Bernardi Stella, Michelli Andrea, Bonazza Deborah, Calabrò Veronica, Zanconati Fabrizio, Pozzato Gabriele, Fabris Bruno
Department of Medical Surgical and Health Sciences, Università degli Studi di Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, 34149, Trieste, Italy.
Endocrinology Unit - Azienda Sanitaria Universitaria Integrata Trieste, Cattinara Teaching Hospital, Strada di Fiume 447, 34149, Trieste, Italy.
BMC Endocr Disord. 2018 Nov 19;18(1):86. doi: 10.1186/s12902-018-0312-9.
Thyroid lymphomas are an exceptional finding in patients with thyroid nodules. Burkitt's lymphoma is one of the rarest and most aggressive forms of thyroid lymphomas, and its prognosis depends on the earliness of medical treatment. Given the rarity of this disease, making a prompt diagnosis can be challenging. For instance, fine-needle aspiration (FNA) cytology, which is the first-line diagnostic test that is performed in patients with thyroid nodules, is often not diagnostic in cases of thyroid lymphomas, with subsequent delay of the start of therapy.
Here we report the case of a 52-year-old woman presenting with a rapidly enlarging thyroid mass. Thyroid ultrasonography demonstrated a solid hypoechoic nodule. FNA cytology was only suggestive of a lymphoproliferative disorder and did not provide a definitive diagnosis. It is core needle biopsy (CNB) that helped us to overcome the limitations of routine FNA cytology, showing the presence of thyroid Burkitt's lymphoma. Subsequent staging demonstrated bone marrow involvement. The early start of an intensive multi-agent chemotherapy resulted in complete disease remission. At 60 months after the diagnosis, the patient is alive and has not had any recurrence.
Clinicians should be aware that thyroid Burkitt's lymphoma is an aggressive disease that needs to be treated with multi-agent chemotherapy as soon as possible. To diagnose it promptly, they should consider to order/perform a CNB in any patient with a rapidly enlarging thyroid mass that is suspicious for lymphoma.
甲状腺淋巴瘤在甲状腺结节患者中是一种罕见的发现。伯基特淋巴瘤是甲状腺淋巴瘤中最罕见且侵袭性最强的形式之一，其预后取决于医疗治疗的及时性。鉴于这种疾病的罕见性，做出快速诊断可能具有挑战性。例如，细针穿刺（FNA）细胞学检查是对甲状腺结节患者进行的一线诊断测试，但在甲状腺淋巴瘤病例中往往无法确诊，从而导致治疗开始延迟。
在此，我们报告一例52岁女性患者，其甲状腺肿块迅速增大。甲状腺超声检查显示一个实性低回声结节。FNA细胞学检查仅提示淋巴增生性疾病，未提供明确诊断。是粗针活检（CNB）帮助我们克服了常规FNA细胞学检查的局限性，显示存在甲状腺伯基特淋巴瘤。随后的分期显示有骨髓受累。早期开始强化多药化疗导致疾病完全缓解。诊断后60个月，患者存活且未出现任何复发。
临床医生应意识到甲状腺伯基特淋巴瘤是一种侵袭性疾病，需要尽快用多药化疗进行治疗。为了及时诊断，对于任何甲状腺肿块迅速增大且怀疑为淋巴瘤的患者，他们应考虑安排/进行粗针活检。
