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Open Access Case report

A minute focus of extranodal marginal zone B-cell lymphoma arising in Hashimoto thyroiditis diagnosed with PCR after laser capture microdissection: a case report

Antonio D'Antonio1*, Alessia Caleo1, Stefano Licci2, Maria Addesso3, Maurizio De Palma4, Amedeo Boscaino5 and Oscar Nappi5

Author Affiliations

1 Unit of Pathology, OO.RR. "San Giovanni e Ruggi d'Aragona", Salerno, Italy

2 Department of Pathology, "Santo Spirito" Hospital, Rome, Italy

3 Department of Pathology, "ASL SA1" Scarlato Hospital, Scafati (SA), Italy

4 Department of Endocrine Surgery, "A. Cardarelli" Hospital, Naples, Italy

5 Department of Pathology, "A. Cardarelli" Hospital, Naples, Italy

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Thyroid Research 2009, 2:9  doi:10.1186/1756-6614-2-9

Published: 7 September 2009

Abstract

Background

Primary thyroid gland lymphomas are uncommon tumours that occur in the setting of lymphocytic thyroiditis or Hashimoto's disease in almost all cases. In this condition a distinction between an inflammatory lymphoid infiltrate and a low grade lymphoma may be extremely difficult and precise criteria are necessary for a correct diagnosis.

Patient and methods

We report a case of a minute focus of primary extranodal marginal zone B-cell lymphoma (EMZBCL), incidentally discovered in a 63-year-old man with Hashimoto thyroiditis (HT) and diagnosed by means of polymerase chain reaction (PCR) after laser capture microdissection.

The histological examination of surgical specimen confirmed the diagnosis of HT and showed a minute focus of dense lymphoid infiltrate (less than 4 mm in diameter), composed by centrocyte-like cells forming MALT balls. Immunoistochemistry was not useful. A microscopic focus of EMZBCL was suspected on the basis of morphological features. PCR assays revealed the rearrangement of the heavy chain of immunoglobulins only in the microdissected suspicious area, confirming the diagnosis of EMZBCL.

Conclusion

Our finding suggests that in cases of autoimmune thyroiditis a careful examination of the thyroid specimen is warranted, in order to disclose areas or small foci of lymphomatous transformation. Furthermore, in difficult cases with doubtful immunohistological findings, ancillary techniques, such as molecular studies, are necessary for a conclusive diagnosis.