Problems of primary T-cell lymphoma of the thyroid gland -A case report
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Problems of primary T-cell lymphoma of the thyroid gland -A case report Junkichi Yokoyama1*, Shin Ito1, Shinichi Ohba1, Mitsuhisa Fujimaki1, Eriko Sato2, Norio Komatsu2, Katsuhisa Ikeda1 and Makoto Hanaguri3
Abstract In the following report we discuss a very rare case of malignant T-cell lymphoma of the thyroid gland that developed in a 70-year-old woman with a past history of hypothyroidism due to chronic thyroiditis. The chief complaint was a rapidly growing neck mass. CT and ultrasonographic examination revealed a diffuse large thyroid gland without a nodule extending up to 13 cm. Although presence of abnormal lymphoid cells in the peripheral blood was not found, the sIL-2 Receptor antibody and thyroglobulin measured as high as 970 U/ml and 600 ng/mL respectively. Fine needle aspiration cytology diagnosed chronic thyroiditis. A preoperative diagnosis of suspicious malignant lymphoma of the thyroid gland accompanied by Hashimoto’s thyroiditis was made, and a right hemithyroidectomy was performed to definite diagnosis. Histological examination revealed diffuse small lymphocytic infiltration in the thyroid gland associated with Hashimoto’s thyroiditis. Immunohistochemical examination showed that the small lymphocytes were positive for T-cell markers with CD3 and CD45RO. The pathological diagnosis was chronic thyroiditis with atypical lymphocytes infiltration. However, Southern blot analysis of tumor specimens revealed only a monoclonal T-cell receptor gene rearrangement. Finally, peripheral T cell lymphoma was diagnosed. Therefore, the left hemithyroidectomy was also performed one month later. No adjuvant therapy was performed due to the tumor stage and its subtype. The patient is well with no recurrence or metastasis 22 months after the surgical removal of the thyroid. As malignant T-cell lymphoma of the thyroid gland with Hashimoto’s thyroiditis was difficult to diagnose, gene rearrangement examination needed to be performed concurrently. Keywords: Peripheral T-cell lymphoma, Thyroid, Hashimoto’s thyroiditis, Molecular diagnosis, Gene rearrangement
Background Malignant lymphoma of the thyroid gland is uncommon, representing only 2 to 5% of all thyroid malignancies, and is often associated with autoimmune disorders, such as Hashimoto’s thyroiditis [1]. Many reported cases are B-cell lymphomas of the thyroid, which include marginal zone B cell lymphoma of the mucosa-associated lymphoid tissue (MALT) type (maltoma) and diffuse large Bcell lymphoma. Primary T-cell lymphomas are extremely rare at less than 2% of all primary lymphomas of the thyroid gland. The present case report describes a rare case of primary T-cell lymphoma associated with Hashimoto’s thyroiditis that was difficult to diagnose pathologically. It * Correspondence: [email protected] 1 Department of Otolaryngology, Head and Neck Surgery, Juntendo University School of Medicine, Tokyo, Japan Full list of author information is available at the end of the article
was, therefore, useful
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