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Primary lymphoma of the thyroid initially diagnosed by FNAC. A case report

Primary thyroid lymphoma is an uncommon entity, representing 1-5% of thyroid malignancies and less than 2 % of extranodal lymphomas. The vast majority of primary thyroid lymphomas are of B- cell origin and almost arise in the background of Hashimoto thyroiditis. A 50-year old female was admitted to our hospital due to dysphagia hoarseness and pressure sensation in the neck. Ultrasound (US) examination revealed a hypoechogenic nodule of 3 cm, on the right lobe of the thyroid. The thyroid function was normal and both the thyroid test and the microsome test were negative. An US-guided fine needle aspiration cytology (FNAC) was performed. Giemsa stained FNA smears were cellular with a monotonous population of large atypical lymphoid cells. Immunocytochemistry showed these neoplastic cells to be CD 20 positive and a diagnosis of diffuse large B-celllymphoma (DLBCL) was made. Furthermore, flow cytometry confirmed a monoclonal population of B-cell lineage. A bone marrow biopsy was negative for lymphoproliferative disorder. All investigations, including US and computerized tomography (CT) scans of neck, chest and abdomen revealed no lympadenopathy. The patient underwent right-sided lobectomy and isthmectomy. A biopsy and immunohistochemical studies confirmed the cytological diagnosis of DLBCL. After 3 cycles of chemotherapy (CHOP-R) followed by radiotherapy of 4, 500 cGy in 25 fractions, the patient achieved complete remission. Advances in immunophenotypical studies, including flow cytometry and immunocytochemistry, have improved the accuracy of FNAB in diagnosing thyroid lymphoma, thus making invasive surgical diagnostic procedures potentially unnecessary.

Primary thyroid lymphoma; FNAC

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