Jaafari Ayoub, Mehaudens Sébastien, Gheysens Olivier, Bailly Sarah, Schobbens Nicolas, Mourad Michel, Jamar François
Nuclear Medicine Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium.
Hematology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium.
Diagnostics (Basel). 2025 Aug 28;15(17):2180. doi: 10.3390/diagnostics15172180.
Primary thyroid lymphoma (PTL) is an uncommon malignancy that predominantly affects women in their sixth or seventh decade. It is strongly associated with chronic lymphocytic thyroiditis (Hashimoto's thyroiditis) and other autoimmune conditions. The hallmark clinical feature is a rapidly enlarging thyroid mass, which can quickly cause compressive symptoms such as dysphagia, hoarseness, and dyspnoea. Timely recognition and treatment are essential. [F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ([F]FDG-PET/CT) plays a central role in the diagnosis, staging, response assessment, prognostication, and surveillance of high-grade lymphomas, significantly influencing clinical management. : We report the case of a woman in her sixties with a history of multinodular goitre but without an autoimmune background, who presented with a large left-sided cervical mass that had rapidly enlarged over approximately two months. Laboratory tests, fine-needle aspiration (FNA), and [F]FDG-PET/CT revealed abnormal cytology and a highly hypermetabolic necrotic left thyroid mass, without extra-thyroidal disease, suggestive of lymphoma. Definitive biopsy with immunohistochemistry confirmed a high-grade B-cell lymphoma, positive for CD5 and demonstrating triple expression of Bcl2, Bcl6, and c-Myc. The patient underwent chemotherapy, achieving a marked morphometabolic response after two cycles, consolidated after four cycles. : This rare case highlights the importance of considering PTL in the differential diagnosis of an isolated, rapidly enlarging thyroid mass, regardless of prior Hashimoto's thyroiditis. Early diagnosis and timely treatment are crucial to improve patient outcomes.
原发性甲状腺淋巴瘤（PTL）是一种罕见的恶性肿瘤，主要影响60或70岁的女性。它与慢性淋巴细胞性甲状腺炎（桥本甲状腺炎）和其他自身免疫性疾病密切相关。其标志性临床特征是甲状腺肿块迅速增大，可迅速引起吞咽困难、声音嘶哑和呼吸困难等压迫症状。及时识别和治疗至关重要。氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（[F]FDG-PET/CT）在高级别淋巴瘤的诊断、分期、疗效评估、预后判断和监测中起着核心作用，对临床管理有重大影响。我们报告一例60多岁的女性病例，有结节性甲状腺肿病史但无自身免疫背景，她出现左侧颈部巨大肿块，在大约两个月内迅速增大。实验室检查、细针穿刺活检（FNA）和[F]FDG-PET/CT显示细胞学异常以及左侧甲状腺高度代谢的坏死性肿块，无甲状腺外病变，提示淋巴瘤。免疫组化确诊为高级别B细胞淋巴瘤，CD5阳性，显示Bcl2、Bcl6和c-Myc三重表达。患者接受了化疗，两个周期后取得显著的形态代谢反应，四个周期后巩固治疗。这个罕见病例强调了在孤立性、迅速增大的甲状腺肿块鉴别诊断中考虑PTL的重要性，无论之前是否有桥本甲状腺炎。早期诊断和及时治疗对于改善患者预后至关重要。
