Nodular Lymphocyte Predominant Hodgkin Lymphoma of the Thyroid

Abstract

Thyroid lymphomas are rare clinical entities that may result from either the primary intrathyroid de novo or secondary thyroid gland involvement of a lymphoma. Among these, the Hodgkin's subtype is quite uncommon, accounting for 0.6-5% of all thyroid malignancies. The authors report on a 76-year-old female presenting with a thyroid nodule that, upon surgical excision, was found to be a nodular lymphocyte predominant Hodgkin lymphoma of the thyroid. So far, thyroid involvement by this variant has never been reported. Upon reporting on this clinical case, the authors emphasize the difficulties usually found in establishing the diagnosis and in defining the best management strategy. A thorough review of the available literature is done.

Figure 1

(a) Thyroid nodule, large (29 × 44 × 31 mm transverse, longitudinal, and anteroposterior diameters, resp.) hypoechogenic heterogeneous thyroid nodule with regular borders; (b) lymph node, large (48 × 20 mm), hypoechoic, partly cystic lymph node.

Figure 2

3: FNA of the thyroid with follicular cells with suspicious nuclei (anisokaryosis, longitudinal grooves) on the background of a lymphocytic thyroiditis (Papanicolaou stain, 400x); 4: macroscopy features of the surgical specimens: left hemithyroidectomy (on top) and left cervical lymph node (on the bottom); 5: thyroid parenchyma with a diffuse infiltration of a lymphoid neoplasm (HE, 40x). These features were also found on the lymph node (not shown); 6: the neoplasm consisted of irregular nodules of follicular dendritic cells (CD21, 40x); 7: extensive background of CD4+ T-lymphocytes (CD4, 40x); 8: intermingled scattered large “popcorn cells” could be observed (HE, 200x); 9: the neoplastic popcorn cells were positive for CD20 (CD20, 200x); 10: they were negative for CD30 (CD30, 200x) and CD15 (not shown).