原发性甲状腺恶性淋巴瘤28例临床分析

Primary Malignant Lymphoma of Thyroid Gland :Clinical Analysis of 28 Cases

背景与目的:原发性甲状腺恶性淋巴瘤很少见,其临床治疗方案和预后评判尚无统一标准。本文探讨原发性甲状腺恶性淋巴瘤的临床表现、诊断、治疗和影响预后的主要因素。方法:回顾28例原发性甲状腺恶性淋巴瘤患者的一般临床资料、临床病理分型、治疗方法、组织病理分型,并结合随访资料进行分析。结果:不足40岁组3例均为腺内型;40～60岁组9例中7例为腺内型,2例为腺外型;60岁以上组16例中,7例为腺内型,9例为腺外型。有随访的24例原发性甲状腺恶性淋巴瘤的中位随访期3年(1～14年),15例腺内型中2例死亡(13.33％),而9例腺外型中6例(66.67％)死亡;20例颈部肿物被完全切除者均生存达1年以上,而4例肿物未能彻底切除者均生存不足1年。肿瘤组织病理分型属B大细胞型的11例中,仍生存8例,其最长生存期达68个月;而滤泡Ⅱ型的3例均死于本病,最长生存期仅18个月。本组病例的1年生存率为61.54％,3年生存率为43.31％,5年生存率 为27.35％。结论:原发甲状腺恶性淋巴瘤肿物彻底切除辅以治疗量的放疗和化疗是较合理的治疗方法。发病时的年龄、肿瘤的临床分型(肿瘤侵犯程度)和肿物切除是否彻底是影响原发甲状腺恶性淋巴瘤预后的主要因素;肿瘤的组织病理分型与预后无关。

BACKGROUND & OBJECTIVE: Primary thyroid lymphoma (PTL) is rare, the clinical treatment strategy and prognosis prediction are still to be unified. The objective of this article was to explore the clinical manifestation, diagnosis, treatment and the patients' prognosis, and the main prognostic factors of PTL. METHODS: The general information, clinical and pathologic classification, treatment method of 28 cases of PTL were reviewed retrospectively and analyzed in combination with the follow-up information of 24 cases of this tumor. RESULTS: In spite of 4 cases lost follow-up, 24 cases were followed-up for 1 to 14 years, the median time was 3 years. Clinical classification, all the 3 cases in the group of the age less than 40 years were intraglandular type, 7 of 9 cases in the group of the age of 40 -60 years were intraglandular type, 2 cases were extraglandular type, 7 and 9 cases in the group of the age more than 60 years were intraglandular and extraglandular type separately. By the end of this follow-up period, among these 24 cases, 6 of the 9 patients in the clinical extraglandular type group and only 2 of 15 patients of the clinical intraglandular type group died of PTL. Twenty cases whose neck masses were surgically removed completely lived 1 year or more, but all the 4 cases whose neck masses were resected incompletely lived less than 1 year. Pathologically, 11 cases of the B cell type, large lymphocytic group were still survival, the longest survival time was 68 months; but all the 3 cases of the follicular lymphoma II died of PTL within 18 months. The total survival rate of these 24 patients of 1 year, 3 year, and 5 year were 61.54%, 43.31%, and 27. 35%, separately. CONCLUSION: The proper treatment strategy of primary lymphoma of thyroid gland is complete resection of the tumor followed by the post-operative radical radiotherapy and chemotherapy. The patient's age, clinical classification, and radical resection may be dosely related to the patient's survival. No significant relationship was found between the patient's survival and the pathologic classification of PTL.