Endocrinol Metab.  2012 Mar;27(1):77-82. 10.3803/EnM.2012.27.1.77.

A Case of Solitary Extramedullary Plasmacytoma of the Thyroid Presented as a Thyroid Tumor with Hashimoto's Thyroiditis

• Jo E
• Ha DW
• Choi JH
• Lee KN
• Eom JS
• Kim MR
• Jeon YK
• Kim SS
• Kim BH
• Kim IJ

• KMID: 2134823
• DOI: http://doi.org/10.3803/EnM.2012.27.1.77

Abstract

Extramedullary plasmacytomas most commonly occur in the nasal cavity, nasopharynx, paranasal sinuses, and larynx. Solitary extramedullary plasmacytoma (SEP) of the thyroid gland is rare. The diagnosis of SEP of the thyroid by cytology is typically difficult before surgery, and the entity is often confused with different cytology findings. We report a case of a 59-year-old man with primary plasmacytoma of the thyroid presented as a rapidly enlarging thyroid gland with Hashimoto's thyroiditis. He had been suffering from anterior neck swelling for 1 month. Several fine-needle aspiration biopsies yielded Hashimoto's thyroiditis. During a follow-up period of 3 years, the size of the thyroid gland increased and a mass lesion in right thyroid gland was detected. A total thyroidectomy was performed based on a diagnosis of a thyroid tumor with Hashimoto's thyroiditis. Permanent pathology identified the mass as an extramedullary plasmacytoma associated with Hashimoto's thyroiditis. Skeletal survey and serum electrophoresis tests were normal, and a bone marrow biopsy yielded no evidence of multiple myeloma. The patient underwent definitive radiotherapy and remained free from any recurrences during follow-up.

Keyword

Hashimoto's disease; Plasmacytoma; Thyroid gland

MeSH Terms

Biopsy
Biopsy, Fine-Needle
Bone Marrow
Electrophoresis
Follow-Up Studies
Hashimoto Disease
Humans
Larynx
Middle Aged
Multiple Myeloma
Nasal Cavity
Nasopharynx
Neck
Paranasal Sinuses
Plasmacytoma
Recurrence
Stress, Psychological
Thyroid Gland
Thyroidectomy
Thyroiditis

Figure

• 

  Fig. 1 Technetium-99m thyroid scan. Thyroid scan shows mild diffuse enlargement of the thyroid gland with heterogeneous uptake. Right thyroid gland has lesion suspicious for cold nodule (black arrows).

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  Fig. 2 Initial ultrasonography (US) of thyroid gland. Thyroid gland is asymmetrically enlarged and has heterogeneous echogenicity with scattered hypoechogenic lesions (white arrows).

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  Fig. 3 Follow-up computed tomography (CT) neck and US thyroid after 3 years. A. CT neck shows the 6.5 × 7.6 cm sized mass at right thyroid gland (arrow). B. Right thyroid gland is asymmetrically enlarged and has mass like lesion with backward growth (arrows).

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  Fig. 4 Microscopic findings of pathologic specimen. A. Low-power view of the specimen shows demarcation of the tumor from the thyroid parenchyma (H&E stain, × 40). B. Photomicrograph of the specimen shows numerous plasma cells packed in the mass (H&E stain, × 400).

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  Fig. 5 Immunohistochemical stain of pathologic specimen. A. Leukocyte common antigen (immunohistochemical stain, × 400). B. Immunoglobulin G (immunohistochemical stain, × 400). C. Kappa light chain (immunohistochemical stain, × 400). D. MUM1 (immunohistochemical stain, × 400).

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