Plasma Cell Granuloma of the Thyroid: A Conservative Approach to a Rare Condition and Review of the Literature

Table 1

Clinical and pathological features of reported cases of plasma cell granuloma of the thyroid.

Paper	Age/Sex	Presentation	Thyroid function	Autoimmunity	Pathology	Treatment
Chan et al. 1986 [15]	35 F	Neck lump, right lobe nodule. Mild tracheal compression	Euthyroid	No	3 cm white, round nodule. Plasma cell aggregates. Hurtle cells absent. Polyclonal pattern on staining	Right hemithyroidectomy
De Mascarel et al. 1989 [16]	35 F	3 cm nodule in left lobe	Euthyroid	No	2.2 cm firm lesion. Fibrous tissue with polyclonal plasma cells	Thyroidectomy
Ferrer-Garcia et al. 2004 [11]	41 M	Goiter	Hypothyroid	Hashimoto’s	Polyclonal plasma cells with evidence of Hashimoto’s thyroiditis.	FNA inconclusive. Total thyroidectomy
Fontenot et al. 2008 [17]	55 F	Enlarging neck swelling, with compressive symptoms	Hypothyroid	No	Firm, fibrotic lesion. Polyclonal plasma cells with the expression of both kappa and lambda light chains	Thyroidectomy
Holck, 1981 [18]	70 F	Neck swelling with breathing difficulties. Right lobe, 3 cm nodule on examination	Hypothyroid	No	Obliteration of parenchyma with mature plasma cells. No Hurtle cell changes	Subtotal thyroidectomy
Kojima et al. 2009 [19]	75 F	Painless left-sided neck swelling	Euthyroid	No	Inflammatory pseudotumour (IPT). Predominantly fibrohistiocytic. Vimentin and CD68 +ve.	Lobectomy
Kriegl et al. 2007 [12]	50 M	Thyroid enlargement with dysphagia	Euthyroid	Hashimoto’s	Polyclonal plasma cells with associated Hashimoto’s thyroiditis. EBV and HHV8 DNA negative.	Subtotal thyroidectomy
Laurent et al. 2004 [13]	35 F	Dysphagia and asthenia. Normal thyroid on examination. Later painful enlargement of thyroid with signs of tracheal compression	Hypothyroid	?Hashimoto’s ($\uparrow$ antimicrosomal antibodies, anti-TPO positive)	Numerous plasma cells, macrophages and T lymphocytes and B lymphocytes. Plasma cells polyclonal	Methylprednisolone initially without response. Unable to excise due to fibrosis, biopsy taken. IV methylprednisolone given followed by IV cyclophosphamide and oral azathioprine for 6 months
Li Voon Chong et al. 2001 [20]	29 M	Neck tenderness, dysphagia, odynophagia, and fever. 8 cm mass in left lobe.	Euthyroid	Diabetes Mellitus	Histology proven plasma cell granuloma. Staining showed presence of IgG, IgM, and IgA.	Initial antibiotics. Surgical exploration with multiple biopsies
Martinez et al. 2002 [8]	46 F	Large painless neck mass. History of goitre.	Euthyroid	No	3 to 15 mm nodules separated by fibrous bundles. Numerous plasma cells with Hurtle cell changes	Total thyroidectomy
Mugler et al. 2003 [14]	46 M	Painless left neck mass. Family history of thyroid Ca. Dominant nodule on examination	Hypothroid	Hashimoto’s	$5\times 3\times 3$ cm nodule. Changes consistent with thyroiditis, including Hurtle cell changes. Plasma cell aggregation, polyclonal on staining.	Neoplasm could not be ruled out on FNA. Total thyroidectomy
Talmi et al. 1989 [21]	51 F	Painless enlarging nodule in right lobe.	Not known	No	2 cm white nodule. Mature polyclonal plasma cells.	Lobectomy
Yapp et al. 1985 [9]	61 F	Painless goiter enlargement.	Hypothyroid	No	Polyclonal plasma cells. Hurtle cell changes. Some lymph node enlargement	Total thyroidectomy
Zingrillo et al. 1995 [10]	65 F	Neck swelling and breathing difficulties. $3\times 5$ cm nodule in left lobe	Hypothyroid	Hashimoto’s	Polyclonal plasma cells with lymphocytic infiltrate. Hurtle cell changes present	Total thyroidectomy