Burkitt-like lymphoma infiltrating a hyperfunctioning thyroid adenoma and presenting as a hot nodule

Clinicopathological features of primary thyroid Burkitt's lymphoma: a systematic review and meta-analysis

Background

Primary thyroid Burkitt’s lymphoma (BL) is an extremely rare and highly aggressive form of non-Hodgkin’s lymphoma; only isolated case reports are available for patients with this disease.

Methods

We analyzed the clinicopathological features of thyroid BL by conducting a meta-analysis of 21 known patients (including ours) and compared them to those of extrathyroidal BL.

Results

There were 13 men and 8 women with a median age of 39.3 years (range, 6–75 years). The median follow-up was 46.5 months (range, 0.5–361 months). Six patients (28.6%) had stage I disease, 2 (9.5%) had stage II, 2 (9.5%) had stage III, and 11 (52.4%) had stage IV. Five of 7 tested patients with thyroid BL (71.4%) had histological evidence of underlying Hashimoto’s thyroiditis. Ki-67 labeling indices exceeding 90% in all 19 patients tested (100%). Fluorescence in situ hybridization performed on 12 patient samples revealed that all (100%) had MYC rearrangement. Among the 16 patients for whom follow-up data were available, 4 died of disease-related causes. Kaplan-Meier analysis revealed that the 12- and 60-month overall survival rates for patients with thyroid BL were 87.5 and 70.7%, respectively.

Conclusions

Ours was the largest study of thyroid BL and its detailed clinicopathological features to date. Thyroid BL is not associated with underlying Epstein-Barr virus infection but is closely linked to Hashimoto’s thyroiditis; patients generally have good overall survival and respond well to intensive chemotherapy. The correct pathological diagnosis is essential for treatment selection and outcome improvement.

Coexistence of primary thyroid diffuse large B cell lymphoma and papillary thyroid carcinoma: a case report and literature review

Primary thyroid lymphoma (PTL) is a very rare type of thyroid malignant tumor. PTL coexisting with papillary thyroid carcinoma (PTC) is even scarcer and can be easily overlooked. We present our experience of the diagnosis and treatment of a 37-year-old woman with primary thyroid diffuse large B cell lymphoma complicated with PTC. We also considered this case in the context of previous reports. The results indicated that the incidence of concurrent Hashimoto’s disease varied among patients with different lymphoma subtypes, with the highest incidence in patients with mucosa-associated lymphoid tissue lymphoma. Furthermore, thyroid cancer and thus the combination of PTL and PTC were more common in women.

Usefulness of core needle biopsy for the diagnosis of thyroid Burkitt's lymphoma: a case report and review of the literature

BACKGROUND

Thyroid lymphomas are an exceptional finding in patients with thyroid nodules. Burkitt's lymphoma is one of the rarest and most aggressive forms of thyroid lymphomas, and its prognosis depends on the earliness of medical treatment. Given the rarity of this disease, making a prompt diagnosis can be challenging. For instance, fine-needle aspiration (FNA) cytology, which is the first-line diagnostic test that is performed in patients with thyroid nodules, is often not diagnostic in cases of thyroid lymphomas, with subsequent delay of the start of therapy.

CASE PRESENTATION

Here we report the case of a 52-year-old woman presenting with a rapidly enlarging thyroid mass. Thyroid ultrasonography demonstrated a solid hypoechoic nodule. FNA cytology was only suggestive of a lymphoproliferative disorder and did not provide a definitive diagnosis. It is core needle biopsy (CNB) that helped us to overcome the limitations of routine FNA cytology, showing the presence of thyroid Burkitt's lymphoma. Subsequent staging demonstrated bone marrow involvement. The early start of an intensive multi-agent chemotherapy resulted in complete disease remission. At 60 months after the diagnosis, the patient is alive and has not had any recurrence.

CONCLUSIONS

Clinicians should be aware that thyroid Burkitt's lymphoma is an aggressive disease that needs to be treated with multi-agent chemotherapy as soon as possible. To diagnose it promptly, they should consider to order/perform a CNB in any patient with a rapidly enlarging thyroid mass that is suspicious for lymphoma.

Real-time elastography in autonomously functioning thyroid nodules: relationship with TSH levels, scintigraphy, and ultrasound patterns

BACKGROUND

Real-time elastography has been proposed to increase the sensitivity of ultrasound and improve the detection of thyroid nodules at risk of malignancy. To date sparse data on real-time elastography assessment of autonomously functioning thyroid nodules exist. Here, we investigated the potential role of real-time elastography in autonomously functioning thyroid nodule assessment. Specifically, the correlation between serum hormones and real-time elastography score, as well as other clinical and ultrasound features, was analyzed.

