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Medicine (Baltimore). 2019 Aug;98(35):e16994. doi: 10.1097/MD.0000000000016994.

Down syndrome with primary thyroid diffuse large B-cell lymphoma and Hashimoto thyroiditis: A CARE compliant case report.

Author information

1
Department of General Surgery.
2
Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China.

Abstract

RATIONALE:

Adult patients with Down syndrome (DS) commonly develop Hashimoto thyroiditis (HT). However, primary diffuse large B-cell lymphoma (DLBCL) of the thyroid is uncommon, and its simultaneous occurrence with HT is very rare. To our knowledge, coexisting DLBCL and HT in a patient with DS has not been reported in the medical literature.

PATIENT CONCERNS:

We present a 43-year-old woman with DS who reported progressive swelling of the neck on the right side and dyspnea over the previous 1 month, with associated neck ache, hoarseness, and dysphagia. Thyroid ultrasonography and computed tomography of the neck revealed a large mass in the right lobe compressing the surrounding tissues.

DIAGNOSES:

Based on the clinical and histopathologic findings, the patient was diagnosed with coexisting primary thyroid DLBCL and HT.

INTERVENTIONS:

A palliative unilateral thyroidectomy was performed; postoperative histopathology and immunohistochemistry revealed thyroid DLBCL and HT. The patient was scheduled for chemotherapy and targeted therapy after recovering from surgery.

OUTCOMES:

The patient died 3 weeks after surgery due to asphyxia caused by uncontrollable growth of recurrent tumor.

LESSONS:

The coexistence of DS, primary thyroid DLBCL, and HT is very rare. There is no standardized approach to the clinical identification of primary thyroid lymphoma (PTL), making early diagnosis difficult. A multidisciplinary approach and close follow-up are needed. The mechanisms of the link between DS and PTL are poorly understood and remain to be elucidated.

PMID:
31464950
DOI:
10.1097/MD.0000000000016994
[Indexed for MEDLINE]
Free PMC Article

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