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. 2015 Nov-Dec;56(6):433-5.
doi: 10.4103/0300-1652.171612.

Report of a case of papillary thyroid carcinoma in association with Hashimoto's thyroiditis

Chukwudi Onyeaghana Okani  1 , Benjamin Otene  2 , Terhemba Nyaga  2 , Joseph Ngbea  2 , Agaba Eke  3 , Felix Edegbe  4 , Daniel Anyiam  5
Affiliations

Report of a case of papillary thyroid carcinoma in association with Hashimoto's thyroiditis

Chukwudi Onyeaghana Okani et al. Niger Med J. 2015 Nov-Dec.

Abstract

Hashimoto thyroiditis (HT) is an autoimmune disease, known to be the most common cause of hypothyroidism in nonendemic goitrous areas. It is usually characterized by symmetric, painless, and diffused but sometimes localized swelling of the thyroid gland with features of hypothyroidism. Papillary thyroid carcinoma (PTC), on the other hand, is the most common yet less aggressive form of thyroid cancer, especially in iodine-deficient areas. The coexistence of the two diseases is possible but not common. This case study reports a 50-year-old female with a 10-year history of a huge goiter, which was essentially symptom-free until about 3 months prior to presentation when the patient started complaining of neck pain, dysphagia, productive cough, and cold intolerance. Physical examination revealed focal cystic and tender area in the multinodular swelling and associated cervical lymphadenopathy on the left side of the neck. The serum thyroid stimulating hormone was high, sub-normal T3, and the T4 was low. The fine needle aspiration cytology yielded 10 ml of aspirate of pus admixed with altered blood which on microscopy showed a few suspicious follicular epithelial cells with open nuclei admixed with mainly neutrophil polymorphs, siderophages, and foam cells in a hemorrhagic background. The patient had an incision biopsy that showed areas displaying PTC and HT.

Keywords: Hashimoto thyroiditis; Hurthle cell; histopathology; papillary thyroid carcinoma.

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Figures

Figure 1
Figure 1
Multinodular goiter in a 50-year-old woman diagnosed with concurrent Hashimoto thyroiditis, papillary thyroid carcinoma, and Hurthle cell adenoma. (a) Anterior view of goiter with focal cystic areas filled with pus. (b) The lateral view of the goiter showing extension of the swelling into the posterior aspect of the neck
Figure 2
Figure 2
Hashimoto thyroiditis. Residual thyroid follicle being destroyed by a dense lymphocytic infiltrates
Figure 3
Figure 3
The microscopic appearance of a papillary carcinoma showing well-formed papillae and cells with ground glass nuclei
Figure 4
Figure 4
Papillary carcinoma of the thyroid. The microscopic appearance of a papillary carcinoma showing cells with characteristic empty-appearing nuclei called “Orphan Annie eye” nuclei
See this image and copyright information in PMC

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