原发于甲状腺的恶性淋巴瘤13例诊治分析

Clinical diagnosis and treatment of 13 cases primary thyroid lymphoma

目的探讨原发性甲状腺恶性淋巴瘤的诊断和治疗方法。方法回顾性分析2000年—2012年我院收治的13例原发性甲状腺恶性淋巴瘤患者的临床资料。结果 13例患者均以颈部肿块就诊,2例稍有气管压迫症状,13例原发性甲状腺恶性淋巴瘤术前均被误诊为甲状腺癌,常规病理学检查确诊3例,常规病理学检查加免疫组化染色确诊10例。4例行患侧甲状腺全切及对侧次全切除术,7例行双侧甲状腺全切除术,2例行患侧甲状腺及峡部切除术。术前13例患者均行颈部B超检查,有6例患者术前首次行颈部CT检查发现肿块。11例患者术后给予CHOP方案化疗,其中2例患者术后接受外院放疗。至2012年3月随访结束,53.8%(7/13)仍存活,平均生存74.6个月;2例未行放化疗者平均生存16个月。结论原发性甲状腺淋巴瘤诊断较困难,临床易误诊。B超在诊断甲状腺恶性肿瘤方面较其他实验室辅助检查更有优势,手术是首选治疗方法,获得良好预后需采用综合治疗方法。

Objective To analyze the diagnosis and therapy of primary thyroid malignant lymphoma.Methods 13 cases of primarymalignant thyroid lymphoma were reviewed between January 2000 and June 2012.Results Thirteen cases complained of cervical mass,and 2 cases complained of pressing on the windpipe,the symptoms ranging from 1 weeks to 3 years.After operation,3 cases were diagnosed by routine pathologic methods,the other 10 cases were confirmed as PLT via immunohistochemical methods.Total thyroidectomy of affected side and partial thyroidectomy of the other side was performed in 4 cases,bilateral total thyroidectomy was performed in 7 cases,and simp le total thyroidectomy of affected side was performed in 2 cases.All 13 cases were examined by cervical BUS before the operation.6 cases were examined by cervical CT before the operation first.Conclusion The right diagnosis was difficult in primary malignant thyroid lymphoma,The misdiagnosis of PLT was often encountered in clinic examination.BUS was better than other equipment examinations.Surgical resection was an effective treatment for PTL.The good prognostic factors of PTL were associated with comprehensive treatment.