A thyroidectomy specimen shows dense lymphocytic infiltration with germinal centers, atrophic follicles lined by cells with abundant eosinophilic granular cytoplasm, and interstitial fibrosis. Which complication does this patient have an approximately 60 to 80 fold increased risk of developing?

• A Follicular thyroid carcinoma
• B Papillary thyroid carcinoma
• C Medullary thyroid carcinoma
• D Primary thyroid lymphoma ✓

Explanation

The histology is classic Hashimoto thyroiditis: lymphoid germinal centers, Hürthle cell (oncocytic) metaplasia of follicular epithelium, and atrophy. Chronic lymphocytic stimulation predisposes to extranodal marginal zone lymphoma of MALT type and diffuse large D cell lymphoma, the two most common primary thyroid lymphomas, which arise almost exclusively in Hashimoto glands. The risk of papillary and follicular carcinoma is only modestly increased, and medullary carcinoma has no association with lymphocytic thyroiditis.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.