Endocrine Abstracts

The simultaneous occurrence of MTC and extrathyroidal B large cell NHL are very rare. MTC may be sporadic or part of a MEN and NHL is not reported in association with MEN. A woman of 76 year old with a history of cholelithiasis and hepatitis B, is admitted for left abdominal pain. On examination it is detected inguinal, axillary and clavicular lymphadenopathy, splenomegaly and also a multinodular thyroid disease. The thyroid function was normal, antithyroid antibodies were negative and calcitonin (Ct) serum levels were moderately elevated (28.9 pg/ml). The thyroid ultrasound will detect bilateral hypoechoic areas the largest to the right of 2.4 cm with hypoechoic halo and peri- and intranodular vascularization. Total body CT scan showed splenomegaly almost breaking and so was made of splenectomy. The histology showed splenic localization of lymphoma diffuse large B cell. The PET/CT scan with F18 FDG was positive of upper- and subdiaphragmatic lymph nodes and a right thyroid nodule. Immunochemotherapy was initiated according to the R-COMP protocol and at the end a new PET/CT F18FDG detects activities only to the lower right thyroid pole. A control of Ct showed an increase to 45.1 pg/ml and the calcium gluconate infusion test was suggestive of MTC (peak Ct >2.000 pg/ml). Total thyroidectomy and lymph node draining was performed. Histology showed a MTC bifocal, 2.5–1.5 cm to the right and left respectively, with all node-negative. Screening for MEN 2 was negative. Seven months after surgery Ct levels are <1.0 pg/ml; molecular analysis of the RET gene showed no pathogenetic variants. In conclusion, the two neoplasms appear to be independent and not correlated to a multiple cancer syndrome; moreover also in the NHL detect on palpation of the neck and then the morphological examinations a thyroid nodule suggest the dosage of Ct.