MALIGNANT HEMATOLOGIC FINDINGS BEYOND TYPICAL ENDOCRINE CONDITIONS

Abstract

Endocrine morbidities are a vast panel of conditions; the most frequent diseases in daily endocrine practice are typically thyroid nodules or primary osteoporosis. We aim to introduce two cases who underlined a hematologic malignancy in association with apparently low risk endocrine conditions involving thyroid, respective osteoporosis field. A 24-year female is admitted for anterior cervical lumps which she self-detected one month ago. Normal thyroid blood assays are associated with neck ultrasound anomalies as: 2 thyroid nodules of 0.5/0.3 cm, respective of 0.5/0.2 cm; 5 left cervical lumps (largest at supraclavicle level of 1.5/ 0.7/1.5 cm); 4 right lateral cervical lymph nodes; multiple similar lesions were also revealed at others neck areas – largest at submandible level of 1.3/0.9/1.2 cm (right), respective 1.1/0.9/2.4 cm (left). Evaluation at oto-rhino-laringology, infectious disease was unrevealing; diagnosis of stage IIA Hodgkin lymphoma was established starting from ganglion biopsy. This is 78-year female, admitted for evaluation of bone loss under densumab for the latest year after a decade history of bisphosphonates. Secondary causes of osteoporosis or hypovitaminosis D were ruled out; computed tomography detected a small adrenal incidentaloma, whole body bone scintigrame did not reveal metastasis while flow cytometry of peripheral lymphocytes identified B monoclonal lymphocytosis/chronic lymphatic leukaemia with B cell starting from a mild elevation of white blood cells in routine hemogram. Behind classical endocrine conditions as goitre or osteoporosis, severe diagnosis might be found in situations as associated cervical nodes involvement, respective non-response to specific anti-osteoporotic therapy if active case finding strategies in a multidisciplinary manner are performed.

Keywords

• osteoporosis
• lymphoma
• thyroid