原发性甲状腺非霍奇金淋巴瘤的临床细胞病理学观察

Clinical cytopathological observation of primary thyroid non-Hodgkin's lymphoma

目的:探讨原发性甲状腺非霍奇金淋巴瘤(NHL)的临床特点,细胞病理学形态,免疫表型及鉴别诊断,积累诊断经验。方法:报道2例原发性甲状腺NHL,复习有关文献报道,分析原发性甲状腺NHL的临床表现,影像学资料,观察其细胞病理学形态及鉴别诊断。结果:例1,男,58岁,甲状腺肿块4年余,肿块可随吞咽上下活动,曾诊断桥本甲状腺炎。B超提示双侧甲状腺体积增大,双侧颈部淋巴结增大。甲状腺峡部肿块针吸,镜下见弥漫排列的幼稚淋巴细胞,细胞病理学诊断疑非霍奇金淋巴瘤,行甲状腺峡部肿块切除术,术后组织病理学诊断:甲状腺弥漫性大B细胞淋巴瘤,免疫表型:CD20,CD79a,PAX-5,Bcl-6,Bcl-2,Mum-1(+);Cyclinol,PD1,Cxclb,CD30,ALK,TdT,CD15,CD3,CD4均(-),Ki67LI80%左右。例2,女,25岁,妊娠4月,右甲状腺肿块4月,突然增大1个月。B超提示右甲状腺非均匀肿大。右甲状腺肿块针吸,镜下见较多弥漫排列的圆形肿瘤细胞,可见细小核仁,偶见核分裂相,细胞病理学诊断考虑非霍奇金淋巴瘤,行右甲状腺肿块切除术,术后组织病理学诊断:甲状腺B细胞淋巴瘤(高度侵袭性),符合伯基特淋巴瘤,免疫表型:CD20,PAX-5,CD43,Bcl-6,CD10,Mum-1(+),Bcl-2弱(+),CD3,CD5,CD21,CD23,TdT,CD99,CD34(-),Ki67LI>95%。结论:原发性甲状腺NHL少见,应与桥本甲状腺炎,小细胞型髓样癌,全身型淋巴瘤累及甲状腺等相鉴别。

Objective：To explore the clinical features,cytopathological morphology,immunophenotype and differential diagnosis of primary thyroid non-Hodgkin＇s lymphoma （NHL） and gather experience for diagnosis. Method：Reporting two cases of primary thyroid non-Hodgkin＇s lymphoma,reviewing corresponding references,analyzing the clinical manifestation and iconography features of primary thyroid NHL,observing the cytopathological morphology,and analyzing the differential diagnosis. Result：Case 1：58-year-old male was found thyroid mass 4 years ago which could move with swallowing and was diagnosed as Hashimoto thyroiditis. Ultrasound showed enlargement of thyroid and bilateral cervical lymph nodes. Fine needle aspiration from isthmus mass showed diffusely immature lymphocytes. Then suspicious non-Hodgkin＇s lymphoma was diagnosed and isthmus mass lumpectomy was done. It was diagnosed as diffuse large B-cell lymphoma. Immunophenotype：CD20,CD79a,PAX-5,Bcl-6,Bcl-2,Mum-1（＋）;Cyclinol,PD1,Cxclb,CD30,ALK,TdT,CD15,CD3,CD4（-）,Ki67LI（≈80%）. Case 2：25-year-old female,pregnancy in the 4th month,was found right-side thyroid mass 4 months ago,with quick enlargement in the last month. Ultrasound showed uneven enlargement of right lobe. Fine needle aspiration from thyroid mass showed diffuse round tumor cells in microscope, containing small nucleoli and rare mitosis. Cytopathologic characteristics suggested the diagnosis of non-Hodgkin＇s lymphoma and lumpectomy was performed. Then it was diagnosed as B cell lymphoma （high invasive） pathologically and consistent with the feature of Burkitt Lymphoma. Immunophenotype：CD20,PAX-5,CD43,Bcl-6,CD10,Mum-1（＋）,Bcl-2 weakly positive CD3,CD5,CD21,CD23,TdT,CD99,CD34（-）,Ki67LI95%. Conclusion：Primary thyroid non-Hodgkin＇s lymphoma is rarely seen,which should be differentiated with Hashimoto thyroiditis,medullary carcinoma （small cell variant） and general lymphoma with thyroid involved.