DISCUSSIONThis report serves to document a rare form of thyroid lymphoma of the T cell variety that occurred in the setting of biopsy-defined celiac disease, underlying chronic thyroiditis and dermatitis herpetiformis. In earlier studies of celiac disease as well as dermatitis herpetiformis, including a prior report in this journal from this hospital, the apparent relationship between celiac disease, dermatitis herpetiformis and thyroid disease, particularly chronic thyroiditis, was noted. In addition, in the latter report, the relatively frequent complication of an intestinal lymphoma was reported in three of 16 celiac patients with thyroid disease. In a single previous report from Japan, a T cell lymphoma was recorded in a patient with a prior diagnosis of chronic thyroiditis. In their study, lymphoma cells were also shown to react with gamma-type, but not beta-type, T cell receptors, and DNA analysis revealed clonal rearrangement of the T cell receptor gamma-chain gene. Studies were not described to determine whether celiac disease was present in that patient. However, these immunophenotypical characteristics are reminiscent of changes that have been reported in the intestinal T cell type lymphoma that has been closely linked with celiac disease as well as the recent description of a rare peripheral T cell hepatosplenic variety of lymphoma that has been described in a single patient with biopsy-defined celiac disease complicated by fulminant liver failure. This case illustrates another form of extranodal lymphoma that may be linked to celiac disease. You will always come across cialis professional at a pharmacy that will offer best deals.