原发性甲状腺淋巴瘤的外科治疗(附10例报告)

Experience of diagnosis and treatment of primary thyroid lymphoma(PTL)

目的:讨论原发性甲状腺淋巴瘤的诊断及治疗原则。方法:回顾分析、总结10例原发性甲状腺淋巴瘤的临床、病理特点和治疗、预后情况。结果:10例中女6例,男4例,平均年龄59岁,平均病程10个月。7例甲状腺蛋白抗体和(或)微粒体抗体升高;病理诊断为黏膜相关淋巴组织B细胞淋巴瘤(MALT型)3例,黏膜相关淋巴组织B细胞淋巴瘤伴大细胞转化型(MALT伴大细胞转化型)3例,弥漫性大B细胞淋巴瘤(DL-BCL型)4例,4例伴有慢性淋巴细胞性甲状腺炎。ⅠE期4例,ⅡE期2例,ⅢE期2例,ⅣE期2例。本组2例行手术切取活检术,8例行甲状腺腺体切除术,1例同时行气管切开造口术。8例术后明确行CHOP方案化疗等治疗。10例平均随诊30个月,10例平均存活36个月。结论:对于慢性淋巴细胞性甲状腺炎病例,应积极处理其迅速出现的甲状腺结节或甲状腺肿大的情况。对于原发性甲状腺淋巴瘤,手术主要起明确诊断的作用,放、化疗是其主要的治疗手段,MALT型、Ⅰ-Ⅱ期病例预后较好。

Objective：To discuss the principles of diagnosis and treatment of primary thyroid lymphoma （PTL）. Methods： The clinical data, including clinicopathologic features, treatment and prognosis of 10 PTL patients were re- viewed. Results： The patients included 6 women and 4 men, with an average age of 59 years and symptoms duration of 10 months. The level of serum TGAb and TPOAb increased in 7 cases. Histopathology of the 10 patients determined 3 different subtypes-3 B -cell lymphoma of mucosal -associated lymphoid tissue （MALT） ,4 diffuse large B cell lym- phoma （DLBCL） ,3 DLBCL with MALT lymphoma. Hashimoto＇s disease or chronic lymphocytic thyroiditis were found in 4 cases. 4 cases were stage I E,2 stage 112 stage mE,2 cases were stage IVE,2 patients had incisional thyroid biopsy ,8 patients had thyroideetomy with 1 having tracheostomy. 10 patients received chemotherapy after surgery, in which 8 cases were treated with combined - modality approaches. The median follow - up for 10 cases was 30 months, 10 were alive with median survival of 36 months. One patient with DLBCL stage Ⅲ E and one DLBCL with MALT lym- phoma stage 1VE died. Conclusion：Symptoms of rapid thyroid eulargment or nodule in old patients with chronic lym- phocytic thyroiditis or Hashimoto~ disease should be emphasized. Surgery- mainly plays a role of providing an adequate diagnostic biopsy for PTL. Chemotherapy and radiotherapy are the standard treatments for PTL. Patients with MALT lymphoma or stage I - Ⅱ have a good prognosis.