3例原发性甲状腺滤泡性淋巴瘤的临床分析及文献复习

Clinical analysis of 3 cases primary thyroid follicular lymphoma and literature review

目的探讨原发性甲状腺滤泡性淋巴瘤(PTFL)的临床表现、病理学特征、免疫表型、鉴别诊断、治疗及预后。方法回顾性分析3例患者术后病理诊断考虑为PTFL的临床资料,整理并分析治疗方案及随访预后。结果3例均行手术治疗。1例术后病理诊断明确,规律化疗,随访3年余,完全缓解;1例术后病理诊断尚不明确,不支持经典的滤泡性淋巴瘤,但不排除Bcl⁃2阴性的PTFL,未行进一步检查和化疗,随访6年余,疾病稳定;1例病理诊断困难,经过病理专科会诊后确诊,行1程CD20单克隆抗体治疗后随访1年余,完全缓解。结论PTFL在临床上并不多见,容易误诊和漏诊。通过收集3例PTFL进行临床分析,提供鉴别诊断思路,并为其制定个体化临床治疗策略提供依据。

Objective To explore the clinical manifestations,pathological features,immunophenotype,differential diagnosis,treatment and prognosis of primary thyroid follicular lymphoma(PTFL).Methods The clinical data of three patients with PTFL were retrospectively analyzed,and the therapy strategy and follow⁃up prognosis were sorted out and analyzed.Results All three patients underwent surgery.One of them was confirmed as FL by pathological diagnosis,and regular chemotherapy after surgery.This patient was followed up for more than 3 years and completely remission(CR).The postoperative pathological diagnosis of other one was not clear,for the results didn′t support typical FL.However,the Bcl⁃2⁃negative PTFL couldn′t be exclude.This case was in stable condition after followed up for more than 6 years without any further examination or chemotherapy.The last case had difficulties in pathological diagnosis,and finally diagnosed as FL by pathology specialist consultation.Then the patient was treated with 1 course CD20 monoclonal antibody and followed up for over 1 year,CR.Conclusion PTFL is rare in clinical practice and is prone to misdiagnosed or missed.By collecting 3 cases of PTFL for clinical analysis,the differential diagnosis ideas were provided and the basis for formulating individualized clinical treatment strategies were provided.