原发性甲状腺淋巴瘤的诊断及临床分析

Diagnosis and Clinical Analysis of Primary Thyroid Lymphoma

目的总结原发性甲状腺淋巴瘤不同亚型的诊断特征及临床预后,提高诊断和治疗的水平。方法回顾性分析了北京协和医院1998年1月至2014年12月收治的27例原发性甲状腺淋巴瘤患者的临床资料,其中病理类型不能分类的B细胞淋巴瘤5例,黏膜相关性淋巴瘤(MALT)9例,弥漫大B细胞淋巴瘤(DLBCL)12例,T细胞淋巴瘤1例。结果27例患者中,21例(77.8%)为无痛性颈部肿大。7例行术前穿刺病理检查的患者中,2例(28.6%)回报可疑淋巴瘤;其中,3例DLBCL的淋巴瘤阳性回报率为66.7%,3例MALT为0,1例不能分类的B细胞淋巴瘤为0。25例行术中冰冻检查的患者中,16例(64.0%)回报为淋巴瘤或不除外淋巴瘤,其中不能分类的B细胞淋巴瘤阳性率66.7%,MALT阳性率77.8%,DLBCL阳性率58.3%,T细胞淋巴瘤阳性率为0。所有患者总体生存期估值为(89.3±12.4)个月,总体5年生存率为61.6%。合并淋巴瘤相关症状患者的生存期估值为31.6个月,明显短于无相关症状的97.9个月(P=0.032),年龄、性别、肿瘤直径、肿瘤分期、国际预后指数、气管狭窄、乳酸脱氢酶水平、手术肿瘤残留、病理分型等因素对生存期估值的影响无统计学意义(P均>0.05)。结论 DLBCL穿刺病理阳性率最高,MALT冰冻病理阳性率最高,术中冰冻病理的恶性诊断率高于术前穿刺病理。合并淋巴瘤相关症状可能为预后的不良因素。

Objective To summarize our experiences in the diagnosis and prognosis of different subtypes of primary thyroid lymphoma（PTL）. Methods The clinical data of 27 PTL patients who were treated in our hospital from January 1998 to December 2014 were retrospectively analyzed. The pathological types of these patients included B cell lymphoma unclassifiable（BCLU）（n = 5）,mucosa-associated lymphiod tissue lymphoma（MALT）（n = 9）,diffuse large B cell lymphoma（DLBCL）（n = 12）,and T cell lymphoma（n = 1）.Results Of all these 27 cases,the most common clinical symptom was painless swelling of the neck（n = 21,77. 8%）. Of 7 patients who had received preoperative fine needle biopsy,lymphoma was suspected in 2 cases（28. 6%）. Among these 7 cases,the positive rate of suspicious lymphoma was 66. 7% in 3 DLBCL patients,0 in 3 MALT patients,and 0 in 1 BCLU paitent. Also,25 patients underwent intraoperative frozen pathological examination,which revealed lymphoma or suspicious lymphoma in 16 cases（64. 0%）; in these patients,thepositive rate was 66. 7% for BCLU,77. 8% for MALT,58. 3% for DLBCL,and 0 for T-cell lymphomas. The overall survival was（89. 3 ± 12. 4） months,and the overall 5-year survival rate was 61. 6%. The estimated survival in symptomatic group was 31. 6 months,which was significantly shorter than that in asymptomatic group（97. 9 months）（P = 0. 032）. Other factors including age,sex,tumor size,tumor stage,international prognostic index,tracheal compression,lactate dehydrogenase,residual tumor,and pathological type showed no significant effect on survival（all P 〉0. 05）. Conclusions DLBCL has the highest fine needle biopsy positive rate,MALT has the highest frozen pathological positive rate,and intraoperative frozen pathology has more malignant results than the preoperative fine needle biopsy in the diagnosis. The accompanying lymphoma symptoms may be an adverse prognostic factor.