Aim: To report a case of Hodgkin lymphoma involving thyroid gland and to review the literature for the same.
Background: Thyroid lymphomas occur most commonly in the form of non-Hodgkin lymphomas. In contrast, Hodgkin lymphoma involving the thyroid gland is a relatively rare scenario and which, by virtue of its rarity, is mistaken for usual thyroid lesions both on clinical and cytological examination.
Case report: A 34-year-old female was presented with anterior neck mass and breathlessness. The fine needle aspiration cytology of the mass was suspicious for Hodgkin lymphoma and the diagnosis was further confirmed on a thyroid biopsy. Suspicion of Hodgkin lymphoma on cytology in this patient ensued proper medical management, thus averting a surgical treatment. Patient defaulted chemotherapy and died 6 month after initial diagnosis.
Conclusion: A careful cytological examination assisted with ancillary techniques ensures a proper treatment strategy and avoids unnecessary surgical intervention.
Clinical significance: With thorough literature review, this study highlights the way immunocytochemistry and thyroid biopsy dictates the treatment decision when dealing with uncommon tumours at this site.
Chan JKC, Burke JS, Ferry JA, Wotherspoon A. Primary Hodgkin Lymphoma. In: Lloyd RV, Osamura RY, Kloppel G, Rosai J, editors. WHO Classificiation of Tumors of Endocrine Organs. 4th ed. Lyon, France: IARC Press; 2017:137-138.
Graff-Baker A, Roman SA, Thomas DC, Udelsman R, Sosa JA. Prognosis of primary thyroid lymphoma: Demographic, clinical, and pathologic predictors of survival in 1,408 cases. Surgery. 2009;146:1105-1115.
Wang SA, Rahemtullah A, Faquin WC, Roepke J, Harris NL, Hasserjian RP. Hodgkin's lymphoma of the thyroid: A clinicopathologic study of five cases and review of the literature. Mod. Pathol. 2005;18:1577-1584.
Bello CT, Cassis J, Simoes H, Sequeira Duarte J. Nodular lymphocyte predominant Hodgkin Lymphoma of the thyroid. Case Rep. Endocrinol. 2016. http://doi.org/10.1155/2016/8756723
De Baets M, Vanholder R, Eeckhaut W, Hamers J, Van Hove W, De Roose J, Vermeulen A, Roels H, Van Breda Vriesman PJ. Primary Hodgkin's disease of the thyroid. Report of a case demonstrated by immunoperoxidase-positive Reed-Sternberg cells. Acta Haematol. 1981;65:54-59.
Hardoff R, Bar-Shalom R, Dharan M, Luboshitsky R. Hodgkin's disease presenting as a solitary thyroid nodule. Clin. Nucl. Med. 1995;20:37-41.
Aschebrook-Kilfoy B, Ward MH, Sabra MM, Devesa SS. Thyroid cancer incidence patterns in the United States by histologic type, 1992-2006. Thyroid. 2011;21:125-134.
Stein SA, Wartofsky L, Primary thyroid lymphoma: A clinical review. J. Clin. Endocrinol. Metab. 2013;98:3131-3138.
Guermazi A, Brice P, de Kerviler EE, Ferme C, Hennequin C, Meignin V, Frija J. Extranodal Hodgkin disease: Spectrum of disease. Radiographics. 2001;21:161-179.
Rupp JJ, Moran JJ, Griffith JR. Goiter as initial manifestation of Hodgkin's disease. Arch. Intern. Med. 1962;110:386-388.
Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Aoun P, Bello CM, Bierman PJ, Blum KA, Chen R, Dabaja B, Duron Y, Forero A, Gordon LI, Hernandez-Ilizaliturri FJ, Hochberg EP, Maloney DG, Mansur D, Mauch PM, Metzger M, Moore JO, Morgan D, Moskowitz CH, Poppe M, Pro B, Winter JN, Yahalom J, Sundar H. Hodgkin lymphoma, version 2.2012 featured updates to the NCCN guidelines. J. Natl. Compr. Canc. Netw. 2012;10:589-597.
Rueda Dominguez A, Marquez A, Guma J, Llanos M, Herrero J, de Las Nieves MA, Miramon J, Alba E. Treatment of stage I and II Hodgkin's lymphoma with ABVD chemotherapy: Results after 7 years of a prospective study. Ann. Oncol. 2004;15:1798-1804.
