Diffuse Large B-Cell Lymphoma of Thyroid: A Case Report and Review of Literature
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CLINICAL REPORT
Diffuse Large B-Cell Lymphoma of Thyroid: A Case Report and Review of Literature Prakash Khanal1
•
Nabin Lageju1 • Bina Adhikari1
Received: 8 March 2020 / Accepted: 20 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract Primary thyroid lymphoma is a rare malignancy, accounting for 1–2% of extra-nodal lymphomas and 1–5% of thyroid malignancies. Diffuse large B-cell lymphoma is the most common type of primary thyroid lymphoma. It usually presents with a rapidly enlarging neck mass with cervical lymphadenopathy. Though rare, early diagnosis of this condition is important because its management is quite different from the treatment of other thyroid neoplasms. It is usually treated by chemotherapy with or without radiotherapy. We present the case of a 43 years old male who presented with thyroid swelling which on histopathology and subsequent immunohistochemistry was confirmed as diffuse large B-cell lymphoma of the thyroid. Keywords Primary thyroid lymphoma Non-hodgkin’s lymphoma Diffuse large B-cell lymphoma Hashimoto’s thyroiditis
Introduction Primary thyroid lymphoma (PTL) is a rare tumor and accounts for 1–5% of thyroid malignancies and 1–2% of extra nodal lymphomas [1]. PTL is more common in elderly women, with a female: male ratio of 4:1. Patients usually present in the 6th to 7th decade of life with an enlarging neck mass with cervical lymphadenopathy [2, 3]. Preexisting Hashimoto’s thyroiditis is a well-recognized risk factor predisposing to the development of PTL [4]. & Prakash Khanal [email protected] 1
Department of ENT-Head and Neck Surgery, Nepal Police Hospital, Maharajgunj, Kathmandu, Nepal
Most primary thyroid lymphomas are B cell non-Hodgkin’s lymphoma and usually treated by combination of chemotherapy and radiotherapy.
Case Report A 43 years old man presented to ENT outpatient department with a history of anterior neck swelling for 2 weeks. There was no history of exposure to neck radiation. Other medical and family history was not significant. On examination, there was enlarged left lobe of the thyroid gland. Thyroid function tests were within normal limits. Ultrasonography (USG) of neck showed hyperechoic lesion in left lobe of thyroid (42 9 35 mm) with increased vascularity, suggestive of malignant lesion (Fig. 1). Patient was advised for USG guided fine needle aspiration cytology (FNAC) from thyroid swelling. FNA smear showed atypical lymphoid cells with high N:C ratio, irregular nuclear membrane, prominent nucleoli and scant amount of cytoplasm suggestive of Non-Hodgkin’s lymphoma in a background of Hashimoto’s thyroiditis (Fig. 2). Biopsy and immunohistochemistry were advised for confirmation and typing. Patient underwent left hemithyroidectomy and specimen was sent for histopathological examination. Microscopic pictures showed diffuse infiltration by monotonous population of atypical lymphoid cells in focal area (Fig. 3). Individual tumor cells were small to intermediate size, round shaped with scant to moderate amount of cytoplasm and round
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