Ghazanfar S, Quraishy MS, Essa K, Muzaffar S, Saeed MU, Sultan T.
Mucosa associated Lymphoid Tissue Lymphoma (Maltoma) in Patients with Cold Nodule Thyroid.
J Pak Med Assoc Jan ;52(3):131-3.

A 55 years old lady presented in the outpatient clinic with one year history of rapidly growing swelling in front the neck. She also complained of fatigue, low-grade fever and body aches. No history of pressure symptoms or weight loss was present. There was no significant family history. Clinical examination revealed a diffuse smooth swelling involving whole of the right lobe of the thyroid. It was firm in consistency. There was no reterosternal extension. No cervical lymphadenopathy was noted. No signs of hypo. or hyperthyroidism were present. Laboratory investigations revealed an ESR of 75 mm/hr. Thyroid hormonal assay was normal. Thyroid scintigraphy showed a cold nodule in the right lobe of thyroid. On fine needle aspiration cytology, predominantly lymphoid cells showing diferent stages of maturation along with immunoblasts were seen. Also no thyroid tissue was identified, the impression was that of a reactive lymph node. Fine needle aspiration cytology (FNAC) was repeated with the same result. In view of the indeterminate nature of the swelling a right thyroid lobectomy with is themusectomy was carried out. The patient had an uneventful postoperative recovery and was discharged from hospital.

Gross examination of the resected right lobe revealed a greyish brown nodular mass measuring 8x3x3 cms which was partially encapsulated. On sectioning, the cut surface was greyish and homogenous throughout. Histopathological examination showed effaced architecture of the thyroid and its replacement by sheets of neoplastic cells. The tumor cells were composed of small lymphoid cells with round to reniform nuclei. Many of the cells exhibited plasmacytoid differentiation. Interspersed thyroid follicles of variable sizes and shapes were seen lined by flattened to cuboidal epithelium and filled with colloid in the lumen. The tumor cells were invading the follicular cells giving an appearance of a lymphoepithelial lesion (Figure). Interspersed histiocytes were appreciated. Immunohistochemistry showed leukocyte common antigen (LCA) and CD20 (L26) positivity in lymphoid cells. UCHL1(Pan T cell marker) were non-reactive. Features were consistent with NonHodgkin`s Lymphoma low grade Maltoma.

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