Endocrine Abstracts

Introduction: Primary thyroid lymphoma (PTL) represents about 1–5% of thyroid malignancies and < 2% of extra-nodal lymphoma. The most common subtype is diffuse large B-cell lymphoma (DLBCL) (~ 50% of cases), followed by mucosa-associated lymphoid tissue (MALT) lymphoma, both non-Hodgkin’ lymphomas. sophageal perforation is a very rare complication during the course of PTL, characterized by poor prognosis.

Case presentation: A 65-year-old Caucasian woman was admitted to our department due to anterior neck enlargement and compressive symptomatology (dysphagia and hoarseness) during the preceding two months. Her medical history was remarkable for rheumatoid arthritis, treated with methotrexate. On physical examination, she had a stiff, non-tender and diffuse goitre. Thyroid ultrasound showed a heterogeneous sub-sternal goitre, including a 34 mm hypoechoic nodule of irregular margins, in the middle of right thyroid lobe. Fine-needle-aspiration (FNA) biopsy was inconclusive (Bethesda III). A computerized tomography (CT) scan showed severe trachea compression, esophageal dilatation and air bubbles in the surrounding structures (Panel A, arrow). The patient’ swallowing capacity was progressively deteriorating and, subsequently, she underwent a total thyroidectomy, which revealed esophageal perforation (Panel B, arrow). Histological diagnosis was compatible with large B-cell thyroid lymphoma of high malignancy grade, in the right lobe. The patient was transferred to the intensive care unit, but she developed acute renal failure and repeated respiratory infections, with a progressive thrombocytopenia and normocytic anemia. Bone marrow biopsy showed infiltration by lymphoma cells, but chemotherapy was not feasible due to the patient’ clinical state. She died one month later.