Most Common Diseases of Age of 50+ - Thyroid disease: Thyroid Lymphomas - The Misdiagnosis and Diagnosis

Home of Kyle J. Norton for The Better of Living & Living Health Thyroid is one of the largest endocrine glands found in the neck, below the Adam’s Apple with the function of regulating the body use of energy, make of proteins by producing its hormones as a result of the stimulation of thyroid-stimulating hormone (TSH) produced by the anterior pituitary.
Thyroid disease is defined as a condition of malfunction of thyroid. Hyperthyroidism is a condition in which the thyroid gland is over active and produces too much thyroid hormones. Hypothyroidism is a condition in which the thyroid gland is under active and produces very little thyroid hormones. Thyroid cancer is defined as condition in which the cells in the thyroid gland have become cancerous.
D. Misdiagnosis and Diagnosis
D.1. Misdiagnosis
1. Hashimoto’s thyroiditis
Fine-needle aspiration cytology (FNAC) is an important method in the evaluation of goiter. However, difficulties are encountered when using this technique to distinguish Hashimoto’s thyroiditis from thyroid lymphoma. According to the study by the University College of Medicine, FNAC had a sensitivity of only 55%, its major limitation being misdiagnosis of lymphoma as Hashimoto’s thyroiditis(17).

2. Thyroiditis and chronic thyroiditis
There is a report of a case of a 60-year old woman first presented a rapidly growing left cervical mass. The fine needle aspiration-puncture (FNAP) lead to a diagnosis of thyroiditis. Due to the persistence of the symptoms, the FNAP was repeated again but was not conclusive, so that a surgical biopsy was performed. The pathological diagnosis was diffuse large cell primary thyroid lymphoma (PTL)(18).

3. Anaplastic carcinoma 
There is a report of three cases misdiagnosed as anaplastic carcinoma of small-cell type and two of these three cases were subsequently revised as malignant lymphoma after a second aspiration, according to the study by the Center for Adult Disease(19).
 
D.2. Diagnosis
According to the study by the Attikon University Hospital, Athens, primary thyroid lymphomas (PTL) are very rare tumors, typically presenting as a rapidly enlarging, painless thyroid mass, which may cause pressure symptoms of the aerodigestive tract. Preoperative diagnosis can be established by using modern imaging methods (mainly ultrasonography) and FNA with immunohistochemistry and flow cytometry. Open (surgical) biopsy may be indicated to confirm the diagnosis and identify the subtype of PTL(20).

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 Sources
(17) http://www.ncbi.nlm.nih.gov/pubmed/11678001
(18) http://www.ncbi.nlm.nih.gov/pubmed/11578581
(19) http://www.ncbi.nlm.nih.gov/pubmed/3665692
(20) http://www.ncbi.nlm.nih.gov/pubmed/20620043 
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