桥本甲状腺炎与甲状腺恶性淋巴瘤相关基因

目前研究表明甲状腺恶性淋巴瘤大多发生在桥本甲状腺炎的基础上,二者在组织学特征上存在着一定的交叉,为鉴别二者带来一定的困难。Survivin、API2-MALT1融合基因、同源B细胞群、微卫星DNA、死亡相关蛋白激酶基因及周期素依赖性激酶-1在这两种疾病中有着差异性的表达和不同特征,提示这些指标在桥本甲状腺炎进展为淋巴瘤过程中起着重要的作用。对这些指标的研究可进一步揭示疾病发生、发展及相互转变的分子机制,并为鉴别诊断二者提供新的思路。     

Evans综合征合并慢性淋巴细胞性甲状腺炎一例

患者女 ,5 3岁。因面色苍黄 ,乏力 1月余 ,于 2 0 0 2年 7月 1日入院。外院经骨穿曾考虑为巨幼细胞性贫血 ,给予口服叶酸及肌注维生素B12 。既往 10年前因胃穿孔行胃大部切除术 ,发现甲状腺肿大 10余年 ,未行诊治。查体 :贫血貌 ,全身皮肤轻度黄染 ,浅表淋巴结不大 ,睑结膜略苍白 ,巩膜黄染 ,双侧甲状腺肿大Ⅱ度 ,以右侧明显 ,质硬无压痛 ,无结节 ,未闻及血管杂音。胸骨无压痛 ,心肺无异常。肝脾肋下未及。实验室检查 :多次查血象Hb 72～ 76g/L ,RBC(1 99～2 0 1)× 10 12 /L ,平均红细胞体积 (MCV) 113 4fl,网织红细胞 (Ret) 0 15 3…     

慢性淋巴细胞性甲状腺炎

慢件淋巴细胞件甲状腺炎于1912年由日本学者首先报道,属于最常见的自身免疫性甲状腺疾病,也是甲状腺功能减退(甲减)最主要的病因,好发于中老年女性.患者起病隐匿,常无特征性的临床表现,容易漏诊.本病诊断尚缺乏国际统一标准,主要依靠一些非特异性的症状与体征,尤其是甲状腺肿大、甲状腺功能减退,并结合相应的辅助检查.如甲状腺自身抗体阳性,且滴度较高,对诊断意义更大.甲状腺穿刺细胞学检查不作为常规项目,但对诊断困难者具有确诊价值.伴有甲减者,需要常规采用替代治疗,尤其是甲状腺肿大明显者、孕妇以及儿童可以给予左旋甲状腺素替代治疗,但仅有亚临床甲减者,或甲状腺功能正常而甲状腺自身抗体阳性的患者是否需要治疗尚存在争议.     

淋巴细胞性甲状腺炎转化为非霍奇金淋巴瘤1例

患者男,54岁.因右颈前肿物伴颜面潮红2年,于1992年9月10日入我院.1983年无意中发现右颈前部有一5cm×8cm肿块,无不适感,无发热、消瘦、多汗等症状.甲状腺B超疑为甲状腺癌,在某医院行右侧甲状腺大部及椎体叶切除术.病理检查结果:右侧淋巴细胞性甲状腺炎.1990年发现原右颈前部肿块上方又出现1肿块,无红肿痛感.颜面发热,潮红状.未治疗.1992年6月,开始声音嘶哑,喘气,心悸,咳嗽.检查:一般情况可.右颈前部可扪及3cm×4cm肿块,质地中等,光滑,边缘清楚,无红、肿、痛.颜面潮红.肝脾未触及.血象:Hb130g/L,WBC7.O×10~9/L,中性0.60,淋巴0.30,嗜酸性0.02,单核,0.08BPC130×10~9/L;血沉12mm/h;尿常规、肝肾功能正常,血电解质正常,血T_3、T_4正常,胸部CT提示中上纵隔淋巴结肿大.颈前肿块活检,发现瘤性小淋巴细胞弥漫增生,排列稠密,肿瘤细胞比正常淋巴细胞大,大小较一致,核小而圆,罕见核裂,染色质浓染,胞浆极少.病理诊断:非霍奇金淋巴瘤(弥漫性小细胞型;B细胞来源),骨髓涂片检查:未见淋巴瘤细胞浸润.经采用COPP方案,2个疗程化疗后,颜面潮红、心悸、喘气缓解,发音正常.复查胸部CT:中上纵隔淋巴结明显缩小.现继续用COA(阿霉素)方案化疗.甲状腺恶性淋巴瘤发病率低.有人认为此恶性淋巴瘤可能来源于慢性淋巴细胞性甲状腺     

