title: Gamma heavy chain disease in a patient with underlying lymphoplasmacytic lymphoma of the thyroid. Report of a case and comparison with other reported cases with thyroid involvement.
abstract: BACKGROUND
  Gamma heavy chain disease with underlying thyroid pathology is rare. There are 5 reported cases in the English literature, including the present case of an elderly female with γ heavy chain disease with underlying lymphoplasmacytic lymphoma of the thyroid who initially presented with long-standing goiter and chronic thyroiditis.
  
  
  METHODS
  The protein studies and histopathologic findings in her thyroid are described. Her case is compared with reported cases of γ heavy chain disease with thyroid involvement.
  
  
  RESULTS
  Initial impression on most cases was chronic thyroiditis; however pathology showed 3 cases with plasmacytoma and 2 with lymphoplasmacytic infiltrate. All were diagnosed and followed up using serum and urine electrophoresis.
  
  
  CONCLUSIONS
  Gamma heavy chain disease has a protean manifestation; however there appears to be a more uniform pattern of the disease when it is associated with the thyroid. The inclusion of protein studies in cases diagnosed with chronic thyroiditis by FNA may aid in establishing γ heavy chain disease with underlying thyroid involvement. In this case serum and urine electrophoresis, and immunofixation studies which are simple and affordable tests facilitated the hematologic workup and follow up.
authors.affiliation: Department of Pathology and Laboratory Medicine, Boston University Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA. Josenia.Tan@bmc.org
authors.forename: Josenia N M
authors.initials: JN
authors.lastname: Tan
authors.forename: Martin H
authors.initials: MH
authors.lastname: Kroll
authors.forename: Carl J
authors.initials: CJ
authors.lastname: O'Hara
authors.forename: Peter C
authors.initials: PC
authors.lastname: Everett
authors.forename: Evrim
authors.initials: E
authors.lastname: Erdogan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D001797:Blood Protein Electrophoresis; D002908:Chronic Disease; D005260:Female; D006362:Heavy Chain Disease / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007142:Immunoglobulin gamma-Chains / Q000276:immunology; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010954:Plasmacytoma / Q000175:diagnosis / Q000276:immunology; D013961:Thyroid Gland / Q000276:immunology* / Q000473:pathology; D013964:Thyroid Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D013966:Thyroiditis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D008258:Waldenstrom Macroglobulinemia / Q000150:complications / Q000175:diagnosis* / Q000276:immunology
chemical_list: D007142:Immunoglobulin gamma-Chains