Mucosa-associated lymphoid tissue lymphoma of thyroid and adrenal glands with primary adrenal insufficiency.

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM Endocrinology, Diabetes and Metabolism Case Reports Pub Date : 2024-01-29 Print Date: 2024-01-01 DOI:10.1530/EDM-23-0019
Chi-Ta Hsieh, Jui-Ting Yu, Tang-Yi Tsao, Yao Hsien Tseng
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Abstract

Summary: A 69-year-old woman presented with weight loss, fever, dizziness, exertional dyspnea, and drenching night sweats. Imaging showed a thyroid goiter at the left lobe that measured 5.6 × 3.4 × 3.5 cm in size. On computed tomography, she was found to have large adrenal masses. Core needle biopsy of the left thyroid mass revealed the presence of a mucosa-associated lymphoid tissue extranodal marginal zone B cell lymphoma. Non-Hodgkin's lymphomas (NHL) typically develop in lymph nodes or other lymphatic tissues. There have been cases where the thyroid has been affected, and the secondary involvement of the adrenal gland is common. In reported cases, 7-59% of patients with NHL exhibited symptoms of thyroid dysfunction. Our patient presented no symptoms of thyroid dysfunction or Hashimoto's thyroiditis. The patient had bilateral adrenal lymphomas that led to adrenal insufficiency. Immunochemotherapy provided a good response in this case, as seen by the rapid improvement in thyroid and adrenal mass on follow-up PET/CT.

Learning points: Thyroid lymphoma requires a high index of suspicion for diagnosis in patients with a rapidly growing thyroid tumor, even in the absence of chronic inflammatory thyroid disease. Depending on the extent of involvement, adrenal lymphoma may rapidly cause adrenal insufficiency. In the setting of acute illness, appropriate levels of plasma cortisol are often unclear, necessitating early initiation of glucocorticoid therapy based on clinical suspicion, especially when features like bilateral adrenal masses and elevated ACTH levels are present. Treatment modalities include chemotherapy and radiation therapy for localized lesions, together with hormone replacement for organ dysfunction. The origin of the tumor influences the clinical outcome of patients with lymphoma simultaneously involving the thyroid and adrenal glands.

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甲状腺和肾上腺粘膜相关淋巴组织淋巴瘤伴原发性肾上腺功能不全。
摘要:一名 69 岁的妇女因体重减轻、发烧、头晕、劳力性呼吸困难和盗汗而就诊。影像学检查显示,左叶甲状腺肿大,大小为 5.6 × 3.4 × 3.5 厘米。计算机断层扫描发现,她的肾上腺有较大肿块。对左侧甲状腺肿块进行的核心针活检显示,存在粘膜相关淋巴组织结外边缘区B细胞淋巴瘤。非霍奇金淋巴瘤(NHL)通常发生在淋巴结或其他淋巴组织中。也有甲状腺受累的病例,肾上腺继发受累也很常见。在报道的病例中,7%-59%的NHL患者表现出甲状腺功能障碍症状。我们的患者没有甲状腺功能障碍或桥本氏甲状腺炎的症状。患者患有双侧肾上腺淋巴瘤,导致肾上腺功能不全。免疫化疗为该病例带来了良好的反应,这一点从随访的 PET/CT 中甲状腺和肾上腺肿块的迅速改善可以看出:学习要点:即使没有慢性甲状腺炎症,甲状腺淋巴瘤也需要高度怀疑。肾上腺淋巴瘤可迅速导致肾上腺功能不全,这取决于受累程度。在急性发病时,血浆皮质醇的适当水平往往并不明确,因此有必要根据临床怀疑及早启动糖皮质激素治疗,尤其是当出现双侧肾上腺肿块和ACTH水平升高等特征时。治疗方法包括对局部病变进行化疗和放疗,同时对器官功能障碍进行激素替代治疗。肿瘤的来源会影响同时累及甲状腺和肾上腺的淋巴瘤患者的临床预后。
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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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