Endocrine Abstracts

JOINT2682

Background: Follicular thyroid adenomas, though benign, are rare in pediatric populations and may pose diagnostic and therapeutic challenges due to their potential overlap with malignancies. Burkitt lymphoma, a high-grade B-cell non-Hodgkin lymphoma, accounts for 30% of pediatric lymphomas and typically presents with rapidly enlarging lymph nodes or extranodal masses. The co-occurrence of these two distinct conditions in a pediatric patient is exceptionally rare and has not been previously reported, underscoring the need for careful evaluation and a multidisciplinary approach to management.

Clinical Case: We report the case of an 8-year-old male presenting with a one-year history of progressive cervical lymphadenopathy. Clinical examination revealed a 3. 5 cm firm, non-tender, poorly mobile submandibular lymph node conglomerate on the right side, along with smaller lymph nodes in the anterior cervical and submandibular regions bilaterally. The patient exhibited no systemic symptoms of infection or malignancy. Family history revealed malignancies on the maternal side, including intestinal, lung, and uterine cancers, raising concerns about genetic predispositions. Initial investigations, including ultrasonography and fine-needle aspiration biopsy (FNAB) of a thyroid nodule, suggested hyperplastic changes. Biochemical findings were significant for suppressed TSH: <0. 01 mU/l (N 0. 4–3. 6) with elevated FT4: 25. 99 pmol/l (N 7. 87–20. 3), consistent with thyrotoxicosis. Despite antibiotic therapy, the lymphadenopathy persisted, prompting further imaging and evaluation. Subsequent histopathological analysis of a resected thyroid nodule and adjacent lymph nodes revealed the coexistence of Burkitt lymphoma and follicular thyroid adenoma, confirmed by immunohistochemical studies. The patient underwent hemityroidectomy and lymphadenectomy followed by chemotherapy for Burkitt lymphoma. Thyroid hormone replacement therapy was initiated postoperatively, and the patient remains under close endocrinological and oncological follow-up.

Discussion: This case underscores the importance of a multidisciplinary approach in managing pediatric thyroid nodules and lymphadenopathy, particularly when the presentation deviates from typical patterns. The coexistence of Burkitt lymphoma and follicular thyroid adenoma highlights the need for thorough diagnostic workup, including FNAB, imaging, and histopathological confirmation. Additionally, the potential link to familial cancer syndromes, such as DICER1 mutation, warrants further investigation in this patient.

Conclusion: This rare case emphasizes the diagnostic and therapeutic challenges posed by concurrent thyroid and lymphoid pathology in children. Awareness of such presentations can aid in timely diagnosis and optimized care strategies.