结节性甲状腺肿合并弥漫性淋巴细胞性甲状腺炎23例诊治体会

弥漫性淋巴细胞性甲状腺炎（桥本病）,易与其他甲状腺病变合并存在,鉴别困难。2000-2005年,我们收治结节性甲状腺肿合并桥本病患者23例。现报告如下。     

慢性粒细胞白血病患者4年后并发恶性淋巴瘤1例

患者 ,男 ,38岁。 1 996年 6月 2 6日因左上腹不适伴乏力半年入院。病程中无皮肤瘀斑、点、不规则发热等。体检 :轻慢性病容 ,双颈部、锁骨上、腋下可扪及花生米大小淋巴结 ,活动、质硬、无压痛 ,胸骨压痛 ,心肺无异常 ,肝未扪及 ,脾肋缘可扪及 ,质稍硬 ,无触痛 ,余未发现异常。实验室检查 :血常规 :WBC82× 1 0 9/L,HGB1 1 0 g/L,PLT2 80× 1 0 9/L,分类 :中幼粒细胞 0 .1 9,晚幼粒细胞 0 .3,中性杆状核细胞 0 .2 5 ,中性分叶核细胞 0 .1 1 ,嗜酸粒细胞0 .0 1 ,嗜碱粒细胞 0 .0 2 ,淋巴细胞 0 .1 2。骨髓象 :增生极度活跃 ,粒∶红 =1 …     

慢性淋巴细胞甲状腺炎的诊断及治疗

慢性淋巴细胞甲状腺炎又称自身免疫性甲状腺炎或称桥本氏病 ,是一种较常见的自身免疫性疾病 ,多见于女性 ,近年来发病有明显增多趋势。现将其临床表现及特点简述如下。1　临床表现慢性淋巴细胞甲状腺炎可以发生在任何年龄的患者 ,但好发于 30～ 5 0岁之间 ;90 %以上为女性 ,男性患者的发病年龄较女性晚 10～ 15岁。本病起病缓慢 ,常无意中发现甲状腺肿大 ,或常有咽部不适感 ,颈部局部压迫和全身症状不明显 ;甲状腺呈弥漫性轻度或中度肿大 ,质地硬韧、不平、有结节感 ,无疼痛或轻压痛。其临床表现多种多样 ,可以是甲状腺功能正常 ,也可表现为…     

原发性甲状腺恶性淋巴瘤1例报告

患者女,65岁,因发现颈部肿块1年,于2004年2月12日入院。B超检查示颈部实性肿物,6cm×5cm×4cm大小,随吞咽活动,无压痛,颈部无肿大淋巴结。12月15日行手术治疗,切除一侧甲状腺,切面见结节性肿物(约5cm×5cm×4cm),肿物切面呈灰白、灰黄色,质地细腻,侵犯甲状腺包膜。病理诊断:甲状腺非何杰金氏恶性淋巴瘤。讨论:原发性甲状腺恶性淋巴瘤好发于女性,多发于淋巴性甲状腺炎患者。恶性淋巴瘤细胞单一,具有异形性,同时破坏甲状腺滤泡。该瘤的预后与组织学类型、肿瘤大小、患者年龄有关;局限于甲状腺内者较累及甲状腺外者预后好,高分化小细胞型较低…     

胃癌合并恶性淋巴瘤一例

患者男 ,82岁。 2 0 0 2年 5月无明显诱因出现上腹胀 ,经外院胃肠道造影及胃镜检查 ,诊断为“胃窦癌”。 6月 13日行胃癌根治术 (毕II式 ) ,术中见脾脏肿大。术后病理提示 :胃窦部腺癌I～II级 ,癌细胞浸润达胃壁深肌层 ,淋巴结 (0 /10 )。术后未接受化疗 ,饮食逐日恢复正常。 7月无明显诱因下发热达 38 7℃ ,体检脾脏肿大平脐。外周血白细胞 2 4× 10 9/L ,血红蛋白 80～ 90 g/L ,血小板正常。外院再次收入院予抗生素治疗效果不佳 ,8月 12～ 2 4日应用泼尼松 15mg/d口服 ,体温恢复正常 ,停药后又上升。 9月 2～ 10日应用地塞米松 5mg/d…     

A case of primary thyroid lymphoma with Hashimoto thyroiditis

A seventy four year old man presented with a mass of the thyroid which was diagnosed as a lymphoma arising from the thyroid gland with Hashimoto thyroiditis. Postoperative course was complicated by the tumor reoccurence presenting as invasion of the larynx with a critical narrowing of the lumen of the larynx. With chemotherapy complete remission has been achieved. This case illustrates common aetiology of the thyroid lymphoma of MALT type and Hashimoto thyroiditis.     

