Thyroid lymphoma

Case contributed by Dalia Ibrahim
Diagnosis certain

Presentation

Anterior neck swelling.

Patient Data

Age: 50 years
Gender: Female
mri

The thyroid gland is diffusely enlarged showing an abnormal increased signal on T2 and STIR. It shows diffusion restriction.

Multiple enlarged deep cervical, right retropharyngeal, pretracheal, and suprasternal lymph nodes.

PET-CT

ct

FDG avid diffusely enlarged thyroid gland with SUV max 15.

Multiple FDG avid right retrophayrngeal, deep cervical, pretracheal, and suprasternal lymph nodes.

US-guided biopsy (right thyroid lobe)

Gross description: Referred single H&E stained slide and 3 slides stained for antibodies (CD20, CD3, and cyclin D1).

Result:

The referred slides stained for:

CD20: positive: strong positive staining in lymphoid infiltrates

CD3: strong staining in reactive T lymphocytes

Cyclin D1: Negative in infiltrating lymphocytes

Performed immunohistochemical markers:

CD10: Negative

BCL6: Negative

BCL2: Negative

Conclusion:

Immunohistochemical features are consistent with extranodal marginal zone B-cell lymphoma.

Case Discussion

In this case, radiological criteria might suggest the possibility of thyroid lymphoma such as the diffuse involvement of the thyroid gland, the marked diffusion restriction, and the avid FDG uptake, as well as the distribution of the enlarged cervical lymph nodes.

Thyroid lymphoma is rare, accounting for a minority of both thyroid malignancies and lymphoma in general. The thyroid may be affected primarily or secondary to lymphoma elsewhere.

Hashimoto thyroiditis is a major risk factor (~60 times increased risk) but the development of thyroid lymphoma is still rare in this group. 

Thyroid lymphoma may be a focal mass or diffuse gland enlargement.

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