METHODS

Patients with autonomously functioning thyroid nodule identified by I-123 scintigraphy from September 2015 to July 2016 and undergoing ultrasound, real-time elastography, and thyroid function evaluation were selected. All autonomously functioning thyroid nodule were classified as RTE I (prevalence of red or green color with blue in up to 25% of the nodule area), RTE II (blue in 25-75%), or RTE III (blue in more than 75%). The association between suppressed thyroid stimulating hormone and patient's age, nodule's size, ultrasound presentation, and real-time elastography scoring was analyzed by Odds Ratio in univariate fashion and multivariate model.

RESULTS

A number of 47 subjects with single autonomously functioning thyroid nodule were enrolled. Median age of 63 years, median size of 2.0 cm, and suppressed thyroid stimulating hormone levels in 32% of cases were found. Those nodules classified by ultrasound at high risk underwent fine-needle aspiration cytology and cancer was excluded. At real-time elastography evaluation, a 45% of autonomously functioning thyroid nodule had a hard appearance (RTE III) and had thyroid stimulating hormone significantly lower than the other (p < 0.0001). A model of multivariate logistic regression including nodule's size, ultrasound characteristics, and elastographic presentation showed that only RTE III was significantly associated with suppressed thyroid stimulating hormone (Odds Ratio of 50).

CONCLUSIONS

Autonomously functioning thyroid nodule may have variable elasticity at real-time elastography examination, being hard score associated with reduced/suppressed thyroid stimulating hormone. For clinical practice, the presence of autonomously functioning thyroid nodule should be considered in patients with hard lesions. Also, as quoted by the most recent ATA guidelines, elastography should not be accounted for risk stratification of thyroid nodules.

Primary Burkitt lymphoma of the thyroid gland: case report of an exceptional type of thyroid neoplasm and review of the literature

Background

Primary thyroid lymphoma is an uncommon pathological entity that accounts for only 1 to 5 % of all thyroid malignancies. Primary Burkitt lymphoma of the thyroid gland is very rare. This article presents the first Moroccan case of a primary BL of the thyroid to be reported in the literature to date.

Case presentation

We describe here a case of a 70-year-old male who developed a rapidly enlarging thyroid gland with progressive symptoms of compression. Core biopsy confirmed the diagnosis of Burkitt lymphoma. The patient died of septic shock, 2 weeks after the first cycle of appropriate therapeutic chemotherapy.

Conclusions

This presentation emphasizes the importance of considering lymphoma when dealing with a thyroid mass, as its management is different from that of other thyroid pathologies, and affords an opportunity to review a very rare type of primary thyroid lymphoma.

Burkitt lymphoma of thyroid gland in an adolescent

Burkitt Lymphoma is a highly aggressive form of non-Hodgkin's lymphoma that in nonendemic areas has abdominal primary sites. We report a very rare case of Burkitt lymphoma of the thyroid gland presenting as a rapidly growing thyroid swelling in a 14-year-old white Caucasian British male with no preexisting thyroid or medical problems. The diagnosis was confirmed by an open wedge biopsy following a fine needle aspiration. The patient was treated according to the Children's Cancer and Leukaemia Group guidelines for BL—Group B protocol and currently is in remission.

Burkitt-like lymphoma arising in the thyroid gland

INTRODUCTION

Primary Burkitt lymphoma of the thyroid gland is exceptionally rare. This highly aggressive, potentially curable malignancy arises from B cells. It presents as a rapidly expanding thyroid mass causing compressive symptoms. This article reports a very rare occurrence of Burkitt-like lymphoma in the thyroid, a variant of Burkitt lymphoma.

METHODS

A 60-year-old white female developed a rapidly expanding thyroid mass associated with airway compression and difficulty in swallowing.

RESULTS

Fine needle aspiration and cytometry studies established the diagnosis of lymphoma. The patient underwent an incisional neck biopsy which confirmed the final diagnosis according to the latest World Health Organization criteria. It was successfully treated with 1 cycle of appropriate therapeutic chemotherapy.

CONCLUSION

In patients with lymphoma diagnosed on fine needle aspiration, an incisional thyroid and bone marrow biopsies are required to aid in the diagnosis and assure the appropriate chemotherapy protocol.

Tumors metastatic to thyroid neoplasms: a case report and review of the literature

Metastasis into a thyroid neoplasm-tumor-to-tumor metastasis-is exceedingly rare. We describe the 28th documented case of a tumor metastatic to a thyroid neoplasm and review the literature on tumor-to-tumor metastasis involving a thyroid neoplasm as recipient. All cases showed a recipient thyroid neoplasm with an abrupt transition to a morphologically distinct neoplasm. Metastasis into primary thyroid neoplasm was synchronous in 33% of cases and metachronous in 67%. Follicular adenoma was the most common recipient thyroid neoplasm overall (16/28), and papillary thyroid carcinoma was the most common malignant recipient neoplasm (9/28). Of the 9 recipient papillary carcinomas, 6 were follicular variants. Renal cell carcinoma was the most common neoplasm to metastasize to a primary thyroid neoplasm (9/28), followed by lung (6/28), breast (5/28), and colon (3/28) carcinoma. Tumor-to-tumor metastasis should be considered whenever a dimorphic pattern is encountered in a thyroid tumor.