engleski

Hyalinising trabecular tumor in adenomatoid goiter- a case of 59-year old man with HIV disease

A 59-year old man with a history of HIV disease was admitted to our department due to enlargement of a nodular goiter with compression of trachea and symptoms of difficulty swallowing. The patient was euthyroid. After preliminary diagnostics he was sent to surgery and total thyroidectomy was performed. Pathohistologic diagnosis revealed 48 mm hyalinising trabecular tumour in adenomatoid goiter in the left thyroid lobe. The patient was followed-up with serum thyroglobulin (Tg) on L-T4 therapy and neck ultrasonography (US). Two years after surgery US revealed suspicious lymph node enlargement in the left side of neck and subsequent FNA reported suspected metastatic disease with high levels of Tg in the aspirate. Postoperative serum stimulated Tg was 7.2 ng/mL and Tg antibodies were negative. The patient was treated with 3700 MBq of 131-I. Posttreatment 131- I whole body scan (WBS) revealed extensive uptake in the thyroid bed and a small pathologic accumulation of 131-I on the left side of the neck. Diagnostic WBS performed 8 months after 131- I therapy revealed no pathologic accumulation of 131-I and serum TSH stimulated Tg level normalized at 1.52 ng/ml. The patient was followed-up with US and serum Tg on L-T4 therapy. Suspicious small lymph nodes at both sides of the neck were detected, but without progression, and serum Tg on L-T4 therapy was 0.15 ng/mL. Conclusions: Most cases of this rare thyroid tumour show benign clinical presentation and only few develop metastatic disease in regional lymph nodes. Hyalinising trabecular tumour shares morphological similarities with paraganglioma and medullary thyroid carcinoma, as well as nuclear features and RET/PTC1 translocations of papillary thyroid carcinoma. In this case additional HIV disease was probably the promoter of lymph node dissemination, but in spite of that, the disease has continued to remain stable for the last eight years.

Thyroid; Hyalinising trabecular tumor; HIV

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