Hsieh Chi-Ta, Yu Jui-Ting, Tsao Tang-Yi, Tseng Yao Hsien
Department of Internal Medicine, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
Division of Hematology and Medical Oncology, Department of Internal Medicine, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
Endocrinol Diabetes Metab Case Rep. 2024 Jan 29;2024(1). doi: 10.1530/EDM-23-0019. Print 2024 Jan 1.
A 69-year-old woman presented with weight loss, fever, dizziness, exertional dyspnea, and drenching night sweats. Imaging showed a thyroid goiter at the left lobe that measured 5.6 × 3.4 × 3.5 cm in size. On computed tomography, she was found to have large adrenal masses. Core needle biopsy of the left thyroid mass revealed the presence of a mucosa-associated lymphoid tissue extranodal marginal zone B cell lymphoma. Non-Hodgkin's lymphomas (NHL) typically develop in lymph nodes or other lymphatic tissues. There have been cases where the thyroid has been affected, and the secondary involvement of the adrenal gland is common. In reported cases, 7-59% of patients with NHL exhibited symptoms of thyroid dysfunction. Our patient presented no symptoms of thyroid dysfunction or Hashimoto's thyroiditis. The patient had bilateral adrenal lymphomas that led to adrenal insufficiency. Immunochemotherapy provided a good response in this case, as seen by the rapid improvement in thyroid and adrenal mass on follow-up PET/CT.
Thyroid lymphoma requires a high index of suspicion for diagnosis in patients with a rapidly growing thyroid tumor, even in the absence of chronic inflammatory thyroid disease. Depending on the extent of involvement, adrenal lymphoma may rapidly cause adrenal insufficiency. In the setting of acute illness, appropriate levels of plasma cortisol are often unclear, necessitating early initiation of glucocorticoid therapy based on clinical suspicion, especially when features like bilateral adrenal masses and elevated ACTH levels are present. Treatment modalities include chemotherapy and radiation therapy for localized lesions, together with hormone replacement for organ dysfunction. The origin of the tumor influences the clinical outcome of patients with lymphoma simultaneously involving the thyroid and adrenal glands.
一名69岁女性出现体重减轻、发热、头晕、劳力性呼吸困难和盗汗。影像学检查显示左叶甲状腺肿大，大小为5.6×3.4×3.5厘米。计算机断层扫描发现她有巨大肾上腺肿块。左甲状腺肿块的粗针活检显示存在黏膜相关淋巴组织结外边缘区B细胞淋巴瘤。非霍奇金淋巴瘤（NHL）通常发生于淋巴结或其他淋巴组织。已有甲状腺受累的病例报道，肾上腺继发性受累很常见。在已报道的病例中，7%至59%的NHL患者出现甲状腺功能障碍症状。我们的患者未出现甲状腺功能障碍或桥本甲状腺炎的症状。该患者双侧肾上腺淋巴瘤导致肾上腺功能不全。免疫化疗在本病例中取得了良好效果，随访PET/CT显示甲状腺和肾上腺肿块迅速缩小。
对于甲状腺肿瘤迅速增大的患者，即使没有慢性炎症性甲状腺疾病，甲状腺淋巴瘤的诊断也需要高度怀疑。根据受累程度，肾上腺淋巴瘤可能迅速导致肾上腺功能不全。在急性疾病的情况下，血浆皮质醇的适当水平往往不明确，因此有必要根据临床怀疑尽早开始糖皮质激素治疗，特别是当出现双侧肾上腺肿块和促肾上腺皮质激素水平升高等特征时。治疗方式包括针对局限性病变的化疗和放疗，以及针对器官功能障碍的激素替代治疗。肿瘤的起源同时影响甲状腺和肾上腺均受累的淋巴瘤患者的临床结局。
