Thyroid Nodule in an Eighteen-Year-Old Man as the First Presentation of Acute Lymphoblastic Leukemia

Abstract

Introduction:Acute lymphoblastic leukemia (ALL) is the most common malignancy of childhood. Patients with ALL commonly present with easy bruising and infections due to medullary involvement. The extra medullary involvements of ALL manifests as hepatosplenomegaly, lymphadenopathy, and testicular enlargement. Among extramedullary manifestations of the ALL, thyroid involvement is rare. Herein, we reported a case of ALL that manifested as a thyroid nodule.Case Presentation:An 18-year-old young man with a thyroid nodule presented without any other symptom or sign. The excisional biopsy of the nodule was planned by the surgeon. After two months of lost to follow-up, the patient returned with a complaint of continuous bleeding after a tooth extraction. Peripheral blood smear (PBS) study and bone marrow aspiration proposed ALL and the flow cytometry confirmed the diagnosis. The R-Hyper-CVAD induction chemotherapeutic regimen (rituximab in combination with cyclophosphamide, vincristine, doxorubicin, and dexamethasone) was used for treatment. Interestingly, thyroid sonography and Tc99m scan showed resolution of the thyroid nodule after chemotherapy.Discussion:In this patient, poor interdisciplinary communication and the rarity of this manifestation led to a delayed diagnosis. Therefore, we insist on more careful clinical examinations, reassessment of unusual FNA reports, and closer communication between clinicians and pathologists in such cases. This approach would lead to accurate and earlier diagnosis and would prevent unnecessary interventions.

Dual malignancy in a thyroid; papillary thyroid carcinoma and small lymphocytic lymphoma; a report of a case with a cyto‐histologic correlation

“…Among lymphomas, DLBCL is the most common and the CLL/SLL is the least common. 17 In our case, we were able to identify two concurrent malignancies in a thyroid nodule by FNA cytology. 12 However the concomitant occurrence of two different primary malignancies in the thyroid is rare, a few cases have been reported in the context of Hashimoto's thyroiditis as PTC with MALT lymphoma.…”

“…15 Symptomatic presentation of thyroid leukemias/lymphomas is unusual; however, it has been reported as thyroid lesions simulating thyroid cancer in some cases, 15 and thyroid dysfunction in others, 16 or even as primary presentation of the leukemia/lymphoma itself. 17 In our case, we were able to identify two concurrent malignancies in a thyroid nodule by FNA cytology. After finding the PTC as the primary lesion of concern, a second population of monomorphic atypical lymphocytes was also observed.…”

Rapidly Growing Thyroid Mass: An Unusual Case of Acute Lymphoblastic Leukemia

“…In the literature, there are ALL patients presenting with extramedullary infiltration signs and complete blood count within normal ranges [ 1 , 2 ]. To the best of our knowledge this is the fourth case of B ALL with extramedullary thyroid infiltration in the literature [ 3 , 4 , 5 ]. As highlighted by the present report, performing fine-needle aspiration cytology should always be considered in the clinical context of a rapidly growing thyroid mass under treatment, and without resolving symptoms.…”