原发性甲状腺淋巴瘤17例临床分析

Clinical analysis of 17 cases of primary thyroid lymphoma

摘要:

目的：探讨原发性甲状腺淋巴瘤（primary thyroid lymphoma，PTL）的临床特点、诊断、治疗及预后。方法：回顾性分析2013年1月至2019年9月北京协和医院收治的17例PTL患者临床资料。结果：9例患者出现甲减，16例患者合并桥本甲状腺炎（Hashimoto’s thyroiditis，HT），7例患者通过甲状腺穿刺活检确诊，10例患者通过甲状腺部分切除术确诊。弥漫大B细胞淋巴瘤（diffuse large B cell lymphoma，DLBCL）11例，黏膜相关淋巴瘤（mucosa associated lymphoid tissue lymphoma，MALT），DLBCL、MALT转化和滤泡型淋巴瘤（follicular lymphoma，FL）各2例。DLBCL组患者平均年龄（61.7±13.0）岁，DLBCL、MALT转化组患者平均年龄（59.0±2.8）岁，MALT组患者平均年龄（61.5±3.5）岁，均明显大于FL组患者的（31.0±14.1岁）。DLBCL组患者血LDH为（380.3±197.9）U/L，高于MALT组和FL组。FL组国际预后指数（international prognostic index，IPI）为 0分，低于其他3组。DLBCL组患者Ki-67为（70.0±16.1）%，高于MALT组的（16.25±8.80）%。结论：原发性甲状腺淋巴瘤与HT关系密切，诊断依靠病理，DLBCL为最常见病理类型，治疗方案根据病理类型及临床分期决定。

Abstract:

Objective：To investigate the clinical feature，diagnosis，treatment and prognosis of primary thyroid lymphoma（PTL）. Methods：The general information of 17 patients with PTL from January 2013 to September 2019 in our hospital was retrospectively analyzed. Results：Among those patients，9 patients had hypothyroidism，16 patients complicated with Hashimoto’s thyroiditis（HT），7 patients were finally diagnosed via core-needle biopsy（CNB） of thyroid，while the other 10 patients were diagnosed via partial thyroidectomy. The pathological types of these patients included diffuse large B cell lymphoma（DLBCL）（n=11），mucosa-associated lymphoid tissue lymphoma（MALT）（n=2），DLBCL and MALT transformation（n=2） and follicular lymphoma（FL）（n=2）. The average age of patients in the DLBCL group was （61.7±13.0） years old，in the DLBCL and MALT transformation group was （59.0±2.8） years old，in the MALT group was （61.5±3.5） years old，which all were significantly older than that in the FL group of （31.0±14.1） years old. The LDH level of patients in the DLBCL group was （380.3±197.9）U/L，which was higher than that in the MALT group and the FL group. The international prognostic index（IPI） in the FL group was 0，which was lower than that in the other three groups. The Ki-67 index in the DLBCL group was （70.0±16.1）%，which was higher than that in the MALT group of （16.25±8.80）%. Conclusion：PTL is closely related with the HT and diagnosis of PTL depends on histopathology. DLBCL is the most common pathological type，and the treatment protocol should be decided in accordance with the pathological type and clinical stage.