Thyroid nodule as a first manifestation of Hodgkin lymphoma–report of two cases and literature review

Abstract

Lymphomas account for less than 5% of thyroid malignant lesions. Vast majority of them are B-cell non-Hodgkin lymphomas (NHL), while Hodgkin lymphoma (HL) is extremely rare. Here we present two cases of HL, at baseline manifesting as a thyroid lesion. First patient, 29-year-old pregnant female, initially suspected for metastatic medullary thyroid cancer, was eventually diagnosed with mixed cellularity type of thyroid HL. Second patient, 22-year-old woman with suspicion of advanced thyroid cancer, was in the end diagnosed with an extra-lymphatic classical HL of the thyroid. In both cases, despite repeated fine-needle aspiration biopsy, cytological examination gave inconclusive or misleading results. On histopathological examination, thyroid tumor cells were positive for CD15 and CD30 antigen, which is typical for Reed-Sternberg cells. In the report authors also discuss difficulties in management as well as potential importance of novel methods such as FISH, PCR and other molecular techniques in diagnostics of thyroid lymphomas.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2896947559559648

Nodular Lymphocyte Predominant Hodgkin Lymphoma of the Thyroid

“…In 80% of patients, thyroid HL became manifest as a rapidly enlarging neck mass, compressive symptoms being somewhat frequent, hoarseness (35%), dyspnea (65%), and dysphagia (53%). Classical B symptoms, fever (>38°C) for 3 or more days, drenching night sweats, and significant weight loss (>10% body weight in 6 months), are rare and may herald systemic involvement and disease progression, representing a predictor of poor outcome [3]. Classical Hodgkin's Lymphoma, namely, nodular sclerosis subtype, is the most frequently described variant to affect the thyroid gland [8].…”

“…It accounts for 8.2% of all lymphomas [1] and 0.5% of all cancers diagnosed in the developed world annually [2]. In Europe, the incidence is approximately 2.4 per 100.000 per year [3]. It has a bimodal age distribution with the highest peak affecting young adults (around 20 years of age) and a second peak in the elderly (older adults, approximately 65 years).…”

“…B symptoms (fever, chills, and weight loss) are present in 20% of patients, may alert systemic involvement, and constitute a poor prognostic marker. Extranodal disease, as opposed to non-Hodgkin lymphomas (present in 33% of cases), is less frequent with HL (5–10%) [3]. …”

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

“…Some practitioners 7) have recommended that fine needle aspiration and adjuncts should be the initial tests that are used to di- The management of co-occurring cancers should be considered separately, and the patient's prognosis is probably dominantly affected by the cancer that has the worst prognosis. 3,[10][11][12][13][14] If there is insufficient response after 1 st line chemotherapy for primary thyroid lymphoma, each residual lesion should be biopsied to confirm its pathological type, since the response rate of R-CHOP chemotherapy to DLBL is excellent, over 80% in stage I. In cases that involve the simultaneous occurrence of multiple thyroid neoplasms, surgery can be considered as standard of care.…”

Cystometria przepływowa w diagnostyce różnicowej choroby Hashimoto i chłoniaka MALT tarczycy

“…However, in some clinical cases it can significantly facilitate the final diagnosis. A combination of traditional cytology methods with FACS analysis of fine-needle aspiration biopsy (FNAB) material is considered to be a powerful diagnostic tool in haematological malignancies [1,2,[3][4][5][6]. Assessment of κ/λ light chain clonality belongs to the most important procedures allowing differentiation between polyclonal reactive processes and monoclonal lymphoma [7,8].…”