Coexistence of diffuse large B-cell lymphoma and papillary thyroid carcinoma in a patient affected by Hashimoto's thyroiditis

Abstract

SUMMARYPapillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. On the contrary, primary thyroid lymphoma (PTL) is a rare disease, accounting for 2% to 5% of all thyroid malignancies. Despite several cases in which both PTC and PTL arise in the setting of Hashimoto's thyroiditis (HT), the coexistence of both tumors in HT patients is very rare. Herein we report the case of a 66-year-old woman with long-standing nodular HT under replacement therapy, who presented with a fast, painless enlargement in the right anterior side of the neck. Thyroid ultrasonography demonstrated increased growth of a hypoechoic nodule in the right lobe measuring 32 x 20 mm. A total thyroidectomy was performed, and histology revealed a diffuse large B-cell lymphoma (DLBCL) on a background of florid HT. Moreover, a unifocal papillary microcarcinoma, classical variant (7 mm, pT1aNxMx), was discovered. The patient was then treated with chemotherapy for the PTL, but she did not undergo radioactive iodine ablation treatment for the microPTC as per guidelines. Two years after surgery, the patient had no evidence of recurrence of either malignancy. This rare case highlights the importance of monitoring HT patients with nodular lesions, especially if they have long-standing disease. In addition, PTL should be considered for differential diagnosis in elder HT patients who present with sudden thyroid enlargement. Arch Endocrinol Metab. 2017;61(6):643-6

Coexistence of primary thyroid diffuse large B cell lymphoma and papillary thyroid carcinoma: a case report and literature review

“…9 In addition, Trovato et al. 10 recommended the importance of regular follow-ups to ensure an early diagnosis, considering the increased risk of neoplasms in patients with long-standing Hashimoto’s thyroiditis and nodular lesions.…”

“…Both of the above factors may result in lymphomas in patients with autoimmune disorders. 9 In addition, Trovato et al 10 recommended the importance of regular follow-ups to ensure an early diagnosis, considering the increased risk of neoplasms in patients with long-standing Hashimoto's thyroiditis and nodular lesions. The most common NHLs involving the thyroid include DLBL and extranodal marginal zone B-cell lymphoma, while primary Burkitt's lymphoma and T-cell lymphoma of the thyroid are extremely rare, with only a few isolated case reports.…”

TNF-α May Exert Different Antitumor Effects in Response to Radioactive Iodine Therapy in Papillary Thyroid Cancer with/without Autoimmune Thyroiditis

“…On the other hand, AIT features are independent risk factors for PTC development. The association between AIT, papillary thyroid cancer (PTC) and MALT lymphoma is the main topic of case reports [ 3 ]. Compared to the general population, patients with AIT have a three-fold higher risk of developing PTC [ 3 , 4 ], accounting for approximately 80% of all thyroid cancers.…”

“…The association between AIT, papillary thyroid cancer (PTC) and MALT lymphoma is the main topic of case reports [ 3 ]. Compared to the general population, patients with AIT have a three-fold higher risk of developing PTC [ 3 , 4 ], accounting for approximately 80% of all thyroid cancers. The coexistence of the two conditions has been reported in many studies [ 3 , 4 , 5 , 6 ].…”

“…Compared to the general population, patients with AIT have a three-fold higher risk of developing PTC [ 3 , 4 ], accounting for approximately 80% of all thyroid cancers. The coexistence of the two conditions has been reported in many studies [ 3 , 4 , 5 , 6 ]. However, regardless of the presence or absence of AIT, the treatment is the same, consisting of thyroidectomy followed by radioactive iodine ( 131 I) ablation of the postsurgical thyroid remnant [ 6 ].…”