Solitary Extramedullary Plasmacytoma of the Thyroid Involved by Papillary Carcinoma: A Case Report and Review of the Lit
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Solitary Extramedullary Plasmacytoma of the Thyroid Involved by Papillary Carcinoma: A Case Report and Review of the Literature Darren K. Patten & Maisam Fazel & Roberto Dina & Neil Tolley
Published online: 4 June 2011 # Springer Science+Business Media, LLC 2011
Introduction
Case
Plasmacytoma is a malignant proliferation of plasma cells that can arise in the bone marrow (osseous) and in the soft tissues (extramedullary). Multifocal osseous lesions are often termed multiple myelomas [1]. Extramedullary plasmacytomas are usually seen in aggressive forms of the disease, frequently occurring in the soft tissues of the head and neck, especially in the upper airways [2]. They may occur as an extramedullary manifestation of multiple myeloma, which must be excluded or present as a solitary primary tumour [3]. Extramedullary plasmacytomas are uncommon, and their occurrence in the thyroid is rare. These lesions have often been associated with Hashimoto’s thyroiditis. There have been 54 cases of solitary extramedullary plasmacytoma (SEP) of the thyroid gland described in world literature [4– 7]. Current literature documents a papillary thyroid carcinoma involved by malignant plasma cell disease without confirmation of the diagnosis of SEP of the thyroid [8]. We present a unique case of a SEP of the thyroid involved by multifocal micropapillary carcinoma.
A 54-year-old lady presented to clinic in October 2010 with a 2-month history of a rapidly enlarging mass in the left side of her neck. Clinical examination revealed a smoothly enlarged left thyroid lobe. Clinically and biochemically, the patient was euthyroid. She had no known drug allergies and no significant past medical history. Her family history revealed that her brother was being treated for mantle cell lymphoma. An ultrasound scan of the neck revealed an enlarged left thyroid lobe with the right lobe being of normal size and homogeneity. Subsequently, a fine needle aspiration (FNA) of the left thyroid lobe was performed which suggested lymphoma. Due to the fact that the thyroid mass was rapidly enlarging, surgical resection was preferred over an open biopsy. In November 2010, the patient underwent an uncomplicated left hemithyroidectomy from which she made a good recovery. Histology revealed a 48×30×24 mm unencapsulated nodule composed of medium-sized poorly cohesive plasmacytoid cells in which immunohistochemistry analysis was positive for monoclonal kappa light chains, IgG, CD138, CD20, BCL2 and with some cells positive for CD10 (Fig. 1A–C). The cells were negative for CD3, CD5, CD21, CD56, cyclin D1, IgA and IgD. The background thyroid tissue exhibited features of lymphocytic thyroiditis with multifocal, follicular variant, micropapillary carcinoma (5.9 and 4.8 mm) without evidence of lymphoma (Fig. 1D). IgG paraprotein was detected at 7 g/L, and a bone marrow biopsy did not reveal any evidence of lymphoma or plasma cell dyscrasia (i.e. multiple myeloma (MM)).Full blood count, serum creatinine and calcium were all within normal ranges. In addition, urinalysis wa
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