Session: SAT 429-448-Thyroid Neoplasia & Case Reports
Poster Board SAT-438
University of Maryland, Department of Medicine, Division of Endocrinology, Diabetes & Nutrition1, Baltimore, MD
Poorly Differentiated Thyroid Cancer in an Human Immunodeficiency Virus (HIV) and Epstein Barr Virus (EBV) - Positive Adolescent Patient
Background: Thyroid cancer in children and adolescents is uncommon and poorly differentiated carcinomas are exceptionally rare. Patients with HIV infection have an increased risk for malignancies. We present a case of a young man with HIV and EBV diagnosed with poorly differentiated thyroid cancer.
Clinical case: A17 year-old African American man presented with a new neck mass and cervical lymphadenopathy. The mass rapidly grew over the last few weeks. Given his age and presentation, the underlying concern was for lymphoma or other malignancy.
Past medical history was significant for multiple recent admissions for atypical skin rashes, one episode of cellulitis, and neutropenia. The patient denied any history of radiation exposure or family history of thyroid cancer.
White blood cell count was 3.9 K/mcL (4.5-13.0 K/mcL), hemoglobin was 11.9 g/dL (13.0-16.0 g/dL) and platelet count was 112 K/mcL (135-367 K/mcL).
A CT scan demonstrated an enlarged left thyroid lobe with a hypervascular mass, measuring 4.3 x 4.9 x 4.6 cm, with cervical and right subpectoral lymphadenopathy.
EBV and/or HIV infections were suspected as possible causes for underlying malignancy. Given his previous history of multiple recent admissions an HIV test was also performed.
Testing for EBV IgG Abs was positive and HIV 1 RNA was 903611 cop/mL (20 - 10000000 cop/mL).
Fine needle aspiration of the mass revealed suspicion for follicular neoplasm. Thyroidectomy was performed without lymph node dissection. Surgical pathology revealed poorly differentiated thyroid cancer (size: 5.5cm; pT3NxMx) with insular and papillary features.
Thyroid cancer in children and adolescents is uncommon with a prevalence of 3% (1). Poorly differentiated carcinomas are exceptionally rare and anaplastic carcinomas are practically absent (2). Patients with HIV infection have an increased risk for malignancies, including thyroid cancer, as well an increased risk for aggressive behavior of cancers in general (3, 4). The fact that our patient was also EBV positive is an additional risk factor. The presence of EBV is documented in papillary and undifferentiated thyroid cancer tissue samples, with an increased expression seen in the poorly differentiated thyroid carcinomas compared to papillary thyroid carcinomas (5). It is our recommendation that adolescent patients with poorly differentiated thyroid cancer with rapid progression should be evaluated for both HIV & EBV.
Nothing to Disclose: MK, HBL, KP
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