A 16-year-old female patient, with no morbid history, who began in September 2004 with progressive anterior cervical volume increase, so she consulted three months later, being studied with a non-echoic diffuse enlargement of the thyroid gland.
Thyroid puncture reported lymphoid infiltrate with some atypia.
Diffuse goiter was diagnosed and treatment with levothyroxine 50 mcg/day was started, after which there was regression of the clinical picture.
In December of that year, he consulted our hospital for a recurrence of rapidly growing goiter in weeks, associated with dyspnea, laryngeal stridor and general malaise.
On physical examination we found laccid, afferent, tachypneic, with symmetrical anterior cervical volume increase and supraglottic tape.
The blood count, ESR, biochemical profile, LDH, thyroid hormones and TSH taken at admission were normal.
Thyroid ultrasound showed a large multinodular goiter with characteristics similar to previous ultrasound.
Cervical radiography showed tracheal lumen compromise by a mass projected from the posterior wall of the trachea.
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Cervical CT reported a heterogeneous multinodular goiter with high density septal septa surrounding the cervical trachea and at the level of the posterior wall of the trachea, projecting into its lumen 70%.
In addition, right jugular chain adenopathies were observed.
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The patient was hospitalized with a diagnosis of thyroid tumor with endotracheal intubation and secondary airway obstruction.
A thyroid lymphoma was diagnosed.
Surgical exploration was performed, as well as total thyroidectomy and cystostomy under tracheal intubation level (Table 8).
The rapid biopsy revealed an indifferentiated etiology of lymphoma, with diffuse involvement of prethyroid lymph nodes.
The definitive biopsy concluded lineage B NHL, with morphology and immunohistochemistry consistent with Burkitt's lymphoma, located in the thyroid gland and periglandular tissues.
Neoplastic cells positive for common leukocyte antigen CD20, CD79 and Ki67 with specific staining, and negative for Bcl2, CD10, TdT, CD30,
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Emerged favorably in the postoperative period.
A metastatic study was performed with abdomlnopelvic CT that showed 2 left renal lesions of neoplasic aspect (1.3 and 2.8 cm).
Bone marrow biopsy reported mild hyperplasia predominantly mleloid.
Definitive diagnosis according to the specialists was stage IV NHL (renal compression) of thyroid origin.
Chemotherapy was started one week later, with hyper CVAD phase I protocol (vinfamlda, dexamethasone, onco and adriamlcina).
The patient developed feverish neutropenia, which resolved within 24 hours with antibiotic treatment.
She completed 5 days with intrathecal methotrexatebetamethasone, with adequate response of endotracheal residual mass, after which she was discharged.
He received in consecutive months the second and third cycle, achieving complete response, with definitive discharge in June 2005.
