Hashimotos Thyroiditis with Coexistent Papillary Carcinoma and Non-hodgkin Lymphoma-thyroid
A 32-year-old female with solitary nodule and hypothyroidism since 6 months, presented with a sudden increase in size since 15 days. Local examination showed a solitary nodule in the left lobe of the thyroid. General, physical, and systemic examinations were within normal limits. There were no clinically palpable cervical lymphnodes. Thyroid function test showed high thyroid stimulating hormone and decreased T4 levels. Ultrasound neck showed enlarged thyroid with nodularity and hyperechoic areas. Fine needle aspiration cytology (FNAC) of the nodule showed features of HT with papillary carcinoma.\nHence, a total thyroidectomy was performed and revealed nodularity on the outer surface. Left lobe measured 4 cm × 2.5 cm × 1.5cm and right lobe measured 3 cm × 2 cm × 1 cm. Cut surface of both the lobes was homogenous, grey white with tiny colloid filled areas []. Histology showed areas of HT with prominent lymphoid follicles having germinal center and atrophied thyroid follicles lined by hurthle cells []. A tiny focus of follicular variant of papillary carcinoma was also seen [Figure and ]. Another focus showed effacement of the thyroid parenchyma by diffuse monotonous lymphoid infiltrate suggestive of NHL []. Immunohistochemistry showed these cells immunoreactive for CD 45, CD 20, and bcl 2, which suggested a B-cell origin []. Areas of papillary carcinoma showed positivity for both low and high molecular weight cytokeratin [Figure and ]. Hematological parameters and marrow evaluation were within the normal limits. Hence, the final diagnosis of HT coexisting with papillary carcinoma and primary NHL (B-cell lineage) was made. Levothyroxine was initiated at 300mcg/day and patient was treated with chemotherapy (R-CHOP regime). Patient tolerated the chemotherapy well and with 12 months of follow-up, no recurrence or metastasis was noted.