原发性甲状腺恶性淋巴瘤的临床病理分析

The clinical pathology study of primary thyroid lymphoma

目的结合文献总结原发性甲状腺恶性淋巴瘤（primary thyroid lymophoma，PTL）的临床病理特点，探讨合理的临床治疗方法。方法回顾性分析我院1998—2007年之间收治的23例PTL患者的临床和病理资料，其中男5例，女18例，年龄31—71岁，中位年龄51岁。所有患者均为B细胞性非何杰金淋巴瘤（NHL）。23例患者中有21例行手术治疗。其中6例行局部病灶活检，7例行单侧腺叶切除，6例行甲状腺次全切除术，2例甲状腺全切术。术后进一步接受化疗和／或放疗患者15侧，其中化疗8例，放疗5例，化疗加放疗2例，化疗方案采用CHOP方案。结果本组23例中，失访6例，随访率73．9％。随访时间2．142个月，中位随访32个月。5年无复发生存率30．4％。结论吼好发于60岁左右的女性，病理类型大多为B细胞来源的NHL。原发性甲状腺恶性淋巴瘤诊断较困难，治疗应采用综合治疗，而手术只是作为确诊或减瘤的次要手段。

Objective To study the clinical pathology of primary thyroid lymphoma and investigate the optimal treatment schedule for patients with this kind of disease. Methods Clinical and pathological materials from 23 patients with PTL form 1998 - 2007 were retrospectively analyzed .The pathological type of these lymphomas was all B cells derived Non-Hodgkin＇s Lymphoma .21 cases were subjected to operations, among which 6 cases with local biopsy ,7 cases with single lobelectomy, 6 cases with subtotal thyroidectomy and the other 2 cases with total thyroidectomy. And these patients received further radiotherapy or/and chemotherapy with CHOP scheme after operations. Results 6 patients were lost follow-up, and the other 17 patients were followed 2 - 142 months, median 32 months. The five years tumor-free survival rate was 30.4% .Conclusion The primary thyroid lymphoma mainly derived from B cells and mostly affected aged females. PTL is difficult to diagnose, and should be treated synthetically while surgery is just a secondary alternative for diagnosis or cytoreductive therapy.