Journal List > Int J Thyroidol > v.8(2) > 1082728

Ko, Lee, Lee, and Choi: Rare Concurrence of Triple Primary Thyroid Cancer: A Patient of Papillary Carcinoma, Follicular Carcinoma, and Primary Lymphoma of the Thyroid


We report a rare case of co-occurrence of papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC) and primary thyroid lymphoma. A 55-year-old woman presented with a large mass in left lobe of thyroid, biopsy confirmed diffuse large B-cell lymphoma. After 4 cycles of rituximab, cyclophosphamide, doxorubicin hyd-rochloride, vincristine sulfate, and prednisolone chemotherapy, positron emission tomography scan revealed markedly decreased in size, but still present. Repeated ultrasonography-guided gun biopsies of 2 lesions indicated Hurthle cell neoplasm. After total thyroidectomy and bilateral central lymph node dissection, residual hypermetabolic lesion of left lobe was determined to be FTC and right lower lesion to be nodular hyperplasia. Besides, a PTC was incidentally detected in left lobe. If there are multiple nodular lesions at diagnosis or there is insufficient response after 1st line chemotherapy for primary thyroid lymphoma, each lesion should be biopsied to confirm its pathological type.


1. Sipos JA, Mazzaferri EL. Thyroid cancer epidemiology and prognostic variables. Clin Oncol (R Coll Radiol). 2010; 22(6):395–404.
2. Cheng V, Brainard J, Nasr C. Co-occurrence of papillary thyroid carcinoma and primary lymphoma of the thyroid in a patient with long-standing Hashimoto's thyroiditis. Thyroid. 2012; 22(6):647–50.
3. Cakir M, Celik E, Tuncer FB, Tekin A. A rare coexistence of thyroid lymphoma with papillary thyroid carcinoma. Ann Afr Med. 2013; 12(3):188–90.
4. Graff-Baker A, Roman SA, Thomas DC, Udelsman R, Sosa JA. Prognosis of primary thyroid lymphoma: demographic, clinical, and pathologic predictors of survival in 1,408 cases. Surgery. 2009; 146(6):1105–15.
5. Doria R, Jekel JF, Cooper DL. Thyroid lymphoma. The case for combined modality therapy. Cancer. 1994; 73(1):200–6.
6. Meyer-Rochow GY, Sywak MS, Reeve TS, Delbridge LW, Sidhu SB. Surgical trends in the management of thyroid lymphoma. Eur J Surg Oncol. 2008; 34(5):576–80.
7. Mack LA, Pasieka JL. An evidencebased approach to the treatment of thyroid lymphoma. World J Surg. 2007; 31(5):978–86.
8. Noureldine SI, Tufano RP. Association of Hashimoto's thyroiditis and thyroid cancer. Curr Opin Oncol. 2015; 27(1):21–5.
9. Kim KW, Park YJ, Kim EH, Park SY, Park do J, Ahn SH, et al. Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto's thyroiditis. Head Neck. 2011; 33(5):691–5.
10. Mian M, Capello D, Ventre MB, Grazio D, Svaldi M, Rossi A, et al. Early-stage diffuse large B cell lymphoma of the head and neck: clinico-biological characterization and 18 year followup of 488 patients (IELSG 23 study). Ann Hematol. 2013. [Epub ahead of print].
11. Stein SA, Wartofsky L. Primary thyroid lymphoma: a clinical review. J Clin Endocrinol Metab. 2013; 98(8):3131–8.
12. Eccles A, Challapalli A, Khan S, Barwick T, Mangar S. Thyroid lymphoma incidentally detected by 18F-fluorocholine (FCH) PET/CT. Clin Nucl Med. 2013; 38(9):755–7.
13. Szczepanek-Parulska E, Szkudlarek M, Majewski P, Breborowicz J, Ruchala M. Thyroid nodule as a first manifestation of Hodgkin lymphoma-report of two cases and literature review. Diagn Pathol. 2013; 8:116.
14. Diaconescu MR, Costea I, Glod M, Grigorovici M, Diaconescu S. Unusual malignant tumors of the thyroid gland. Chirurgia (Bucur). 2013; 108(4):482–9.

Fig. 1.
Initial ultrasonography of thyroid. A huge lobulated contoured hypoechoic solid mass in left thyroid gland, measured 6.4×5.4×3.0 cm (A), isoechoic solid mass with calcifications in left thyroid gland upper pole, measured 1.1×1.1×0.6 cm (B), isoechoic solid nodule in right thyroid gland lower pole, measured 0.9×0.8×0.7 cm (C), hypoechoic solid nodule in right thyroid middle lobe, measured 0.7×0.5×0.3 cm (D).
Fig. 2.
Pathologic examination of thyroid lymphoma obtained by core needle biopsy (Hematoxylin & Eosin stain) (A) and immunohistochemical examination of CD20 of primary thyroid lymphoma (B); (×400), follicular thyroid cancer (C) and papillary thyroid carcinoma (D) collected by surgical resection (Hematoxylin & Eosin stain; ×400).
Fig. 3.
PET scan image after 8 th chemotherapy of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (R-CHOP) (A), residual hypermetabolic nodular lesion (SUV 6.6) in the left thyroid (B), mild hypermetabolic lesion (SUV 3.9) in the right lower lobe (C).
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