Endocrine Abstracts

JOINT2889

Introduction: Primary thyroid lymphoma (PTL) is a rare cancer, representing 1% to 5% of all thyroid malignancies and 1% to 7% of all extra nodal lymphomas. It predominantly affects females, with the highest incidence occurring in the seventh decade of life. The most common histotypes are diffuse large B-cell lymphoma, which accounts for 50% to 70% of cases. The most significant risk factor for PTL is Hashimoto’s thyroiditis, which increases the risk of PTL by 40 to 80 times. However, it remains unclear whether Hashimoto’s thyroiditis is a necessary condition for the development of PTL. The aim of this study was to describe a case report of a primary thyroid lymphoma associated with a lesion of Hashimoto’s thyroiditis

Materials and Methods: This is a retrospective case report focusing on a patient diagnosed with primary thyroid lymphoma (PTL) associated with Hashimoto’s thyroiditis. The study includes a detailed review of the patient’s medical history, clinical presentation, imaging results, histopathological examination, and treatment course.

Results: An 84-year-old female patient was admitted for management of dysphagia. On examination, a hard, fixed mass was palpated in the anterior cervical region, adherent to the deep planes. Cervical ultrasound revealed a right-sided thyroid mass measuring 41x28x12 mm, causing mass effect on the trachea. A cervical-thoracic CT scan confirmed the presence of a mass in the right thyroid lobe. An esophagogastroduodenal transit showed deviation of the cervical esophagus to the right, consistent with extrinsic compression. The patient underwent an exploratory cervicotomy, revealing a firm, stone-like mass adherent to the right thyroid lobe, while the left lobe appeared normal. A multiple biopsy of the right mass confirmed a diagnosis of diffuse B-cell lymphoma of germinal center cells, while the left lobe showed lymphocytic thyroiditis. The patient was presented in a multidisciplinary case review (MCR) for chemotherapy consideration.

Conclusion: The strong association between Hashimoto’s thyroiditis (HT) and primary thyroid lymphoma (PTL) highlights the significantly increased risk (40- to 80-fold) of developing PTL in patients with HT. PTL should be considered in the differential diagnosis of rapidly enlarging goiter or shortness of breath in patients with thyroiditis. Early recognition and prompt pathological diagnosis are crucial to initiate chemotherapy and improve patient outcomes.