Endocrine Abstracts

Background

Primary thyroid lymphoma (PTL) is defined as a lymphoma involving only the thyroid gland or the thyroid gland and adjacent (regional) neck lymph nodes. Primary lymphomas of the thyroid are uncommon tumours, representing approximately 5% of the thyroid neoplasms and 2% of extranodal lymphomas. The most characteristic presentation is that of a rapidly enlarging neck mass often associated with dysphagia [5]. The majority of patients are euthyroid and one third of patients have compressive symptoms. The mass is usually fixed to surrounding tissues and half the patients have unilateral or bilateral cervical lymph node enlargement. Abscess formation in the background of thyroid lymphoma with thyro-cutaneous fistula is further rare. Reaching the final diagnosis can be delayed if insufficient biopsy material is obtained and ıt may be difficult to distinguish thyroid lymphoma from anaplastic carcinoma and thyroiditis. The present study describes the case of a patient who was presentad with Abscess formation suggesting the possibility of anaplastic carcinoma and finaly diagnosd by diffuse large B-cell lymphoma.

Case

A 73-year-old female presented with anterior neck pain, hoarseness and rapidly expanding mass with Abscess formation on here neck. the patient was admitted to our clinic for preoperative thyroid surgery suggesting the possibility of anaplastic carcinoma due to fine needle aspiration cytology of suspicious for malignancy. Her serum TSH was elevated to 47 mU/l and anti TPO was very high. Here neck ultrasound showed a significantly enlarged, diffuse parenchymal inhomogeneity and ill defined border of the thyroid gland. We performed Tru-cut biopsy and histological diagnosis was Diffuse large B-cell lymphoma of the thyroid gland. After 18FDG-positron emission tomography/computed tomography (PET/CT) scanning the patient reseaved 6 regimen of chemotherapy R-CHOP (rituximab, cyclophosphamide, doxorubicin [hydroxydoxorubicin], vincristine [Oncovin], prednisone with antibioticsand she has a good physical condition.

Discussion

Thyroid abscess is a rare clinical situation. It is most commonly associated with pyriform sinus fistula. Abscess formation in the background of thyroid cancer with thyro-cutaneous fistula is further rare. PTL is an uncommon malignancy of the thyroid. PTL occur most commonly in elderly women and are commonly of B- cell origin. Fine needle aspiration has become the procedure of choice for the initial pathological diagnosis of thyroid nodule. However, studies have also shown inconsistent results in the diagnosis of lymphoma of the thyroid. But clinical and radiological suspicion and cytomorphological features can help reaching the correct diagnosis in such cases.