原发性甲状腺弥漫性大B淋巴细胞瘤的诊断学特征

Diagnostic features of primary thyroid lymphoma with diffuse large B lymphocyte

目的探讨原发性甲状腺弥漫性大B淋巴细胞瘤(DLBCL)的诊断学特征。方法回顾性分析1例原发性甲状腺DLBCL临床资料,并复习相关文献。结果患者甲状腺左叶可触及直径约6 cm的结节,甲状腺球蛋白抗体阳性,铁蛋白372 ng/ml,甲状腺激素检查均正常;彩超结果:左侧颈部及右侧锁骨上淋巴结显示;CT结果:右肺门及纵隔内多发淋巴结肿大并钙化。病理学显示左侧甲状腺DBCLB-生发中心来源(Ⅱ期A组);免疫组化:白细胞分化抗原20(CD20)、B细胞特异性激活蛋白(PAX-5)、CD10、B细胞淋巴瘤6(BCL-6)、BCL-2、多发性骨髓瘤癌基因-1(MUM-1)、原癌基因c-myc均阳性,CD3、CD5均T细胞阳性,CD30、间变性淋巴瘤激酶(ALK)均阴性,增生指数67(Ki67)约85%。骨髓活检及骨髓病理显示:CD10偶见阳性、CD20散在少量阳性、CD5偶见阳性、CD38偶见阳性、MUM-1阴性、BCL-6阴性、细胞周期蛋白D1(Cyclin D1)阴性、Ki67定位差。流式结果未检测到明显免疫表型异常的淋巴细胞。结论原发于甲状腺的弥漫性大B淋巴细胞瘤是少见淋巴瘤之一,依据常规病理免疫组化,结合B超等影像学检测手段对其进行准确诊断,是选择合理有效治疗方案的重要依据。

Objective To investigate the diagnostic features and treatment of primary thyroid lymphoma with diffuse large B lymphocyte （DLCBL）.Methods One patient of primary thyroid lymphoma with diffuse large B lymphocyte was diagnosed.The related literatures were reviewed.Results A nodule with diameter of 6cm could be touched in the left lobe of thyroid with the patient.Thymoglobulin antibody was positive,and the levels of other thyroid hormones were normal.The level of Ferritin was 372ng/ml.The lymph nodes were detected on the left neck and right supraclavicular with ultrasound.Multiple lymph nodes enlargement and calcification were found in the right hilum and mediastinum.DLCBL（Stage ⅡA） in the left thyroid originated from germinal center with pathological examination.Cluster of differentiation 20（CD20）,B cell specific active protein-5（PAX-5）,CD10,B cell lymphoma-6 gene（BCL-6）,B cell lymphoma-2 gene （BCL-2）,Multiple myeloma oncogene-1 （MUM-1）,c-myc were positive by immunohistochemistry.Meanwhile,bone marrow biopsy and bone marrow pathology showed,CD3,CD5 were positive in T lymphocytes.CD30,anaplastic lymphoma kinase （ALK） were negative.Ki 67 was about 85%.CD10,CD20,CD5,CD38 were occasionally positive.MUM-1,BCL-6,CyclinD1 were negative.Ki 67 was not clearly located.The immunophenotype of lymphocytes were normal with flow cytometry.Conclusion s Diffuse large B cell lymphoma located in thyroid is one of the rare lymphomas.An optional protocol is based on precision diagnosis according to pathological characteristics and other imageological examinations.