Rapidly Growing Goitre: Not Always A Carcinoma

Area of Science:

• Oncology
• Hematology
• Endocrinology

Background:

• Primary thyroid lymphoma (PTL) is an uncommon thyroid malignancy.
• It often presents as a rapidly growing goiter, particularly in patients with Hashimoto's thyroiditis.
• Misdiagnosis can occur with fine needle aspiration cytology (FNAC).

Purpose of the Study:

• To highlight the importance of recognizing PTL in clinical practice.
• To emphasize the diagnostic value of histological biopsy over FNAC for rapidly growing goiters.
• To illustrate a successful treatment outcome for PTL.

Main Methods:

• Case report of a 53-year-old woman with a rapidly growing goiter.
• Diagnostic workup included Computed Tomography (CT) imaging and histological biopsy.
• Treatment involved corticosteroids for compressive symptoms followed by R-CHOP chemotherapy.

Main Results:

• Histological biopsy confirmed B-cell non-Hodgkin lymphoma, stage I.
• The patient achieved remission for 12 months following R-CHOP chemotherapy.
• High-dose prednisone effectively managed compressive symptoms.

Conclusions:

• PTL requires consideration in rapidly growing goiters, especially with a history of Hashimoto's thyroiditis.
• Histological biopsy is essential to prevent misdiagnosis.
• Chemotherapy, potentially with radiation, is the preferred treatment, often avoiding surgery.