Endocrine Abstracts

Introduction: Non-Hodgkin lymphoma (NHL) involving the thyroid gland constitutues 2–3% of all NHL cases, 2–8% of all thyroid malignancies. The majority of lymphomas arising in the thyroid gland are MALT lymphomas and diffuse large B cell lymphomas commonly occuring in the setting of thyroiditis. Most cases are seen in adult or elderly females. The thyroid enlargement is often rapid and can lead to symptoms of tracheal or laryngeal compression. Herein, we present a case of diffuse large B cell lymphoma of the thyroid gland presenting with acute tracheal compression.

Case report: A 60 year-old woman had received a diagnosis of pneumonia with symptoms of cough, expectoration and dispnea. She had begun antibiotherapy. During treatment, a rapid progression of dispnea had occured. A huge, retrosternal goitre compressing trachea had been detected by computerized tomography. She had gave a history of a rapid increase in the size of swelling on her neck over 3-month period associated with difficulty in swallowing. She had been entubated and gone under urgent thyroidectomy and tracheostomy. After operation, she was extubated, followed by tracheostomy. Pathologic specimen established the diagnosis of diffuse large B cell lymphoma of the thyroid gland (Default 1). Bone marrow aspiration was negative for metastasis. Positron Emission Tomography performed for staging revealed involvement of locoregional lymph nodes; cervical, supraclavicular, and mediastinal lymph nodes (Figure 2).

She was given R-CHOP (Rituximab, Cyclophosphamide, Adriamycin, Vincristin, Prednisolon). A remarkable regression for the size of the lesions was observed after the first cure of therapy. Tracheostomy has been decanualeted and is being waited for healing.

Conclusion: Thyroid lymphoma is a rare disease. Fine needle aspiration and ultrasonography may be usefull for acutely swelling glands. Medical treatment and radiotherapy are first line treatments. Patients may present with acute compression symptoms as in our case. Surgery may be needed to overcome compression symptoms.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector