ABCL-286 Abrupt Obstruction of the Central Airway by a Relapse of Thyroid Gland Diffuse Large B-Cell Lymphoma: An Unusual Presentation

Abstract

Primary thyroid lymphoma is a rare neoplasm comprising 1%-5% of all thyroid malignancies and 1%-7% of all extra-nodal lymphomas. Most thyroid lymphomas are of B-cell origin. Sharing a rare case of relapsed primary thyroid gland diffuse large B-cell lymphoma (DLBCL) and its diagnostic and therapeutic outcome, emphasizing the airway obstruction event. A case report. In March 2019, a 69-year-old man was admitted to our hospital with the following results of the thyroid gland biopsy-HP/Dg. High-grade DLBCL of the thyroid gland (CD20+, CD23+, Ki67=95%) was led by the endocrinologist because of the swelling symptoms around the neck and the changes in the thyroid gland ultrasound. The patient had no family history of any chronic or malignant disorders. Since the patient's laboratory tests and physical examination findings were normal, we decided to immediately start treating him with RCHOP protocol. After 8 rounds of chemotherapy, the patient was stable, and we planned to continue with maintenance therapy. Unfortunately, the patient came back before suggested with severe dyspnea, and the neck CT revealed a paravertebral/retrotracheal mass of 10.4×9.7×8.0 cm that was dislocating the trachea in the anterior plan and compromising the trachea and esophagus in T2 level. In the following days, there was an exacerbation of the dyspnea leading to total airway obstruction with SpO2 decreasing below 65%, and we needed to intubate the patient. Immediately after that, a tracheostomy was performed by an otorhinolaryngologist. When the patient's condition stabilized, we decided to treat his relapse with 4 cycles of salvage therapy-R-ESHAP-because of the lack of a transplant procedure in our country. After salvage chemotherapy, a PET-CT revealed no pathological FDG absorption, and a repeated neck CT showed a total reduction of the retrotracheal mass. The patient is still being followed every 6 months and has been in complete remission ever since. Seventeen months after completing the R-ESHAP treatment protocol, the patient is still in remission with no signs of disease and a normal CT scan. Despite the rare presentation of DLBCL, optimal early management and a multidisciplinary approach had a great impact on the patient's prognosis.