伪装成甲状腺癌的高级B细胞非霍奇金淋巴瘤;一份病例报告。

Journal of cancer & allied specialties Pub Date : 2020-05-12 eCollection Date: 2020-01-01 DOI:10.37029/jcas.v6i2.363
Ali Jamal, Rizwan Bilal, Imran Khalid Niazi, Humayun Bashir
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引用次数: 0

摘要

简介:高级别B细胞淋巴瘤和弥漫性大B细胞显示骨髓细胞瘤(MYC)移位,伴有B细胞淋巴瘤2(BCL2)和/或B细胞淋巴瘤6(BCL6)重排,也称为双重和三重侵袭淋巴瘤,是侵袭性实体。世界卫生组织2017年更新将这一细胞遗传学定义的类别“伴有骨髓细胞瘤MYC和BCL2和/或BCL6重排的高级B细胞淋巴瘤”作为一个单独的实体。我们报告了一个有趣的病例,一名肥胖患者出现颈部肿块,怀疑是侵袭性甲状腺癌,最终被证明是一种高级B细胞淋巴瘤。病例描述:一名64岁男性,主诉颈部疼痛10周,颈部前部巨大肿胀4周。呼吸系统评估显示咳嗽、胸膜炎和咳痰。其余的系统性审查并不显著。基线报告显示甲状腺功能减退。超声检查(USG)甲状腺显示右上极甲状腺成像报告和数据系统-4(TIRADS-4)结节伴双侧颈部淋巴结病,建议与细针穿刺细胞学检查(FNAC)相关。提交了磁共振成像(MRI)检查,显示了局部侵袭性原发性甲状腺恶性肿瘤的总体特征。病例在一个多学科小组(MDT)会议上进行了讨论,怀疑肿瘤的非甲状腺起源。根据MDT建议,患者接受了正电子发射断层扫描/计算机断层扫描(PET/CT)。PET/CT结果高度提示淋巴瘤疾病,而不是早期的甲状腺恶性肿瘤怀疑,这在宫颈淋巴结的组织病理学上得到了证实。实际意义:正如本病例报告所示,高级别B细胞淋巴瘤是一种侵袭性实体,其表现可能非常欺骗性。功能成像模式,如氟脱氧葡萄糖(F-18FDG)PET/CT,可以为揭露伪装成其他疾病的欺骗性疾病实体提供关键帮助,从而彻底改变管理计划。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

High-grade B-cell Non-Hodgkin's Lymphoma Masquerading as Thyroid Carcinoma; a Case Report.

High-grade B-cell Non-Hodgkin's Lymphoma Masquerading as Thyroid Carcinoma; a Case Report.

High-grade B-cell Non-Hodgkin's Lymphoma Masquerading as Thyroid Carcinoma; a Case Report.

High-grade B-cell Non-Hodgkin's Lymphoma Masquerading as Thyroid Carcinoma; a Case Report.

Introduction: High grade B-cell lymphoma and diffuse large B cell exhibiting myelocytoma (MYC) translocation with B-cell lymphoma 2 (BCL2) and/or B-cell lymphoma 6 (BCL6) re-arrangements, also known as double and triple hit lymphomas, are aggressive entities. World Health Organization update 2017 includes this cytogenetically defined category of "High grade B cell lymphoma with myelocytoma MYC and BCL2 and/ or BCL6 rearrangements" as a distinct entity on their own. We present an interesting case of an obese patient presenting with a neck mass, suspected to be an aggressive thyroid carcinoma, which eventually turned out to be a high grade B-cell lymphoma.

Case description: A 64 years-old male presented with complaints of neck pain for 10 weeks and a huge swelling in front of neck for 4 weeks. Respiratory system evaluation revealed cough, pleuritic pain and expectoration. Rest of the systemic review was unremarkable. Baseline reports showed hypothyroid status. Ultrasonography (USG) thyroid showed right upper pole Thyroid Imaging Reporting and Data Systems - 4 (TIRADS-4) nodule with bilateral cervical lymphadenopathy for which correlation with fine needle aspiration cytology (FNAC) was advised. Magnetic resonance imaging (MRI) films were submitted for review which showed overall features of locally invasive primary thyroid malignancy. Case was discussed in a multi-disciplinary team (MDT) meeting and suspicion arose of non-thyroidal origin of tumor. Patient underwent Positron emission tomography/computed tomography (PET/CT) as per MDT recommendations. PET/CT findings were highly suggestive of lymphomatous disease as opposed to thyroidal malignancy suspicion early on, which was confirmed on histopathology of cervical nodes.

Practical implications: High grade B-cell lymphoma is an aggressive entity and can be very deceptive in its presentation, as evident from this case report. Functional imaging modalities such as Fluorodeoxyglucose (F-18 FDG) PET/CT can provide crucial assistance in unmasking a deceptive disease entity masquerading as some other, thus changing the management plan completely.

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