Poorly Differentiated Thyroid Cancer in an Human Immunodeficiency Virus (HIV) and Epstein Barr Virus (EBV) - Positive Adolescent Patient

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 429-448-Thyroid Neoplasia & Case Reports
Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-438
Manige Konig*1, Hillary Barnes Loper2 and Komal Patil-Sisodia3
1Univ of Maryland Med Ctr, Baltimore, MD, 2University of Maryland School of Medicine, Baltimore, MD, 3University of Maryland, Baltimore, MD
Manige Konig MD PhD1, Hillary Barnes Loper MD1, Komal Patil-Sisodia MD1

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.

Conclusion:

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.

(1) Alessandri AJ, Goddard KJ, Blair GK, et al. Age is the major determinant of recurrence in pediatric differentiated thyroid carcinoma. Med Pediatr Oncol. 2000;35:41–46. (2) Rosai J, Carcangiu ML, DeLellis RA, eds. Tumors of the Thyroid Gland (Atlas of Tumor Pathology), 3rd series, Fascicle 5. Washington DC: AFIP; 1992.   (3) Colonna M, Grosclaude P, Remontet L, Schvartz C, Mace-Lesech J, et al. Incidence of thyroid cancer in adults recorded by French cancer registries (1978–1997). Eur J Cancer. 2002;38:1762–8. (4) Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295:2164–7. (5) Shimakage M, Kawahara K, Sasagawa T, Inoue H, Yutsudo M, Yoshida A, Yanoma S. Expression of  Epstein-Barr virus in thyroid carcinoma correlates with tumor progression. Hum Pathol. 2003 Nov;34(11):1170-7.

Nothing to Disclose: MK, HBL, KP

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm