Fine-Needle Aspiration Biopsy of Langerhans Cell Histiocytosis of Thyroid Gland
| Autor: | Chutintorn Sriphrapradang, Tanawan Riangwiwat, Siripich Triamchaisri, Jutarat Sangtian, Wasana Kanoksil |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
endocrine system
medicine.medical_specialty Pathology endocrine system diseases Endocrinology Diabetes and Metabolism Biopsy Fine-Needle Clinical Biochemistry Thyroid Gland Levothyroxine Hypopituitarism Biochemistry Endocrinology Langerhans cell histiocytosis Internal medicine medicine Humans Prolactinoma business.industry Biochemistry (medical) Thyroid Middle Aged medicine.disease Thyroid Diseases Histiocytosis Langerhans-Cell medicine.anatomical_structure Diabetes insipidus Female medicine.symptom Thyroid function business Polydipsia medicine.drug |
| Zdroj: | The Journal of Clinical Endocrinology & Metabolism. 100:15-16 |
| ISSN: | 1945-7197 0021-972X |
| DOI: | 10.1210/jc.2014-2859 |
| Popis: | A 54-year-old postmenopausal woman presented with progressive thyroid enlargement for 1 year. Thyroid ultrasonography showed multinodular enlargement with an 8 6-cm isoechoic mass and a 6 5-cm hyperechoic mass on the right and left lobes, respectively. Thyroid function testing, including free T4 of 0.48 ng/dL (normal range, 0.7–1.48), free T3 of 3.12 pg/mL (1.71–3.71), and TSH of 5.39 mIU/L (0.35–4.94), showed primary thyroid failure with an insufficient pituitary response, suggesting both primary and secondary hypothyroidism. Fine-needle aspiration biopsy (FNAB) was performed on the right lobe and reported as Langerhans cell histiocytosis (LCH) (Figure 1). The diagnosis of LCH is confirmed by positive immunohistochemical study for S-100 and CD1a. Further investigations revealed hypopituitarism: morning cortisol, 2.5 g/dL (5–25); FSH, 3.92 IU/L (26–133); LH, 0.14 IU/L (10–26); and IGF-1, 55 ng/mL (87–238). An elevated prolactin of 139.17 ng/mL (5.18–26.53) suggested a prolactinoma, infundibular compression, or bilateral median eminence dysfunction. Central diabetes insipidus was diagnosed based on polyuria, polydipsia, depressed urine osmolarity of 113 mOsm/kg, and elevated serum osmolarity of 295 mOsm/kg. Magnetic resonance imaging pituitary showed a well-defined mass of 1.2 0.8 1 cm involving median eminence of the hypothalamus, superior aspect of the pituitary stalk, extending to the floor of the hypothalamus (Figure 2). The final diagnosis was multisystem LCH. The patient was administered chemotherapy of vinblastine 6 mg/m every week, prednisolone 40 mg/m for 4 weeks then tapered down, and levothyroxine 50 g/d. After seven cycles of chemotherapy, goiter size had decreased to 20 g by palpation, and symptoms of central diabetes insipidus had improved. LCH mostly involved bone, skin, pituitary, liver, spleen, lungs, lymph nodes, and the central nervous system (1). The most common endocrine manifestation of LCH is central diabetes insipidus. LCH of the thyroid is extremely rare and can be presented in localized or multisystem disease (2, 3). |
| Databáze: | OpenAIRE |
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