Fondazione Salvatore Maugeri IRCCS, University of Pavia, Pavia, Italy.
Thyroid. 2010 Sep;20(9):1033-6. doi: 10.1089/thy.2010.0048.
Most solitary hyperfunctiong regions on thyroid scan consist of benign tissue. Here we report a patient with a Burkitt-like lymphoma that was infilterated into a region containing a hyperfunctioning nodule.
A 56-year-old man was referred to our Endocrine Unit in May 2009 due to the incidental discovery of a large left thyroid lobe nodule by a computed tomography study. This had been performed to search for a primitive tumor in a patient with bone metastasis. He was clinically and biochemically thyrotoxic with no evidence of humoral thyroid autoimmunity. The nodule had a dyshomogenous appearance at neck ultrasonography, with multiple hypoechogenic areas and calcifications. (99m)-Technetium thyroid scintiscan revealed a hot nodule with suppression of the contralateral lobe. Fine-needle aspiration cytology indicated the presence of neoplastic cells not of thyroid origin. Remission of hyperthyroidism was obtained with methimazole, and the patient was submitted to left lobe thyroidectomy and istmectomy. Histological analysis of the surgical specimen led to a diagnosis of Burkitt-like large B-cell lymphoma harbored within a thyroid adenoma. After further staging, the final diagnosis was stage IV E Burkitt-like lymphoma with the involvement of the bone and the thyroid. This is the first description of an aggressive Burkitt-like lymphoma that infiltrated an hyperfunctioning thyroid adenoma, thus presenting as a hot nodule at thyroid scintiscan. In our patient there was no humoral or histological evidence of thyroid autoimmunity, thus suggesting a metastatic seeding of the lymphoma within the hyperfunctioning thyroid nodule.
Involvement of the thyroid gland by Burkitt-like lymphoma is extremely rare as is close localization of malignancy and a hyperfunctioning thyroid nodule. As highlighted by the present report, performing fine-needle aspiration cytology should be always considered in the clinical context of a metastatic disease of unknown origin or when there are ultrasonography signs suggesting malignancy, even when the nodule is hyperfunctioning.
大多数甲状腺扫描中的孤立高功能区域由良性组织组成。在这里，我们报告了一例伯基特样淋巴瘤浸润到含有高功能结节的区域的病例。
2009 年 5 月，一名 56 岁男性因计算机断层扫描发现左甲状腺叶大结节而被转至我院内分泌科。该患者因骨转移而进行此项检查以寻找原始肿瘤。他表现为临床和生化甲状腺毒症，无体液性甲状腺自身免疫证据。颈部超声检查显示结节外观不均匀，存在多个低回声区和钙化。（99m）-锝甲状腺闪烁扫描显示热结节，对侧叶受抑制。细针抽吸细胞学检查提示存在非甲状腺来源的肿瘤细胞。他接受甲巯咪唑治疗后甲状腺毒症缓解，并进行了左叶甲状腺切除术和峡部切除术。手术标本的组织学分析提示为伯基特样大 B 细胞淋巴瘤，伴甲状腺腺瘤。进一步分期后，最终诊断为 IVE 期伯基特样淋巴瘤，累及骨骼和甲状腺。这是首例侵袭性伯基特样淋巴瘤浸润高功能甲状腺腺瘤的病例，因此在甲状腺闪烁扫描中表现为热结节。在我们的患者中，没有体液或组织学证据表明存在甲状腺自身免疫，因此提示淋巴瘤在高功能甲状腺结节内发生了转移性种植。
伯基特样淋巴瘤累及甲状腺极为罕见，恶性肿瘤和高功能甲状腺结节的紧密定位也很罕见。正如本报告所强调的，在不明来源的转移性疾病或超声检查提示恶性肿瘤的临床情况下，即使结节为高功能，也应始终考虑进行细针抽吸细胞学检查。
