J Korean Soc Radiol.  2013 Nov;69(5):347-350. 10.3348/jksr.2013.69.5.347.

Solitary Extramedullary Plasmacytoma of Thyroid in Hashimoto's Thyroiditis: Mimicking Benign Cystic Nodule on Ultrasonography

• Kwon Y
• Kim SJ
• Hur JH
• Park SH
• Lee SJ
• Lee TJ

• KMID: 2002853
• DOI: http://doi.org/10.3348/jksr.2013.69.5.347

Abstract

Solitary extramedullary plasmacytoma (SEP) of the thyroid is uncommon and mostly occur in patients with a Hashimoto's thyroiditis (82%). We present a case on SEP of thyroid in Hashimoto's thyroiditis, which mimics growing benign cystic masses on serial ultrasonography.

MeSH Terms

Humans
Plasmacytoma*
Thyroid Gland*
Thyroiditis*
Ultrasonography*

Figure

• 

  Fig. 1 Thyroid ultrasonography image of one year ago. There is 0.5 cm sized benign looking cystic lesion (arrow) in right lobe of thyroid gland. The background thyroid tissue shows multinodular hyperplasia.

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  Fig. 2 Thyroid ultrasonography and enhanced neck CT images. A, B. Transverse and longitudinal scan image of thyroid gland. There is an increase in cystic lesion (arrows) measured with 1.3 cm and the echogenicity of internal tissue has increased. C. Axial CT image shows relatively low enhanced mass (arrowheads) in right thyroid lobe.

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  Fig. 3 Histopathologic findings of the nodule after total thyroidectomy. A. The specimen shows demarcation of the tumor from the thyroid parenchyma (H&E, × 100). B. This mass is composed of plasmacytoid cells. Histologic finding is consistent with plasmacytoma (H&E, × 400).

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  Fig. 4 Immunohistochemical stainings for lambda (A), CD138 (B), and CD79a (C) show positive immunoreactivity, however negative immunoreactivity in CD20 (D).

Reference

1. Kovacs CS, Mant MJ, Nguyen GK, Ginsberg J. Plasma cell lesions of the thyroid: report of a case of solitary plasmacytoma and a review of the literature. Thyroid. 1994; 4:65–71.

2. Chen RH, Chang CT, Chen WC, Tsai CH, Tsai FJ. Proinflammatory cytokine gene polymorphisms among Hashimoto's thyroiditis patients. J Clin Lab Anal. 2006; 20:260–265.

3. Patten DK, Fazel M, Dina R, Tolley N. Solitary extramedullary plasmacytoma of the thyroid involved by papillary carcinoma: a case report and review of the literature. Endocr Pathol. 2011; 22:155–158.

4. Avila A, Villalpando A, Montoya G, Luna MA. Clinical features and differential diagnoses of solitary extramedullary plasmacytoma of the thyroid: a case report. Ann Diagn Pathol. 2009; 13:119–123.

5. Yao CM, Erovic B, Higgins KM. Solitary extramedullary plasmacytomas of the thyroid in Hashimoto's thyroiditis. Thyroid. 2012; 22:861–862.

6. Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia. 2009; 23:3–9.

7. Koh YS, Gaegal YJ, Yoon JH, Park JW, Nam JH, Lee MC. Primary Plasmacytoma of the Thyroid. J Korean Surg Soc. 2002; 63:252–255.

8. Hirano T. Interleukin 6 (IL-6) and its receptor: their role in plasma cell neoplasias. Int J Cell Cloning. 1991; 9:166–184.

9. Ooi GC, Chim JC, Au WY, Khong PL. Radiologic manifestations of primary solitary extramedullary and multiple solitary plasmacytomas. AJR Am J Roentgenol. 2006; 186:821–827.

10. Bachar G, Goldstein D, Brown D, Tsang R, Lockwood G, Perez-Ordonez B, et al. Solitary extramedullary plasmacytoma of the head and neck--long-term outcome analysis of 68 cases. Head Neck. 2008; 30:1012–1019.