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On 25th August 2017, in Diagnostic Pathology, Bo Luo (Tongji Medical College, Wuhan City, Hubei Province, People’s Republic of China) and Jia-mei Chen (Renmin Hospital of Wuhan University, Whan City, Hubei Province, People’s Republic of China) et al. published a case report of 68-year-old male patient with an Intravascular Large B-Cell Lymphoma (IVLBCL) involving the thyroid and accompanied by bilateral nodular goiter.
To the author’s knowledge, only two cases of IVLBCL involving the thyroid had been published in the literature previously. They note that their case was diagnosed late with both thyroid and cerebellum involvement. The group emphasize that “clinicians and pathologists should be aware of the existence of thyroid IVLBCL.” Lastly, they conclude that diagnosing IVLBCL earlier via biopsy and treatment with R-CHOP could have improved the patient’s survival.
BACKGROUND: Intravascular large B-cell lymphoma (IVLBCL) is a subtype of diffuse large B-cell lymphoma (DLBCL) that is rare and highly aggressive and that may progressively involve many organs. CNS (central nervous system), BM (bone marrow) and skin are the most common systems involved. To date, only 2 cases of IVLBCL involving the thyroid have been reported.
CASE PRESENTATION: Here, we report a case of IVLBCL involving the thyroid and accompanied by bilateral nodular goiter. In this case, a thyroid mass was identified in a physical examination of a 68-year-old male who initially presented with dyspnea accompanied by intermittent headache for approximately 1 month. Computed tomography scans revealed that the left lobar thyroid was occupied by a large, slightly lower density mass (5.8 × 4.7 × 8.4 cm). However, the patient had no hyperthyroidism or hoarseness. Levels of thyroid hormones and anti-thyroid autoantibodies in the serum were normal preoperatively. Thyroid mass resection was performed to establish a diagnosis and to relieve symptoms.
CONCLUSIONS: Pathological results of the surgical specimen revealed that large atypical lymphoma cells filled the capillaries in the lesion area. Immunohistochemical staining revealed that the large-sized tumor cells were positive for CD20, PAX-5, MUM-1 and BCL-2, and were negative for CD3, CD5, CD43, CD10, CD23, CyclinD1, CD138, CD30, ALK, CD56, MPO, S-100, TTF-1, TG (thyroglobulin) and CT (calcitonin). The Ki-67 index was estimated to be approximately 85%. The patient was subsequently diagnosed as "Classical" IVLBCL non-germinal center B-cell type. The patient declined chemotherapy and died in the fifth month after operation.
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