Synchronous presentation of papillary thyroid carcinoma and Hodgkin lymphoma – a case report

Abstract

Multiple primary malignancies are increasingly detected due to advanced imaging modalities and comprehensive diagnostic protocols. Papillary thyroid carcinoma (PTC) is the most frequent type of thyroid neoplasm with ever-rising incidence. Hodgkin lymphoma (HL) is a lymphoid neoplasm more common in young adults and usually involves cervical lymph nodes. PTC is known to be radiation-induced in previously treated lymphoma patients but the synchronous appearance of these two malignancies in patients without a history of radiation exposure is very rare. We present a case of a 42-year-old male patient who was incidentally diagnosed with HL during the workup for a lump in the right lobe of the thyroid gland. Contrast-enhanced CT of the neck demonstrated a large heterogeneous nodal mass in the right thyroid lobe suggesting thyroid neoplasm. Lymphadenopathy was present on the opposite left side of the neck and bilaterally in the mediastinum with enlarged homogeneous nodes atypical for thyroid metastases. Fine needle aspiration and histopathological analysis of samples received after thyroidectomy and neck dissection confi rmed PTC and classical HL. The patient was referred to treatment of HL which showed signs of primary refractory disease with response and complete remission on the second-line chemotherapy regimen. Radio-iodine ablation of remnant thyroid tissue is planned after hematological stabilization. This paper aims to describe a rare condition of concomitant occurrence of primary thyroid and hematological malignancies and to discuss the challenges in the diagnosis and management of synchronous tumors.

Keywords

• multiple primary malignancies
• papillary thyroid carcinoma
• Hodgkin lymphoma