Endocrine Abstracts

Introduction

Thyroid cancers account for about 2.9%of all cancers. Although it is reported that the risk of developing PTC as the second primary cancer increases after treatment of Hodgkin lymphoma (HL), concomitant PTC and HL are quite rare and to the best of our knowledge we found only three cases in the literature. This case report presents the treatment management and three-year course of a male patient with simultaneous diagnosis of PTC and HL.

Case

A 26-year-old male presented with a complaint of neck swelling. On physical examination, 3 cm mobile, painless, stiff lymphadenopathy (LAP) was detected in the right cervical region. He did not have fever, night sweats or weight loss. The ultrasonography revealed 6 mm, hypoechoic nodule with irregular boundries and microcalcifications and several hypoechoic LAPs with asymmetric cortical thickness. FNAB was applied to the 6 mm nodule in the right thyroid lobe. Since FNAB reported as suspicious cytomorphological findings for malignancy, patient went on total thyroidectomy and lymph node dissection. Pathology revealed three foci of PTC with sizes of 7 mm, 0.5 mm and 0.75 mm in the right lobe. The first focus was 7 mm in size, with minimal extrathyroidal extension and adjacent to the surgical border posteriorly and no lymphovascular invasion. According to the ATA guidelines, the case was intermediate risk. Nodular lymphocyte predominant Hodgkin lymphoma was detected in the lymph nodes, removed from the right cervical region. On postoperative 1st month, ¹⁸F-FDG whole body positron emission tomography (PET) revealed pathological involvements in the right jugulodigastric and right cervical chain. The patient was diagnosed with low-risk, stage IA lymphocyte predominant Hodgkin lymphoma. In the second postoperative month, conventional radiotherapy (RT) was applied to the neck region. Radioactive iodine was given at the postoperative 5th month. Whole body scan showed an activity in thyroid bed. The patient was then followed up with TSH suppression. Whole body scan with recombinant human TSH, 1.5 years after RAI treatment was normal. The patient, who is currently at the 36th month of his follow-up, is in remission for lymphoma and PTC.

Discussion

Cases with simultaneous diagnosis of PTC with HL are very rare. In these cases it is important to decide which cancer to treat first. It is thought that therapeutical time interval does not affect mortality and morbidity in the treatment of differentiated thyroid cancer. Therefore, as we did in our case, we recommend giving priority to lymphoma treatment.