甲状腺透明变梁状肿瘤伴慢性甲状腺炎一例

甲状腺透明变梁状肿瘤(hyalinizing trabecular tumor,HTT)是一种罕见的甲状腺滤泡源性的肿瘤,1987年 Carney[1]首次报道了该肿瘤独特的梁状生长方式,肿瘤细胞间质中有明显玻璃样变性等病理特征。由于肿瘤形态呈现出的相似性,该肿瘤很容易误诊为甲状腺乳头状癌、髓样癌及副神经节瘤等。现报道1例北京丰台医院2013年收治的 HTT,并就其临床病理特征、特殊染色、免疫组织化学染色结果及鉴别诊断进行讨论。     

Monoclonal gammopathy in Hashimoto's thyroiditis and malignant lymphoma of the thyroid

Serum protein electrophoresis was performed in 681 patients (43 men and 638 women) with an initial diagnosis of Hashimoto's thyroiditis between April and November 1983. All patients whose thyroid size was estimated to be greater than 50 g underwent biopsy; 1 man was found to have thyroid prelymphoma, and 13 patients (4 men and 9 women) were found to have malignant lymphoma of the thyroid. Monoclonal gammopathy (M-component) was demonstrated in 5 of 667 patients (0.7%) with Hashimoto's thyroiditis (1 man and 4 women), 1 man with thyroid prelymphoma, and 3 of the 13 patients (23.1%) with malignant lymphoma of the thyroid (2 men and 1 woman). Intracytoplasmic monoclonal immunoglobulin was found in the 1 thyroid prelymphoma and in all 3 malignant lymphoma of the thyroid in patients who had M-component in their serum, but not in thyroid tissue from any of the 5 patients with Hashimoto's thyroiditis who had M-component in their serum. Thus, the finding of monoclonal intracytoplasmic immunoglobulin in tissue sections permitted the diagnosis of malignant lymphoma of the thyroid or thyroid prelymphoma.     

Hypercalcaemia and malignant lymphoma. One case report

Hypercalcaemia occurs in less than 15% of lymphomas but is associated with a poor prognosis. A patient known to have a testicular lymphoma was admitted because of asthenia and weight loss. Hypercalcemia and high serum level of calcitriol were found. A high-grade lymphoma attesting a Richter's syndrome was diagnosed. Palliative treatment consisting in corticosteroids and pamidronate was instituted. Hypercalcaemia in lymphoma has a poor prognosis and is often attributed to an acquired uncontrolled vitamin D 1-alpha-hydroxylase activity by the macrophages close to the lymphomatous cells. Influences of TNFalpha, interleukine 6 and PTHrp are also reported.     

Contemporary theories concerning chronic lymphocytic thyroiditis

Review of contemporary theories and hypothesis concerning chronic lymphycytic thyroiditis is presented. The origin of the disease depends on various factors: genetics, immunological conditions, cytokins, iodine supply, hormones, TSH and its receptors, apoptosis activation and inhibition. The environmental conditions include goitrogens, selenium, polutants and other still unknown factors. Whether the disease will be accompanied with goiter, nodules or thyroid atrophy with functional disorder is still not evident.     

Coexistence of chronic lymphocytic thyroiditis is associated with lower recurrence rates in patients with papillary thyroid carcinoma

Objective  The effect of coexistent chronic lymphocytic thyroiditis (CLT) on prognosis in papillary thyroid carcinoma (PTC) patients remains controversial. We evaluated the influence of coexistent CLT on prognostic outcome and the association of coexistent CLT with clinicopathological parameters.
Design  A retrospective study with a median follow-up of 70 months.
Patients and measurements  Patients with PTC who underwent total thyroidectomy followed by ¹³¹I remnant ablation between 1995 and 2003 at Asan Medical Center, Seoul, Korea were enrolled. CLT was diagnosed histopathologically.
Results  Among 1441 patients, 214 (14·9%) had coexistent CLT. A greater female preponderance was noted in the patients with CLT compared with those without CLT ( P  <   0·01). Mean tumour size in the patients with CLT was smaller than that in patients without CLT (2·0 ± 1·2 vs . 2·2 ± 1·4 cm; P  =   0·02). One hundred and fifty-one (12·3%) patients without CLT had recurrence, whereas 14 (7·1%) patients with CLT had recurrence during the follow-up period ( P  =   0·016). In patients with cervical lymph node metastases, those with coexistent CLT showed a significantly lower recurrence rate than those without CLT ( P  =   0·012). However, this association was lost on multivariate analysis adjusting for other clinicopathological predictors for recurrence.
Conclusions  In this study, CLT was commonly associated with PTC and was associated with smaller size of the primary tumour at presentation. CLT was also associated with a reduced risk of recurrence during follow-up, although this was not significant after adjustment for other prognostic factors.