Coexistence of diffuse large B-cell lymphoma and papillary thyroid carcinoma in a patient affected by Hashimoto's thyroiditis

SUMMARY Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. On the contrary, primary thyroid lymphoma (PTL) is a rare disease, accounting for 2% to 5% of all thyroid malignancies. Despite several cases in which both PTC and PTL arise in the setting of Hashimoto's thyroiditis (HT), the coexistence of both tumors in HT patients is very rare. Herein we report the case of a 66-year-old woman with long-standing nodular HT under replacement therapy, who presented with a fast, painless enlargement in the right anterior side of the neck. Thyroid ultrasonography demonstrated increased growth of a hypoechoic nodule in the right lobe measuring 32 × 20 mm. A total thyroidectomy was performed, and histology revealed a diffuse large B-cell lymphoma (DLBCL) on a background of florid HT. Moreover, a unifocal papillary microcarcinoma, classical variant (7 mm, pT1aNxMx), was discovered. The patient was then treated with chemotherapy for the PTL, but she did not undergo radioactive iodine ablation treatment for the microPTC as per guidelines. Two years after surgery, the patient had no evidence of recurrence of either malignancy. This rare case highlights the importance of monitoring HT patients with nodular lesions, especially if they have long-standing disease. In addition, PTL should be considered for differential diagnosis in elder HT patients who present with sudden thyroid enlargement.

Dolor abdominal agudo como presentación de un linfoma ovárico / Acute abdominal pain as presentation of an ovarian lymphoma

Antecedentes: El linfoma no Hodgkin de ovario es una patología infrecuente, más aun el ovárico primario. Caso Clínico: Presentamos el caso de una paciente con antecedente de diverticulitis aguda y varios episodios posteriores de dolor abdominal agudo, fiebre y aumento de reactantes de fase aguda con pruebas de imagen no concluyentes. A pesar de la buena respuesta inicial al tratamiento antibiótico, durante uno de los episodios la paciente precisa intervención quirúrgica urgente. Durante la intervención se halla una enfermedad tumoral avanzada con diagnóstico histológico de linfoma difuso de células grandes B. Conclusión: En el diagnóstico diferencial ante una sintomatología similar a la de nuestra paciente, se debería tener presente la posibilidad de un linfoma ovárico, a pesar de su baja incidencia.

Background: Non-Hodgkin's lymphoma of the ovary is an infrequent pathology, even more primary one. Clinical case: We report a patient with a history of acute diverticulitis and several episodes of acute abdominal pain, fever and increased acute phase reactants with inconclusive imaging tests. Patient required urgent surgery during one episode despite a good initial response to antibiotic therapy. A locally advanced tumour disease was found in surgical intervention which was diagnosed as a diffuse large B-cell lymphoma. Conclusion: In the differential diagnosis in a manner similar to that of our patient symptoms, we should keep in mind the possibility of an ovarian lymphoma despite their low incidence.

Linfoma não-Hodgkin de cordão espermático / Non-Hodgkin's lymphoma of the spermatic cord

Non-Hodgkin´s lymphoma of the spermatic cord are rare. There is the registration of 14 (fourteen) cases of spermatic cord lymphoma in the literature, all treated with radical orchiectomy with or without radiotherapy. The adjuvant chemotherapy still is not a consensus, therefore the therapy must be individualized and applied according to the stage of the disease. The present study report a new case of primary non-Hodgkin´s lymphoma of the spermatic cord treated with radical orchiectomy through inguinal via with precocious ligature of the spermatic cord and adjuvant chemotherapy. Presently found with 2 and a half years of follow-up without recidivation clinical evidence, as the image exams show to be normal.

Linfoma de grandes células com esclerose do mediastino / Mediastinal large cell lymphoma with esclerosis

Cinco casos de linfoma primário do mediastino de grandes células com esclerose foram identificados no Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro entre 1986 e 1994, e revistos em relaçåo aos aspectos clínicos, morfológicos e imunohistoquímicos. Clinamente, a doença foi caracterizada por ocorrer em adultos jovens, que apresentaram grande massa mediastínica e sintomaloogia ligada a fenômenos compressivos. Nenhum paciente apresentava evidência de doença extratóracica quando do diagnóstico. Ao exame microscópico, todos exibiam grandes células, com uma mistura de células centro-foliculares e imunoblastos, e graus variados de esclerose. três dos cinco casos provaram ser de origem B. Quatro dos cinco pacientes foram tratados com polioquimioterapia, sendo MACOP-B nos dois primeiros e ProMACE-CytaBOM nos dois últimos; nestes o tratamento foi complementado com radioterapia. Todos tiveram excelente resposta terapêutica, encontrando-se em remissåo completa, já que dura de 1 a 8 anos

Masa mediastinal que simula valvulopatía pulmonar

Se presenta el caso de una paciente de 28 años con un cuadro clínico de estenosis pulmonar severa; en el estudio hemodinámico se comprobó obstrucción a la salida del ventrículo derecho y el angiograma pulmonar demostró constricciones homogeneas en el calibre de los vasos pulmonares. En el estudio patológico post mortem se encontró un linfoma histiocítico del mediastino anterior que comprometía las estructuras vasculares del pedículo aortopulmonar