原发性甲状腺淋巴瘤的超声表现病理及其他影像学特征分析

Primary lymphoma of thyroid gland: sonographic characteristics, histopathologic finding, and other imaging diagnosis analyses

目的:探讨分析原发性甲状腺淋巴瘤超声、病理及其他影像学特征,加强临床医师对本病的深入认识。方法:回顾性复习天津医科大学肿瘤医院放治的20例经手术病理证实的原发性甲状腺淋巴瘤。对该20例患者的临床、超声、病理及相关CT、MRI特征进行分析。结果:20例原发性甲状腺淋巴瘤均为非霍奇金淋巴瘤(Non-Hodgkin lymphoma,NHL)。超声表现为12例甲状腺双叶受累,8例单侧叶受累。主要特征为:甲状腺弥漫性增大,双叶或单侧一叶回声减低,粗糙不均,内可见多个低回声团块,其中16例颈部伴有多发肿大淋巴结。5例表现肿物侵及气管,1例出现食管与气管同时受压。结论:原发性甲状腺淋巴瘤的临床及影像学表现缺乏特异性,最后确诊依靠病理学。如临床发现颈部肿物短时间迅速增大,且超声表现为桥本氏甲状腺炎基础上的恶性征象,应考虑到淋巴瘤,及时做针吸或切取活检,以便临床选择恰当的治疗方案。

Objective：To evaluate the sonographic characteristics of primary lymphoma of the thyroid gland and to analyze histo-pathologic findings and other imaging features to improve the diagnostic accuracy of this disease. Methods：We retrospectively re-viewed the records of 20patients with histologically proven primary lymphoma of the thyroid gland. The clinical, pathologic, sono -graphic, CT, and MRI features were analyzed. Results：Histology revealed non-Hodgkin lymphoma in 20patients. Ultrasound revealed lateral thyroid lobe disease in 12cases and the presence of unilateral masses in 8 cases. The main features seen were diffusely enlarged thyroid gland. The lateral or unilateral thyroid lobe was with hypoechoic masses intermingled with echogenic structures. A total of 16 cases showed enlarged lymph nodes, 5 cases showed invasion of trachea, and 1 case involved the trachea and esophagus. Conclusion： Primary lymphoma of the thyroid gland usually presents with clinical and sonographic findings mimicking a carcinoma or benign tu-mor. If clinical features revealed rapidly enlarging neck masses and sonographic characteristics represented by malignant features of Hashimoto thyroiditis, then we should consider lymphoma. However, the final diagnosis depends on histopathology.