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  #1  
Old 10-01-2011
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Thyroid Thyroid with CD20+ cells ?

A 63-year-old man presented with a clinical history of goiter and dysphagia. Physical evaluation revealed an enlarged and firm thyroid gland without cervical lymphadenopathy. The ultrasound scan showed a diffuse enlargement of the gland, with no calcification. The thyroid function tests showed a primary hypothyroidism with high serum titers of anti-thyroglobulin and anti-microsomal antibodies. One week after admission the patient underwent a total thyroidectomy because of increasing dyspnea and dysphagia.
Thyroid histology showed that in the background composed by small lymphocytes, plasma cells, lymphoid follicles and oncocytic cells, there was a minute area, less than 4 mm in diameter, characterized by a diffuse and dense lymphoid infiltrate, composed by small lymphocytes and centrocyte-like lymphoid cells with slightly irregularly folded nuclei. A few large cells were also present. The immunohistochemical study showed positivity of cells for CD20 and negativity for CD5, CD10, CD23, CD43 and bcl2. What is the most likely diagnosis?

A) Diffuse large B-cell lymphoma
B) Medullary carcinoma of thyroid
C) Extranodal marginal zone B-cell lymphoma of MALT type
D) Precursor T-cell lymphoma
E) Hodgkin lymphoma
F) T-cell granular lymphocytic leukemia
G) Follicular lymphoma
H) Papillary carcinoma of thyroid
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Old 10-01-2011
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A 63-year-old man presented with a clinical history of goiter and dysphagia. Physical evaluation revealed an enlarged and firm thyroid gland without cervical lymphadenopathy. The ultrasound scan showed a diffuse enlargement of the gland, with no calcification. The thyroid function tests showed a primary hypothyroidism with high serum titers of anti-thyroglobulin and anti-microsomal antibodies. One week after admission the patient underwent a total thyroidectomy because of increasing dyspnea and dysphagia.
Thyroid histology showed that in the background composed by small lymphocytes, plasma cells, lymphoid follicles and oncocytic cells, there was a minute area, less than 4 mm in diameter, characterized by a diffuse and dense lymphoid infiltrate, composed by small lymphocytes and centrocyte-like lymphoid cells with slightly irregularly folded nuclei. A few large cells were also present. The immunohistochemical study showed positivity of cells for CD20 and negativity for CD5, CD10, CD23, CD43 and bcl2. What is the most likely diagnosis?

A) Diffuse large B-cell lymphoma
B) Medullary carcinoma of thyroid
C) Extranodal marginal zone B-cell lymphoma of MALT type
D) Precursor T-cell lymphoma
E) Hodgkin lymphoma
F) T-cell granular lymphocytic leukemia
G) Follicular lymphoma
H) Papillary carcinoma of thyroid
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Old 10-02-2011
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Gr8 question.
Marginal zone lymphoma seems appropriate.
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  #4  
Old 10-03-2011
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Correct Answer Answer

You can find the real case report on the following link:
http://www.thyroidresearchjournal.com/content/2/1/9

The answer is C.
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