ECE2015 Eposter Presentations Thyroid cancer (90 abstracts)
Primary thyroid lymphoma: an ominous and commonly forgotten association with Hashimoto's thyroiditis
Cherng Jye Seow 1 , Davin Ryanputra 2 , Tian Ray Lai 1 , Chin Ee Ong 1 , Minyang Chow 1 , Grace Lum 1 , Claire Min-Li Teo 1 & Zhiguang Ng 1
1Tan Tock Seng Hospital, Singapore, Singapore; 2Yong Loo Lin School of Medicine, Singapore, Singapore.
Introduction: Primary thyroid lymphoma (PTL) is rare and constitutes 2–5% of thyroid malignancies. The risk however increases with background Hashimoto’s thyroiditis. (HT) We report a patient with HT complicated by thyroid lymphoma and did a literature review on this topic.
Case presentation: A 61-years-old Chinese lady with background HT on levothyroxine presented with an enlarging goitre of 6 months duration. There was weight loss of 3–4 kg, but no fever or night sweats. Examination showed an enlarged, non-tender thyroid gland with no palpable cervical lymph node. US showed a lobulated heterogeneous mass measuring 5.5×3.2×2.9 cm with internal vascularity. FNAC was suspicious for a lymphoma. CT neck, thorax and abdomen showed a 6.7×7.0×4.1 cm mass with possible infiltration through the left lateral tracheal wall and encasement of the left common carotid artery. There was no significant lymphadenopathy. Referral to the oncologist was made.
Discussion: PTL has an estimated annual incidence of two cases per million and almost all are of B-cell origin. It affects middle-aged to older individuals, predominantly women. Most are diagnosed with stage I disease and the most common histologic subtype is diffuse large B-cell lymphoma. The likelihood of developing thyroidal lymphoma is 40–80 times greater in patients with chronic thyroiditis. Proposed mechanisms include prolonged antigenic stimulation in the setting of autoimmune thyroiditis leading to lymphomatous transformation or malfunction of the somatic hypermutation process, a phenomenon called aberrant somatic hypermutation process, which is regarded as a mechanism of lymphomagenesis. Treatment comprises different modalities depending on histologic subtype and stage of disease.
Conclusion: The diagnosis of PTL should be considered in a rapidly growing goiter especially in the background of HT. Early detection may result in improved survival.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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