have never been described in a setting of SLL. Here, we present a case of primary SLL of the thyroid mimicking extramedullary plasmacytoma on fine-needle aspiration cytology.
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Affiliation(s)
- Meenu Gill
- Department of Pathology, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Ashima Batra
- Department of Pathology, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
- *Dr. Ashima Batra, Department of Pathology, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana 124001 (India), E-Mail
| | - Ashok Sangwaiya
- Department of Pathology, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | | | - Sumiti Gupta
- Department of Pathology, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Rajeev Sen
- Department of Pathology, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
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