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All Journal Indonesian Journal of Endocrinology Metabolism and Diabetes (InaJEMD)
Rayhani Erika Putri
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Health Professions Medicine & Pharmacology Public Health

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Unexpected Histological Finding of Diffuse Large B-Cell Lymphoma in a Patient with Long-standing Goiter and Hashimoto's Thyroiditis: A Case Report Dhinar Kemas Ariawidjaja; Mohammad Robikhul Ikhsan; Hemi Sinorita; Raden Bowo Pramono; Vina Yanti Susanti; Rayhani Erika Putri
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 2 (2025): InaJEMD Vol. 2, No. 2
Publisher : PP PERKENI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66266/inajemd.v2i2.59

Abstract

Primary thyroid lymphoma (PTL) is an uncommon malignancy, comprising less than 5% of all thyroid cancers. Hashimoto's thyroiditis (HT) is the most significant risk factor, increasing the risk of developing PTL by 40 to 80 times. Diffuse large B-cell lymphoma (DLBCL) is the most prevalent and aggressive histological subtype, accounting for over 50% of PTL cases. The diagnosis is challenging, as the clinical and sonographic features of PTL can mimic benign thyroiditis. A 60-year-old female with a three-year history of a progressively enlarging goiter and worsening compressive symptoms presented for surgical evaluation. Initial investigations revealed severe hypothyroidism and ultrasound findings of a nodular goiter with features of thyroiditis (TI-RADS 3). She underwent a total thyroidectomy for symptomatic relief. Postoperative histopathology unexpectedly revealed a DLBCL, confirmed by CD20 positivity, coexisting with a background of classic HT. The patient was subsequently treated with six cycles of R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) chemoimmunotherapy and achieved a complete clinical and radiological response. This case underscores the diagnostic challenge PTL presents, particularly in patients with preexisting HT. A high index of suspicion is crucial for clinicians managing HT patients who present with a rapidly enlarging goiter or worsening compressive symptoms. While fine-needle aspiration has limitations, definitive diagnosis often requires a core needle or excisional biopsy to differentiate neoplastic infiltration from the benign lymphocytic infiltrate of HT.
Co-Authors Dhinar Kemas Ariawidjaja Hemi Sinorita Mohammad Robikhul Ikhsan Raden Bowo Pramono Vina Yanti Susanti