Int J Thyroidol.  2019 May;12(1):58-63. 10.11106/ijt.2019.12.1.58.

Concurrent Medullary Thyroid Carcinoma and Primary Thyroid Lymphoma (Diffuse Large B Cell Lymphoma): the First Case Report

• Han Y
• Kim YH
• Kim HJ
• Choi IH

• KMID: 2449067
• DOI: http://doi.org/10.11106/ijt.2019.12.1.58

Abstract

Cases of simultaneously occurring medullary thyroid carcinoma (MTC) and lymphoma are extremely rare. An 84-year-old woman visited the hospital due to dyspnea, resulting from rapidly aggravated enlarged neck mass. Ultrasonography revealed two lesions in the thyroid and they were diagnosed as concurrent medullary thyroid carcinoma and diffuse large B cell lymphoma after total thyroidectomy. A few cases simultaneously diagnosed with MTC and systemic lymphoma have been reported. However, the coexistence of MTC and primary thyroid lymphoma is extremely rare.

Keyword

Primary thyroid lymphoma; Diffuse large B cell lymphoma; Medullary carcinoma

MeSH Terms

Aged, 80 and over
Carcinoma, Medullary
Dyspnea
Female
Humans
Lymphoma*
Lymphoma, B-Cell
Neck
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy
Ultrasonography

Figure

• 

  Fig. 1 (A) Neck CT reveals about 4.3×6.6×8.3 cm thyroid mass involving the left lobe, isthmus and medial portion of the right lobe and resulting in tracheal deviation. (B, C) Thyroid ultrasonography reveals 1.64 cm sized, hypoechoic mass at the right upper pole (B) and on the left lobe, there is a 6.85 cm sized hypoechogenic mass (C), which shows extension to the isthmus, medial portion of the right lobe and intrathoracic area.

• 

  Fig. 2 (A) Specimen from total thyroidectomy. The right lobe measures 3×4.5×1.5 cm and the left lobe is markedly enlarged by the mass, measures 7×9×3.5 cm. (B) On cut section of right lobe, there is a well-circumscribed ovoid, tan, yellowish solid mass, measuring 1.2×1.1 cm. (C) Cut sections of left lobe of thyroid gland reveals multiple iirregular, patchy or nodular, gray lesions occupying almost entire left lobe and extending to the right lobe with focal necrosis.

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  Fig. 3 (A) Border of medullary thyroid carcinoma (left side) abutting with primary thyroid lymphoma (right side). The left side reveals a well-defined solid mass (detailed view is presented in (B)), and the right side lesion shows diffuse growth pattern of lymphoid cells (detailed view is presented in (C)) (H&E, ×40). (B) The mass of right lobe consists of plasmacytoid cells on the fibrous background, suggesting medullary thyroid carcinoma (H&E, ×400). (C) The large lesion of left lobe shows diffuse growth of large atypical cells with frequent mitoses and apoptotic bodies (H&E, ×400). (D) At the peripheral portion of lesion in left lobe, destruction of thyroid follicles with infiltrate of large atypical lymphoid cells is noted (H&E, ×200).

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  Fig. 4 Immunohistochemical staining of medullary thyroid carcinoma. Right mid pole mass shows positivity for calcitonin (Calcitonin, ×200).

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  Fig. 5 Immunohistochemical staining of primary thyroid lymphoma. Mass shows diffuse strong positivity for CD20 (A, ×200). It shows 90% proliferative rate on Ki-67 (B, ×200). It is negative for Bcl-2 (C, ×200), Bcl-6 (D, ×200) and CD-10 (E, ×200). It is positive for MUM-1 (F, ×200).

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  Fig. 6 (A) Metastatic lymph node by diffuse large B-cell lymphoma. Left paratracheal lymph node is partly involved with diffuse large B-cell lymphoma (right side) (H&E, ×40). (B) Detailed view of (A) (H&E, ×100).

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