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

Eun Jeong Ko; Eun Kyung Lee; Si Won Lee; Sang Il Choi

doi:10.11106/ijt.2015.8.2.216

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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

Case Report

Int J Thyroidol 2015;8(2):216-220.

Published online: 20 November 2015

DOI: https://doi.org/10.11106/ijt.2015.8.2.216

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

Eun Jeong Ko¹, Eun Kyung Lee^1,^2,, Si Won Lee¹, Sang Il Choi¹

¹Department of Internal Medicine, National Cancer Center, Goyang, Korea

²Center for Thyroid Cancer, National Cancer Center, Goyang, Korea

Correspondence: Eun Kyung Lee, MD, Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea Tel: 82-31-920-1743, Fax: 82-31-920–2798, E-mail: waterfol@ncc.re.kr

Received 16 May 2015 Revised 5 August 2015 Accepted 20 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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 1^st line chemotherapy for primary thyroid lymphoma, each lesion should be biopsied to confirm its pathological type.

Keywords: Thyroid lymphoma, Papillary thyroid cancer, Follicular thyroid cancer, Triple primary thyroid cancer

References

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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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