Presentation
Rapidly enlarging neck mass.
Patient Data
6.3 x 4.8 cm left lobe of thyroid mass extending to the manubrium. No capsular breach.
The trachea is displaced to the right but not compressed.
Bilateral internal jugular chain nodes up to 1.1 cm. Paratracheal nodes up to 1.2 cm.
Lungs clear.
Fatty liver.
6.3 x 4.8 cm homogenous mass in the left lobe of thyroid. No capsular breach.
6.3 x 4.8 cm left lobe of thyroid mass extending to the manubrium. No capsular breach.
The trachea is displaced to the right but not compressed.
Bilateral internal jugular chain nodes up to 1.1 cm. Paratracheal nodes up to 1.2 cm.
18G core biopsy of left thyroid mass undertaken.
SPECIMEN Specimen type: Needle core, left hemithyroid
Material received: 4 stained slides and 1 block
Left hemithyroid large mass. 18 G cook needle biopsy. ?Lymphoma. 2 cores.
MACROSCOPY (Transcribed from RFT report) Two needle cores. The largest measuring up to 20 mm.
REVIEW MICROSCOPY These are good sized core biopsies of lesional tissue with a few incomplete fibrous septa and a possible single epithelial element. The neoplastic infiltrate is composed of pleomorphic lymphocytes with centroblastic and large centrocytic morphology. No multinucleated giant cells or indolent lymphoma is noted. There is apoptosis and mitosis. No definite tumor necrosis noted. The phenotype of the neoplastic cells is as follows: PAX5, BCL2, BCL6, MUM1 - diffuse strong expression. CD3, CD5, CD21, AE1/AE3, cyclin-D1, CD10, CD23 - not expressed. AE1/AE3 - highlights a few possible residual epithelial elements. CD21 - emphasizes two small possible follicular dendritic cell meshworks. Ki67 - brisk and around 85%.
Case Discussion
This patient had no evidence of lymphoma in the rest of the body. One of the less common causes of a thyroid mass is a primary thyroid malignancy.
This is a good example of this pathology and illustrates the benefit of clinicoradiological engagement.
Many would say thyroid biopsy should be selective given the risk of bleeding and the pure volume of nodules found in thyroids on imaging.
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