Abstract
BackgroundPrimary thyroid lymphomas (PTLs) account for 5% of thyroid malignant tumors and often develop in patients with Hashimoto Thyroiditis (HT). Fine-needle cytology (FNC) is widely used in the diagnosis of thyroid nodules, including those arising in HT. Two PTL cases in HT elderly patients are here described and discussed.MethodsFNC was performed in rapidly enlarged thyroid nodules of 2 elderly patients under ultrasound (US) control. FNC was used to prepare conventional cytologic smears, immunocytochemistry (ICC) and flow cytometry (FC) assessment of cell populations.ResultsThe above cases were diagnosed as well differentiated, small B-cell and diffuse large B-cell thyroid lymphomas, respectively, by means of FNC. The histological diagnoses were mucosa-associated non Hodgkin lymphoma (MALT) and diffuse large B-cell lymphoma (DLBCL), confirming FNC diagnoses, and patients were treated accordingly.ConclusionsFNC diagnosis of PTL is reliable and accurate; it may be conveniently used in the clinical practice since it provides indications for appropriate therapeutic procedures or diagnostic surgery, and avoids to treat benign nodules.
Highlights
Primary thyroid lymphomas (PTLs) are a rare group of diseases that accounts for 5% of all thyroid malignant tumors, and approximately for 1/2% of all extra nodal lymphomas
An high percentage of PTLs affects patients suffering from long standing Hashimoto Thyroiditis (HT), PTL pathogenesis is probably related to chronic inflammation stimulation [2]
The aim of this study is to present 2 cases of PTL in elderly patients in which Fine-needle cytology (FNC) pre-surgical diagnosis has contributed to a correct and differentiated treatment
Summary
Primary thyroid lymphomas (PTLs) are a rare group of diseases that accounts for 5% of all thyroid malignant tumors, and approximately for 1/2% of all extra nodal lymphomas. Calcitonin is the only available biomarker to this purpose, and its utility is limited to the diagnosis of medullary thyroid carcinoma Both molecular and functional studies have revealed that neoplastic cells remodel their Ca2+ signaling machinery [11,15,16,17,18], thereby leading the notion that up-regulated plasmalemmal Ca2+-permeable channels might serve as alternative diagnostic markers of neoplastic transformation [18]. Inconclusive results are frequent and the application of molecular techniques to FNC has dramatically increased its sensitivity [24,25,26,27,28,29,30,31,32], including in HT cases with diffuse or nodular enlargement [31] These advantages are enhanced in case of HT, which does not require surgical treatment, and even more in elderly patients, for whom surgery is generally more burdensome, complex and expensive than younger patients [33]. Two PTL cases in HT elderly patients are here described and discussed
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