Int J Thyroidol.  2015 Nov;8(2):216-220. 10.11106/ijt.2015.8.2.216.

Rare Concurrence of Triple Primary Thyroid Cancer: A Patient of Papillary Carcinoma, Follicular Carcinoma, and Primary Lymphoma of the Thyroid

• Ko EJ
• Lee EK
• Lee SW
• Choi SI

• KMID: 2171235
• DOI: http://doi.org/10.11106/ijt.2015.8.2.216

Abstract

We report a rare case of co-occurrence of papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC) and primary thyroid lymphoma. A 55-year-old woman presented with a large mass in left lobe of thyroid, biopsy confirmed diffuse large B-cell lymphoma. After 4 cycles of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisolone chemotherapy, positron emission tomography scan revealed markedly decreased in size, but still present. Repeated ultrasonography-guided gun biopsies of 2 lesions indicated Hurthle cell neoplasm. After total thyroidectomy and bilateral central lymph node dissection, residual hypermetabolic lesion of left lobe was determined to be FTC and right lower lesion to be nodular hyperplasia. Besides, a PTC was incidentally detected in left lobe. If there are multiple nodular lesions at diagnosis or there is insufficient response after 1st line chemotherapy for primary thyroid lymphoma, each lesion should be biopsied to confirm its pathological type.

Keyword

Thyroid lymphoma; Papillary thyroid cancer; Follicular thyroid cancer; Triple primary thyroid cancer

MeSH Terms

Adenocarcinoma, Follicular
Biopsy
Carcinoma, Papillary*
Cyclophosphamide
Diagnosis
Doxorubicin
Drug Therapy
Female
Humans
Hyperplasia
Lymph Node Excision
Lymphoma*
Lymphoma, B-Cell
Middle Aged
Positron-Emission Tomography
Prednisolone
Rituximab
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy
Vincristine
Cyclophosphamide
Doxorubicin
Prednisolone
Vincristine

Figure

• 

  Fig. 1. Initial ultrasonography of thyroid. A huge lobulated contoured hypoechoic solid mass in left thyroid gland, measured 6.4×5.4×3.0 cm (A), isoechoic solid mass with calcifications in left thyroid gland upper pole, measured 1.1×1.1×0.6 cm (B), isoechoic solid nodule in right thyroid gland lower pole, measured 0.9×0.8×0.7 cm (C), hypoechoic solid nodule in right thyroid middle lobe, measured 0.7×0.5×0.3 cm (D).

• 

  Fig. 2. Pathologic examination of thyroid lymphoma obtained by core needle biopsy (Hematoxylin & Eosin stain) (A) and immunohistochemical examination of CD20 of primary thyroid lymphoma (B); (×400), follicular thyroid cancer (C) and papillary thyroid carcinoma (D) collected by surgical resection (Hematoxylin & Eosin stain; ×400).

• 

  Fig. 3. PET scan image after 8 th chemotherapy of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (R-CHOP) (A), residual hypermetabolic nodular lesion (SUV 6.6) in the left thyroid (B), mild hypermetabolic lesion (SUV 3.9) in the right lower lobe (C).

Reference

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