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LETTER TO THE EDITOR
Year : 2016  |  Volume : 13  |  Issue : 2  |  Page : 95-97

Papillary carcinoma thyroid associated with Hashimoto's along with lymph node involvement


Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar, Telangana, India

Date of Web Publication1-Jun-2016

Correspondence Address:
Dr. S Srikanth
Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar - 505 415, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-0354.183273

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How to cite this article:
Srikanth S. Papillary carcinoma thyroid associated with Hashimoto's along with lymph node involvement. Thyroid Res Pract 2016;13:95-7

How to cite this URL:
Srikanth S. Papillary carcinoma thyroid associated with Hashimoto's along with lymph node involvement. Thyroid Res Pract [serial online] 2016 [cited 2019 Oct 23];13:95-7. Available from: http://www.thetrp.net/text.asp?2016/13/2/95/183273

Sir,

The normal thyroid gland in an adult weighs 15-40 gm and is composed of two lateral lobes connected in the midline by a broad isthmus. The major function of the thyroid gland is to maintain a high rate of metabolism, which is done by means of iodine containing thyroid harmones. The thyroid is one of the most labile organs in the body and responds to numerous stimuli such as puberty, pregnancy, physiologic stress and various pathologic states. Herein, we present a rare case of PCT associated with HT involving the bilateral cervical lymph nodes.

A 16-year-male patient came with complaints of diffuse enlargement of thyroid from past nine months with no associated symptoms. The swelling was of size 5 × 4 cm. Patient complains of multiple swellings as well in the cervical region from past five months, of size 2 × 2 cm, as mobility was restricted and firm. Ultrasonography (USG) was done and diagnosed as PCT. Fine needle aspiration cytology (FNAC) was done from thyroid and from lymph nodes and diagnosed as PCT metastasizing to lymph nodes. Complete thyroidectomy was done and we received a thyroid specimen of size 5 × 5 ×3 cm, firm, externally show multiple papillae like projections [Figure 1]a. Cut section shows lymph node like architecture, gray white with normal thyroid tissue [Figure 1]b. We also received 10 lymph nodes. Largest node was measuring 2.5 × 1× 0.5 cm [Figure 2]. Histopathologically, we diagnosed it as PCT associated with HT and 5/10 cervical lymph nodes show metastatic deposits.
Figure 1: Grossly showing complete thyroidectomy specimen with papillary projections (a). Cut section showing lymph node like architecture with normal thyroid (b)

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Figure 2: Gross showing lymph nodes of the same patient

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Thyroid gland, which plays a major role in day-to-day life is a common problem in females of all age groups. Hashimoto's thyroiditis (HT), also called chronic lymphocytic or autoimmune thyroiditis, is part of the spectrum of autoimmune thyroid diseases and is associated with various degrees of thyroid hypofunction and circulating antibodies to thyroid antigens.[1],[2] By strict criteria, it is a histological diagnosis that was first described by Hakaru Hashimoto, a Japanese surgeon working in Berlin, Germany.[3] The cause of HT is thought to be a combination of genetic susceptibility and environmental factors.[4] The incidence of HT is estimated to be 10-15 times higher in females; its annual incidence worldwide is estimated to be 0.3-1.5 cases per 1000 individuals.[5] Autoimmune disorders like Hashimotos does not pose a major serious problem, but carcinomas in thyroid should need appropriate treatment. Although the link between chronic inflammation and cancer is well established, the association between HT and papillary thyroid carcinoma has been controversial in medical bibliography since its initial description by Dailey et al., in 1955. The aim of our study was to determine the prevalence of PCT and HT coexistence and to assess the relationship between Hashimotos and the development, presentation, management and outcome of the PCT.

The prevalence of Hashimotos is significantly higher in patients with PCT. These patients typically have a dominant nodule, with 44% of which are discovered incidentally on routine examination. The prognostic variables at the time of a diagnosis of PCT and the approach to management are not altered by the presence of co-existent Hashimotos. In addition, the rate of surgical complications was not higher in patients with co-existent Hashimotos disease.

In the present case, FNAC from thyroid show highly cellular smears arranged in papillary pattern, showing nuclear grooving and inclusions [Figure 3]. FNAC from cervical lymph nodes also show the same picture [Figure 4]. Histopathologically, it shows a lesion consisting of multifocal dense lymphoid aggregates with germinal centers, with foci of Hurthle cells. The other areas show a neoplastic lesion comprising of papillae with central fibro vascular core and follicles lined by cells with optically clear nucleus with nuclear grooving [Figure 5]. Cytoplasm is scant and clear. Foci of calcific sperules (Psammoma bodies) seen with intervening normal thyroid tissue.
Figure 3: Highly cellular smears from thyroid showing tumor cells arranged in papillary pattern (Figure a, H and E, ×4).Smears showing tumor cells with inclusions and clearing (Figure b, H and E, ×40)

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Figure 4: Highly cellular smears from lymph node showing tumor cells with scattered lymphocytes (Figure a and b, H and E, ×10)

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Figure 5: Section showing germinal centers, Hurthle cells and tumor tissue arranged in papillary pattern with cells showing nuclear clearing and grooving (Figure a, H and E, ×4, Figure b, H and E, ×10)

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Sections from lymph nodes show (5/10) well-defined tumor deposits [Figure 6]. Isthmus is normal and no capsular or vascular invasion is seen.
Figure 6: Sections from the lymph node showing tumor tissue arranged in papillary pattern with nuclear clearing and lymphocytic infiltrate (Figure, H and E, ×10)

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The main aim of presenting this case is to highlight the importance of co-existence of PCT with Hashimotos, and to explain that there is an increased prevalence of HT in patients with PCT. The presence of co-existent HT does not affect the diagnostic evaluation or management of PCT. Generally, thyroid lesions are more commonly seen in females, but in this case, we present a 16-year-male boy, who is of unusual age group to present. The survival of patients who have PCT may be superior in co-existent with HT. The outcome and prognosis of PCT appear to be improved with the presence of co-existent HT.[6],[7]

 
  References Top

1.
Mazokopakis EE, Chatzipavlidou V. Hashimoto's thyroiditis and the role of selenium. Current concepts. Hell J Nucl Med 2007;10:6-8.  Back to cited text no. 1
    
2.
Mazokopakis EE, Papadakis JA, Papadomanolaki MG, Batistakis AG, Giannakopoulos TG, Protopapadakis EE, et al. Effects of 12 months treatment with L-selenomethionine on serum anti-TPO levels in patients with Hashimoto's thyroiditis. Thyroid 2007;17:609-12.  Back to cited text no. 2
    
3.
Hashimoto H. Struma Lymphomatosa. Archiv fur Klinische Chirurgie 1912;97:219-48.  Back to cited text no. 3
    
4.
Duntas LH. Environmental factors and autoimmune thyroiditis. Nat Clin Pract Endocrinol Metab 2008;4:454-60.  Back to cited text no. 4
    
5.
Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: A twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995;43:55-68.  Back to cited text no. 5
    
6.
Loh KC, Greenspan FS, Dong F, Miller TR, Yeo PP. Influence of lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 1999;84:458-63.  Back to cited text no. 6
    
7.
Kebebew E, Treseler PA, Ituarte PH, Clark OH. Coexisting chronic lymphocytic thyroiditis and papillary thyroid cancer revisited. World J Surg 2001;25:632-7.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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