Concomitant presentation of Hashimoto's thyroiditis and maltoma of the thyroid in a twenty-year-old man with a rapidly growing mass in the neck

We report an uncommon case of a 20-year-old man, who noted a painless, grow ing mass in his neck, which appeared in a weekend, associated with moderate dysphagia and weakness. Laboratory examination revealed an elevated serum thyrotropin of 25 mU/L, normal serum triiodothyronine and thyroxine levels, and high titers of antithyroglobulin and antithyroid peroxidase antibodies . The neck lesion showed a depressed iodine uptake in the left thyroid lobe , which had an asymmetrical pseudocystic pattern associated with poor vascu larization in the ultrasound scan. Cytologic examination showed a lymphocyt e thyroiditis in association with lymphoma of large cell arising from mucos a-associated lymphoid tissue (MALT-lymphoma or maltoma). The patient underw ent a left thyroid lobectomy while being treated with levothyroxine for Has himoto's thyroiditis, and the surgical treatment was further complemented w ith chemotherapy using fludarabine. The histologic examination confirmed th e cytologic findings and the immunohistochemistry showed a B-cell type malt oma. Additional investigation provided no evidence of disease in other tiss ues. The clinical course has been favorable in the first 2 years of follow- up, with no evidence of local or systemic recurrence of the disease.