Non-Hodgkin's Lymphoma of Lymph Node and Papillary Carcinoma of Thyroid-Double Trouble

Dual-primary malignancies are uncommon and are occasionally observed in clinical practice. Although papillary carcinoma of the thyroid and non-Hodgkin lymphoma of the lymph node are the most common conditions, the coexistence of these two is uncommon. We encountered a 44-year-old male with a large lymph node mass on the left side of the neck measuring 10 cm × 15 cm. The ultrasound of the neck showed multiple cervical lymph node enlargements with a normal thyroid. Excision biopsy revealed non-Hodgkin's lymphoma of the lymph node for which he underwent chemotherapy. After six cycles of the R-CHOP regimen, positron emission tomography scan (PET) was done, which showed a hypermetabolic nodule of size 9.5 mm × 8.4 mm in the left lobe of the thyroid with multiple lymph node enlargement (Largest 13 mm × 21 mm in left level IV). The fine needle aspiration cytology revealed papillary carcinoma of the thyroid. With that incidental diagnosis, total thyroidectomy with lymph node dissection was performed. The patient is doing well and is on regular follow-up. This case report highlights the rarity of the presentation of non-Hodgkin's lymphoma of lymph node and papillary carcinoma of the thyroid and the resulting management dilemma.