Endocrinol Metab.  2013 Dec;28(4):341-345. 10.3803/EnM.2013.28.4.341.

Co-Occurrence of Papillary Thyroid Carcinoma and Mucosa-Associated Lymphoid Tissue Lymphoma in a Patient with Long-Standing Hashimoto Thyroiditis

• Nam YJ
• Kim BH
• Lee SK
• Jeon YK
• Kim SS
• Jung WJ
• Kahng DH
• Kim IJ

• KMID: 2169314
• DOI: http://doi.org/10.3803/EnM.2013.28.4.341

Abstract

Papillary thyroid carcinoma (PTC) is a common affliction of the thyroid gland, accounting for 70% to 80% of all thyroid cancers, whereas mucosa-associated lymphoid tissue (MALT) lymphoma of the thyroid gland is uncommon. The simultaneous occurrence of both malignancies is extremely rare. We report the case of a patient with both PTC and MALT lymphoma in the setting of Hashimoto thyroiditis. An 81-year-old female patient was first admitted with goiter and hoarseness, which was attributed to an ultrasonographic thyroid nodule. Subsequent fine-needle aspirate, interpreted as suspicious of papillary thyroid cancer, prompted total thyroidectomy. MALT lymphoma was an incidental postsurgical finding, coexisting with PTC in the setting of Hashimoto thyroiditis. Although the development of MALT lymphoma is very rare, patients with longstanding Hashimoto thyroiditis should undergo careful surveillance for both malignancies.

Keyword

Thyroid cancer, papillary; Lymphoma, B-cell, marginal zone; Hashimoto disease

MeSH Terms

Aged, 80 and over
Carcinoma
Female
Goiter
Hashimoto Disease*
Hoarseness
Humans
Lymphoid Tissue
Lymphoma
Lymphoma, B-Cell, Marginal Zone*
Thyroid Gland*
Thyroid Neoplasms*
Thyroid Nodule
Thyroidectomy

Figure

• 

  Fig. 1 (A) Thyroid ultrasonography shows an ill-defined hypoechogenic mass measuring 3.7×3.0 cm with microcalcifications in the right thyroid gland. (B) Left thyroid gland and isthmus show diffuse goiter with ill-defined multiple patchy hypoechogenicities and a heterogenicity.

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  Fig. 2 (A) Precontrast axial computed tomography (CT) scan shows a low density nodule (arrow) in the upper portion of the right thyroid gland. (B) Contrast-enhanced coronal CT scan shows a large, inhomogeneous enhancement of the left thyroid gland, displacing the trachea to the right, and a hyperintense nodule in the upper portion of the right thyroid gland (arrow).

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  Fig. 3 (A) Histologic section of papillary thyroid carcinoma (left) and Hashimoto thyroiditis background (right) (H&E stain, ×40). (B) Hashimoto thyroiditis showing effacement of thyroid architecture by diffuse lymphocyte infiltration and residual thyroid follicles (H&E stain, ×400).

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  Fig. 4 (A) Effacement of thyroid architecture by neoplastic lymphoid infiltrate (H&E stain, ×400). (B) CD20-positive immunostaining of atypical small B cells (immunohistochemistry, ×200).

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