The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 327
Poster Session
PS 1299 Endocrinology
A Case of Primary Mucosa-Associated Lymphoid Tis- sue Thyroid Lymphoma Presenting as the Focal Nodule without a Rapid Growth
Ga Young Kim1, Jae Wan Kwon1, Jung Hoon Lee1, Cheol Yeon Park1, Eon Ju Jeon1, Ji Hyun Lee1, Ho Sang Shon1, Eui Dal Jung1
Daegu Catholic University Medical Center, Korea1
Introduction: Primary thyroid mucosa-associated lymphoid tissue (MALT) lymphoma is a very rare subgroup of thyroid lymphoma, accounting for about 6 to 28% of all primary thyroid lymphomas. The thyroid gland is normally devoid of such lymphocytic tissue, and chronic autoimmune thyroiditis (Hashimoto’s disease) has been associated with an increased risk of lymphoma, including MALT lymphoma.
Case Report: We report a rare case of thyroid MALT lymphoma accompanied with Hashimoto’s thyroiditis. A 45-year-old woman preseneted to the hospital with en- larged neck. Initially, she was diagnosed with hypothyroidism due to Hashimoto’s thyroiditis and a focal hypoechoic lesion in the left thyroid lobe. Initially, fi ne-needle aspiration cytology (FNAC) in the focal hypoechoic lesion in the left thyroid lobe on ultrasound sonography was performed and consistent with Hashimoto’s thyroiditis.
However, on 4-year follow-up, the result of FNAC revealed atypical lymphoid cells, and the result of core-needle biopsy was also atypical lymphoid hyperplasia. There was no change in the size of thyroid lesion. We proceeded with curative surgery in the absence of preoperative pathologic confi rmation, because the possibility of malignant lymphoma was not ruled out. Total thyroidectomy was performed and the histologic examination was reported to be a MALT lymphoma, low grade, B cell lineage with Hashimoto’s thyroiditis. Follow-up care and long-term results of treatment of patients with thyroid lymphoma are not fully established, as maltoma presenting in the thyroid gland is an uncommon malignancy.
PS 1300 Endocrinology
A Case of Benign Symmetric Lipomatosis Mimicking Thyroid Tumors
Chul Hong Park1, Bo Hyun Kim1, Won Jin Kim1, Yun Kyung Jeon1, Sang Soo Kim1, In Ju Kim1
Department of Internal Medicine, School of Medicine, Pusan National University, Korea1
Benign symmetric lipomatosis (BSL) is a rare disease of unknown etiology, charac- terized by symmetrical fatty deposits on the suboccipital area, neck, shoulders, upper arms and upper parts of the trunk. The disorder predominantly affects male alcoholics between the ages of 30 and 60 years. The incidence is highest among residents of Mediterranean countries. It is very rare disease in oriental countries. We report a case of a benign symmetric lipomatosis mimicking thyroid tumors. 65-year-old man with past history of alcoholism, presented with slowly enlarging mass on anterior neck and posterior neck since 2011. He had no respiratory or gastrointestinal symptom other than palpable neck mass and cosmetic problem. Thyroid function test and all laborato- ry fi nding including anti-thyroid antibody were within normal limits except for mild el- evated aspartate-amino transferase. Neck ultrasonography showed diffuse goiter with heterogeneous echogenicity and well defi ned, mild echogenic mass mimicking thyroid tumors on the left thyroid lobe. Ultrasound guided fi ne needle aspiration (FNA) of the thyroid nodule was performed. However, FNA cytology revealed insuffi cient result. A computed tomography detected a small thyroid gland and diffuse subcutaneous fat infi ltration in the anterior neck and occipital region. He underwent surgical excision of neck mass for diagnosis and cosmetics. In view of the past history, clinical presenta- tion, radiographic, and histologic fi nding, a diagnosis of benign symmetric lipomatosis was made.
PS 1301 Endocrinology
A Case of Graves’ Patient with Thymic Expression of TSH-Receptors and Dynamic Changes of Thymic Hyper- plasia According to Graves’ Disease Activity
Young Shin Song1, Jae Kyung Won2, Mi Jeong Kim3, Dong-Wan Kim1, June-Key Chung3, Young Joo Park1
Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Korea1, Department of Pathology, Seoul National University College of Medicine and Seoul National University Hospital, Korea2, Department of Nuclear Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Korea3
Introduction: Thymic hyperplasia is frequently observed in Graves’ disease, the mech- anism of which has remained elusive.
Case Report: A 22-year-old woman diagnosed with Graves’ disease was detected with thymic hyperplasia. A needle biopsy performed to rule out thymoma revealed nonneoplastic thymic tissue. Her thymus regressed after the dosage of the antithy- roid drug was increased, with a concomitant decrease in serum thyrotropin receptor (TSH-R) antibodies and thyroid hormone levels. She discontinued the drug for over 1 year against medical advice, resulting in elevated TSH-R antibody levels, aggravated hyperthyroidism, and thymic enlargement. After she underwent a thyroidectomy for refractory hyperthyroidism, the size of the thymus markedly decreased again. Her thymic tissues were subjected to immunohistochemical staining for TSH-R, which demonstrated the presence of thymic TSH-R.
Conclusion: This is a unique case showing dynamic changes of thymic hyperplasia on serial CT images according to Graves’ disease activity. Furthermore, the correlation between serum TSH-R antibodies and thymic hyperplasia, and the presence of TSH-R in her thymus suggest that TSH-R antibodies could have a pathogenic role in thymic hyperplasia. Awareness of the association between thymic hyperplasia and Graves’
disease can help physicians to avoid unnecessary invasive investigations.
