ECEESPE2025 Poster Presentations Thyroid (141 abstracts)
Thyroid lymphoma presented as a painful cervical mass: a diagnostic dilemma
Maria Chrysoulaki 1 , Vasiliki Daraki 2 , Fotis Mermigas 2 , Panagiotis-Nikolaos Tsakalomatis 2 , Evangelia Pissadaki 2 , Angelos Matheakakis 3 , Maria Psyllaki 3 , Aikaterini Andrianaki 4 , Paraskevi Floroskoufi 5 , Helen Papadaki 3,6 & Paraskevi Xekouki 2
1Medical School, University of Crete, Heraklion, Crete, Greece; 2University of Crete, School of Medicine, Endocrinology, Diabetes and Metabolism Clinic, Heraklion, Greece; 3University Hospital of Heraklion, Department of Hematology, Heraklion, Crete, Greece; 4Irodotos Medical Center, Heraklion, Crete, Greece; 5Venizelio General Hospital, Department of Endocrinology, Heraklion, Crete, Greece; 6University of Crete, Heraklion, Crete, Greece
JOINT3462
Introduction: Thyroid lymphoma, though rare, can be classified as either primary thyroid lymphoma (PTC) or secondary thyroid lymphoma. PTC typically arises from the thyroid gland and may later spread to the lymph nodes and other organs, often in individuals with preexisting Hashimoto’s thyroiditis. Secondary thyroid lymphoma, on the other hand, originates in lymph nodes or other organs, with subsequent involvement of the thyroid. We present a case of thyroid lymphoma that posed significant diagnostic challenges.
Case Presentation: A 49-year-old male presented with a rapidly enlarging left thyroid mass, dysphagia, and hoarseness. Laboratory tests and thyroid antibodies were normal. Ultrasound revealed a 7x5x6 cm mass with increased blood flow and reactive cervical lymph nodes, raising concern for either thyroid cancer or subacute thyroiditis. A fine needle aspiration (FNA) was inconclusive due to hemorrhage, and a lymph node biopsy suggested reactive lymphadenopathy. Due to the diagnostic uncertainty and significant patient discomfort, a total thyroidectomy was performed, revealing diffuse large B-cell lymphoma (DLBCL). Postoperatively, the patient developed permanent hypoparathyroidism requiring ongoing calcium supplementation. Staging with PET/CT and CT scans revealed involvement of regional lymph nodes, stomach, and pancreas, but not the bone marrow. The lymphoma was classified as stage IV (Lugano) with an International Prognostic Index (IPI) score of 3 and Central Nervous System-IPI score of 3.
Treatment and Outcome: The patient was treated with six cycles of Polatuzumab, Rituximab, Cyclophosphamide, and Methylprednisolone (Pola-R-CHP) every 21 days. Post-treatment PET/CT scans showed no evidence of disease.
Conclusion: Although rare, thyroid lymphoma should be considered in the differential diagnosis of rapidly enlarging thyroid masses. Early recognition and timely intervention are critical for improving prognosis, particularly in cases without a prior history of Hashimoto’s thyroiditis. This case highlights the diagnostic complexity of thyroid lymphoma and the importance of comprehensive staging and tailored treatment.
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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