Proper Management of Rapidly Growing Large B-Cell Primary Thyroid Lymphoma, Case Report and Review of Literature

Abstract

Background: Primary thyroid lymphoma is a rare type of thyroid cancer. It accounts for 1 to 5% of all thyroid cancers and 1 to 2% of all lymphomas outside the lymph nodes. Frequently, based on histology and fine-needle aspiration biopsy (FNA), it is difficult to distinguish between anaplastic carcinoma and thyroid lymphoma. Open biopsy is usually needed to confirm diagnosis. Case Presentation: We present the clinical history, physical findings, imaging studies and treatment plan of a 60-year-old male patient with malignant B cell lymphoma of the thyroid gland. The patient was presented to cancer care Manitoba with rapidly growing neck mass and Hoarseness for three weeks. CT scan of the neck showed large right-sided paratracheal mass consistent with thyroid malignancy, with destruction of the right side of the thyroid cartilage and abnormal small Level II right-sided nodes. The mass was measured to be 7.1 × 4.5 × 5.7 cm. There was displacement of the trachea to the left, but with no compromise of the airway noted. FNA was not diagnostic. Open biopsy under general anesthesia was done and sent for frozen section, which came suggestive of lymphoma. The patient kept intubated in surgical ICU and started on high dose steroid until the diagnosis was confirmed as B-Cell lymphoma then medical oncology staff managed him. Conclusion: Lymphoma of the thyroid gland should be considered in patients with a rapidly enlarging goiter. If there is any doubt of the diagnosis, open surgical biopsy should be performed to confirm the diagnosis.