Int J Thyroidol.  2016 Nov;9(2):195-199. 10.11106/ijt.2016.9.2.195.

Synchronous Occurrence of Papillary Thyroid Carcinoma and Mucosa-Associated Lymphoid Tissue Lymphoma: a Single Case Report

• Byun JS
• Lee HY
• Chun KW
• Yoon DS

• KMID: 2362358
• DOI: http://doi.org/10.11106/ijt.2016.9.2.195

Abstract

Papillary thyroid carcinoma (PTC) is a common lesion, accounting for 70-80% of all thyroid cancers, whereas mucosa-associated lymphoid tissue (MALT) lymphoma of thyroid gland is rare. A simultaneous occurrence of both malignancies is extremely rare. 57 years old Korean woman diagnosed with Hashimoto's thyroiditis at left lobe of thyroid gland where atypical cells of undetermined significance at right lobe. Later, left lobe was confirmed with malignant lymphoma during series of fine-needle aspiration biopsy. Right lobe was interpreted as malignant lesions, such as papillary thyroid carcinoma based on ultrasonography images and previous biopsy results. Total thyroidectomy was performed. Pathology reported papillary thyroid carcinoma at right lobe and MALT lymphoma at left lobe. There were no post-operative complications and no recurrence yet reported. Since an association between Hashimoto's thyroiditis and development of MALT lymphoma has been reported previously, a history of Hashimoto thyroiditis should be suspected MALT lymphoma.

Keyword

Papillary thyroid carcinoma; Mucosa-associated lymphoid tissue lymphoma of the thyroid gland; Hashimoto's thyroiditis

MeSH Terms

Biopsy
Biopsy, Fine-Needle
Female
Hashimoto Disease
Humans
Lymphoid Tissue
Lymphoma
Lymphoma, B-Cell, Marginal Zone*
Pathology
Recurrence
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy
Thyroiditis
Ultrasonography

Figure

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  Fig. 1. Ultrasonography for the thyroid gland revealed the diffuse enlarged left lobe of the thyroid gland with 0.8 cm size of hypoechoic nodule (arrow) whereas about 0.5 cm size of irregular shaped hypoechoic nodule found near the right side of the isthmus (circle).

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  Fig. 2. Enhanced computed tomography (CT) revealed small nodular lesion appeared adjacent to the right side of isthmus (arrow) whereas the left lobe of the thyroid gland and the isthmus involving with lymphoma showed diffusely enlargement and abnormal enlarged lymph nodes involving left level IV, VI and supraclavicular area (circle).

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  Fig. 3. (A) Histologic section of papillary microcarcinoma in background of lymphocytic thyroiditis (H&E stain, ×100). (B) Extranodal marginal zone B-cell lymphoma involving thyroid. Low-power magnification exhibiting a follicular pattern mimicking follicular lymphoma (H&E stain, ×40). (C) Sheets of monocytoid cells and lymphoepithelial lesion (LEL) (H&E stain, ×400). (D) Bcl2-negative germinal centers, excluding follicular lymphoma (Immunohistolochemistry, ×40). (E) CD20-abnormal aggregates of neoplastic B-cells in interfollicular space (immunohistolochemistry, ×40). (F) CK-destructive lymphoid infiltration accompanied by marked lymphoid hyperplasia (immunohistolochemistry, ×40).

Reference

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