Endocrine Abstracts

Introduction: Thyroid and cervical nodules are a common pathology that require a complex management. However, thyroid lymphoma is a rare entity which can be challenging to diagnose. It represents less than 5% of all thyroid malignancies and no more than 2,5% of all lymphomas. We aim to report the case of thyroid lymphoma and a review of the literature.

Clinical Report: We describe the case of 63 year-old women with no relevant personal or family history that presents to our endocrine surgery unit with a quickly enlarging cervical mass over the last 4 months, causing mild compressive symptoms. No other symptoms were present. Laboratory tests showed normal thyroid function. The ultrasound revealed a 5 × 5 cm solid hypoecogenic nodule classified as EU-TIRADS 4, on the left lobe and several cervical adenopathys. Fine needle aspiration biopsy revealed a Bethesda category V – Suspicious for malignancy with small dispersed lymphocytes suggesting a small-cell non-Hodgkin lymphoma. The CT-scan evidenced right traqueal and esophageal deviation, extensive adenopathys in the III and IV cervical levels bilaterally as well as in the supra-clavicular and upper mediastinic space. Cervical Lymph nodule biopsy confirmed the diagnosis of folicular lymphoma with low grade follicular pattern CD20+, CD10+ BCL6+, BCL2+, CD3-, CD5- CD23 e Ciclina D1-. The patient was referenced to the onco-hematology unit and started chemotherapy. The surgical team kept an expectant strategy for worsening of the compressive symptons.

Discussion and Conclusion: The follicular lymphoma is a rare thyroid lymphoma, representing only 12% of all thyroid lymphomas. Is is staged based on the Ann Arbor criteria. The presence of autoimmune chronic lymphocytic thyroiditis is associated with increased risk. Our case is classified as a IIE and no previous diagnosis of Hashimoto’s thyroiditis was known. Unlike other forms of thyroid cancer, surgery is not the first line of treatment and should be reserved for selected cases. Treatment lies mainly in a chemotherapy regimen with or without radiotherapy. The optimal treatment remains controversial given the limited evidence available and lack of large prospective trials. The treatment for thyroid lymphoma and prognosis is broadly divided according to the lymphoma subtype.