29例原发性甲状腺淋巴瘤临床诊疗特征分析

Clinical Features,Management and Prognosis of Primary Thyroid Lymphoma:An Analysis of 29 Cases

目的:总结原发性甲状腺淋巴瘤的临床特征、诊断、治疗及预后情况,提高临床诊断及治疗水平。方法:纳入自2006年1月至2018年5月就诊于我院的29例病理诊断为甲状腺淋巴瘤的患者,对患者的围手术期情况、实验室指标、手术资料等情况进行了回顾性分析。结果:29例患者中,男性4例,女性25例,中位确诊年龄为57岁(48~66岁)。20例(71.4%)以颈部肿物为首诊症状,19例(65.5%)出现吞咽困难,而9例(32.1%)伴有呼吸困难。自起病到确诊的平均时间为(7.0±6.9)个月。12例患者术前接受了超声引导下细针穿刺活检检查,7例(58.3%)的结果为可疑淋巴瘤。术后病理结果为弥漫大B细胞淋巴瘤23例,粘膜相关淋巴组织结外边缘区B细胞淋巴瘤5例,T细胞淋巴瘤1例。所有29例患者均接受了手术治疗,2例患者因一般状况较差(ECOG评分为2分)未接受术后化疗。中位随访时间为27个月(6~120个月);截止至末次随访时,29例PTL患者的总生存率为93.1%。结论:原发性甲状腺淋巴瘤以弥漫大B细胞淋巴瘤为主要病理类型,患者的短期生存较好,术前超声引导细针穿刺活检对于甲状腺淋巴瘤诊断具有一定价值。

Objective:To investigate the clinical features of primary thyroid lymphoma(PTL)and improve diagnostic and therapeutic considerations.Methods:A total of 29 cases of PTL were diagnosed between January 2006 and May 2018 in Beijing Tongren Hospital Affiliated to Capital Medical University.The clinical features,management and prognosis of these patients were retrospectively reviewed.Results:There were 4 male cases and 25 female cases among the 29 cases with a median age of diagnosis of 57 years old(48-66 years).Twenty cases(71.4%)admitted to the clinics were diagnosed with tumor in the neck,19 cases experienced dysphagia,and 9 reported dyspnea.The mean diagnostic time,defined as the time from symptom onset to confirmed diagnosis,was(7.0±6.9)months.Twelve patients underwent ultrasound-guided fine needle aspiration cytology(EUS-FNAC),7(58.3%)of them were suspicious lymphoma.All 29 patients were histopathologically diagnosed as diffuse large B cell lymphoma(DLBCL,23 cases),mucosa associated lymphoid tissue lymphoma(5 cases)and T cell lymphoma(1 case),respectively,and then underwent surgery.And all cases received post-operative chemotherapy except 2 cases due to bad health condition[The Eastern Cooperative Oncology Group(ECOG)performance status grade was 2].The median follow-up period was 27 months(6-120 months).Until the last follow-up,the overall survival rate for the 29 patients was 93.1%.Conclusion:DLBCL is the most common histopathological type of PTL.PTL should be taken into consideration when treating elder female patients with cervical masses.Preoperative EUS-FNAC has certain value in diagnosing PTL.