Solitary Extramedullary Plasmacytoma of the Thyroid Gland Following Head and Neck External Beam Radiotherapy
Bibliographic record
Abstract
Objective We report a case of a solitary plasmacytoma of the thyroid gland that was diagnosed 17 years after external beam radiotherapy for treatment of tonsillar squamous cell carcinoma in a patient on long-term immunosuppression. Although radiation exposure has been reported to be associated with solitary bone plasmacytoma, this is the first case report of an association with external beam radiotherapy and long-term immunosuppression with plasmacytoma of the thyroid. Methods A 54-year-old man presented to the outpatient endocrinology clinic with a 2-year history of a fluctuating but progressively enlarging tender goiter. Past medical history included tonsillar squamous cell carcinoma treated with surgical resection and head and neck external beam radiotherapy 17 years previously, external beam radiotherapy for metastatic squamous cell carcinoma to jugular digastric lymph node, and long-term immunosuppression for liver transplant. Results Fine-needle aspiration biopsy revealed numerous plasmacytoid cells. Core biopsy revealed clonal plasma cell proliferation. Computed tomography of the neck, chest, abdomen, and pelvis showed no evidence of lymphadenopathy, splenomegaly, bony lytic lesions, or other abnormalities to suggest underlying systemic lymphoma or multiple myeloma. A bone marrow aspirate and biopsy showed no evidence of a plasma cell neoplasm or B cell lymphoma. A total thyroidectomy was performed and pathology revealed diffuse plasma cell proliferation consistent with a plasmacytoma. The lesion appeared to be restricted to the thyroid gland. Conclusion Plasmacytoma of the thyroid should be considered in the differential diagnosis of an enlarging thyroid mass in patients with previous exposure to head and neck external beam radiotherapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".