Colby TV, Hoppe RT, Warnke RA. Hodgkin's disease: A clinicopathologic study of 659 cases. Cancer. 1982;49:1848-1858.
Bercovici JP, Machelon V, Gaudin-Nome F, Roudaut N, Conan-Charlet V, Leroy JP, Sensebe L, Kerlan V. Hodgkin's disease masquerading as fibrous thyroiditis: Potential role of cytokines in in vivo and in vitro studies. Clin. Endocrinol. 2002;57:691-697.
Holm LE, Blomgren H, Lowhagen T. Cancer risks in patients with chronic lymphocytic thyroiditis. N. Engl. J. Med. 1985;312:601-604.
Kato I, Tajima K, Suchi T, Aozasa K, Matsuzuka F, Kuma K, Tominaga S. Chronic thyroiditis as a risk factor of B-cell lymphoma in the thyroid gland. Jpn. J. Cancer Res. 1985;76:1085-1090.
Klyachkin ML, Schwartz RW, Cibull M, Munn RK, Regine WF, Kenady DE, McGrath PC, Sloan DA. Thyroid lymphoma: Is there a role for surgery? Am. Surg. 1998;64:234-238.
Roberts TW, Howard RG. Primary Hodgkin's disease of the thyroid: Report of a case and review of the literature. Ann. Surg. 1963;157:625-632.
Gibson JM, Prinn MG. Hodgkin's disease involing the thyroid gland. Br. J. Surg. 1968;55:236-238.
Feigin GA, Buss DH, Paschal B, Woodruff RD, Myers RT. Hodgkin's disease manifested as a thyroid nodule. Hum. Pathol. 1982;13:774-776.
Kugler JW, Armitage JO, Dick FR. Hodgkin's disease presenting as a thyroid mass. Postgrad. Med. 1982;72:243-245.
Granados R, Pinkus GS, West P, Cibas ES. Hodgkin's disease presenting as an enlarged thyroid gland. Report of a case diagnosed by fine needle aspiration. Acta Cytol. 1991;35:439-442.
Vailati A, Marena C, Aristia L, Nelva A, Cebrelli C, Ferrari E. Primary Hodgkin's disease of the thyroid: Report of a case and a review of the literature. Haematologica 1991;76:69-71.
Jayaram G. Hodgkin's disease beginning as a thyroid nodule. Acta Cytol. 1993;37:256-257.
Luboshitzky R, Dharan M, Nachtigal D, Rosen G, Honigman J. Syncytial variant of nodular sclerosing Hodgkin's disease presenting as a thyroid nodule. A case report. Acta Cytol. 1995;39:543-546.
Nakamura S, Mizukami Y, Yokoyama K, Saito Y, Ohtake S, Matsuda T. Thyroid tumor as initial presentation of Hodgkin's disease: A case report including an immunophenotypic characterization. Acta Haematol. 1997;98:214-216.
Zolotar M, Olaleye O, Sherif A, Howe R, Mathews J. Hodgkin's disease presenting as discharging neck sinuses and a mediastinal mass. BMJ. Case Rep. 2011. http://doi.org/10.1136/ bcr.12.2010.3669
Oriot P, Malvaux P, Waignein F, Delcourt A, Doyen C, Rousseau E, Baudry G, Dechambre S. Nodular sclerosing Hodgkin's disease mimicking Riedel's invasive fibrous thyroiditis. Ann. Endocrinol. 2012;73:492-496.
Thomas RM. Hodgkin's lymphoma presenting as an abscess in thyroid gland. Indian J. Pathol. Microbiol. 2012;55:122-124.
Szczepanek-Parulska E, Szkudlarek M, Majewski P, Breborowicz J, Ruchala M. Thyroid nodule as a first manifestation of Hodgkin lymphoma: Report of two cases and literature review. Diagn. Pathol. 2013. http://doi.org/ 10.1186/1746-1596-8-116
Sánchez-Vela P, Roselló-Sastre E, Cortés-Vizcaíno V, Forteza- Vila J. Classical Hodgkin's lymphoma of the thyroid. Rev. Esp. Patol. 2015;48:182-189.