Mucosa-Associated Lymphoid Tissue Lymphoma with Large
Cell Transformation on the Background of Hashimoto’s
Thyroiditis: A Case Report and Review Literature
Natavuth Hengjeerajarus MD*, Teerada Klaisuwan MD***,
Lalita Norasetthada MD**, Natapong Kosachunhanun MD*
Affiliation :
* Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine,
Chiang Mai University, Chiang Mai, Thailand
** Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
*** Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Primary thyroid lymphoma (PTL) is a rare cause of malignancy that occurs in 0.5% of cases with Hashimoto’s
thyroiditis. The most common subtype is diffuse large B-cell lymphoma (DLBCL), followed by mucosa-associated lymphoid
tissue (MALT) lymphoma. We described the case of a 70-year-old man who was diagnosed with MALT lymphoma in the
background of autoimmune thyroiditis with focal area of DLBCL transformation. The patient was a 70-year-old man with
rapidly growing mass of the thyroid gland with compressive symptom over two months. The laboratory data revealed primary
hypothyroidism with positively anti-thyroid antibodies. The computerized tomography scan showed right thyroid mass
extended to anterior mediastinum and compressed adjacent airway with multiple cervical and mediastinal lymphadenopathies.
The pathology from incisional biopsy showed extranodal marginal zone B-cell lymphoma of MALT lymphoma with large
cell transformation. The patient received four courses of systemic chemotherapy combined with involved field radiation
therapy. The mass was dramatically decreased in size after treatment, leading to a complete resolution of compressive
symptoms. Thyroid lymphoma is quite rare; however, the incidence may be higher in patients with Hashimoto’s thyroiditis.
A rapidly growing thyroid gland should be considered as PTL. Chemotherapy and radiation are the mainstays of treatment.
Keywords : Mucosa-associated lymphoid tissue lymphoma, Large cell transformation, Diffuse large B-cell lymphoma,
Primary thyroid lymphoma, Hashimoto’s thyroiditis
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