Coexistence of Hashimoto's thyroiditis with papillary carcinoma thyroid: A rare case report with review of literature

Abstract

Hashimoto's thyroiditis is an inflammatory disease of the thyroid gland. It has an autoimmune etiology. A higher incidence of papillary thyroid carcinoma with Hashimoto's thyroiditis was reported in several studies. 51 year old female patient presented with a swelling in front of the neck region since 5 years. Clinical examination revealed a swelling about 4x4x3 cm, smooth, tender, non-pulsatile and moved with deglutition. Ultrasonography revealed multinodular goiter without evidence of lymphadenpathy. Thyroid profile was done. Patient was euthyroid. FNAC reported as benign lesion. Hemithyroidectomy was done. Grossly thyroidectomy specimen i.e. hemithyroid 6x3x3 cm was received which was externally capsulated and nodular. Cut section showed a greyish white area and cystic areas each of size 1x1 cm filled with haemorrhagic and mucoid material respectively. Microscopy showed thyroid follicles with lymphoid infiltrate in the stroma forming follicles with germinal centres. Hurthle cell change was also noted. Section from both cystic areas showed plenty of complex branching papillae with fibrovascular core lined by cuboidal cells showing ground glass nuclei. The case was diagnosed as papillary carcinoma in Hashimoto's thyroiditis. The frequency of the association of Hashimoto's thyroiditis and differentiated thyroid carcinoma is approximately 30%. However, the presence of Hashimoto's thyroiditis has no effect on the diagnostic evaluation and management of papillary carcinoma of thyroid. Yet, one has to keep an eye for the features of papillary carcinoma in case of Hashimoto's thyroiditis. So a thorough grossing of thyroid specimen is recommended especially in patients who have Hashimoto's thyroiditis.