原发性甲状腺恶性淋巴瘤28例临床分析

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44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。     

原发性甲状腺恶性淋巴瘤10例临床分析

目的：总结原发性甲状腺恶性淋巴瘤的诊断和治疗经验。方法：通过对本院10例原发性甲状腺恶性淋巴瘤的回顾性分析,总结其临床特点及治疗体会：结果：原发性甲状腺恶性淋巴瘤属罕见肿瘤,多种手段综合治疗可提高疗效。结论：术中病理提示为恶性淋巴瘤,应避免行甲状腺癌联合根治术;行肿瘤切除术后或姑息切除术后配合放、化疗,可达到较好疗效。     

甲状腺原发性恶性淋巴瘤 - - 附 5例报道

甲状腺原发性恶性淋巴瘤 (primary thyroid lymphoma,PTL)极少见 , 约占甲状腺原发性恶性肿瘤的 5% , 多发生于中年人 , 女性多见 . 我院自 1989年以来共有 5例 , 均经病理检查证实 , 现报道如下 . 1 临床资料 本组 5例中 , 女性 4例 , 男性 1例 , 年龄 50～ 68岁 , 中位年龄 59.8岁 . 5例患者均为颈前发现无痛性包块 , 短期生长迅速而就诊 . 3例产生气管或喉压迫症状 . 5例甲状腺扫描时肿瘤均表现为冷结节 , 血清 T3、 T4水平正常 ; 4例诊断为甲状腺瘤 , 1例诊断为甲状腺囊肿 .     

原发性甲状腺恶性淋巴瘤2例报道

原发性甲状腺恶性淋巴瘤(primary thyroid malignant lymphoma,PTML)是一种发病率较低的恶性肿瘤,在所有甲状腺恶性肿瘤中占2.0%~5.0%,在所有恶性淋巴瘤中占1.0%~2.5%,在所有结外淋巴瘤中占2.5%~7.0%[1]。我科10年内仅收治PTML患者2例,现报道如下。1临床资料病例1:女,48岁,因"体检发现甲状腺肿物5年     

原发性结外淋巴瘤43例报告

目的:探讨原发性结外淋巴瘤的临床病理特点和早期诊断。方法回顾分析我院1996年11月至2007年12月收治的经病理学证实的的43例原发性结外淋巴瘤临床病理资料。结果:原发性结外淋巴瘤无特异性临床特征,内窥镜取材的部位深度不够,B超,CT等影像学检查不能定性,初诊时误诊率达100%。结论:提高临床医生对该病的认识,尽早获取病理学依据,以早期诊断,治疗。     

甲状腺乳头状癌细针穿刺涂片细胞学诊断(附16例报告)

目的：探讨甲状腺乳头状癌针吸细胞学特点.方法：对16例经组织学证实的甲状腺乳头状腺癌术前细胞学涂片进行回顾分析,重点观察细胞学及其结构在诊断上的特点.结果：甲状腺乳头状癌针吸细胞学常呈团状结构,细胞排列成乳头状,大部分可见纤维轴心,少部分乳头无纤维轴心.细胞团及散在细胞内可见核淡染、核内假包涵体及核沟.结论：甲状腺乳头状癌细针穿刺细胞学检查表现为：①细胞团乳头状结构.②核淡染、核内假包涵体、核沟.为诊断甲状腺乳头状癌的可靠指标.     

细针穿刺细胞病理学在淋巴瘤诊断中的应用

目的 探讨细针穿刺细胞学（FNC）检测在淋巴瘤诊断方面应用的可行性.方法 选择临床怀疑淋巴瘤的患者72例,行FNC检测并切取活组织行组织学病理诊断,对细胞学形态和免疫细胞化学进行分析.结果 72例中61例经FNC诊断为淋巴瘤,其中58例经组织病理学诊断.细胞学诊断敏感度为89.2％（58/65）,特异度为57.1％（4/7）,准确率为86.1％（62/72）,阳性预测值为95.1％（58/61）,阴性预测值为36.4％（4/11）.结论 FNC病理检查对淋巴瘤诊断是有应用价值且易被临床接受的方法,结合流式细胞术、免疫组织化学、荧光原位杂交等技术可提高淋巴瘤诊断的精确性,使淋巴瘤分型成为可能.     

原发性结外淋巴瘤100例临床分析

本文收集1977年到1989年1月在我院住院治疗的原发性结外淋巴瘤患者共100例,现就其临床资料分析总结如下:临床资料本组100例,男61例,女39例,男女之比为1.56:1,年龄最小5岁,最大75岁,18岁以下22例,19—39岁 22例.40—59岁 37例,60岁以上19例,以40—60岁为高峰年龄组.     

原发结外非霍奇金淋巴瘤110例临床分析

目的:探讨原发结外非霍奇金淋巴瘤(PE-NHL)的发病情况、临床特点、诊断及治疗.方法:回顾性分析苏州大学附属第二医院2001年1月～2008年5月收治的PE-NHL 110例.结果:110例PE-NHL占同期收治恶性淋巴瘤患者的60.11%(110/183);原发部位广泛,常见部位依次为胃肠道21.82%(24/110)、Waldeye环10.91%(12/110)、鼻腔和软组织各9.10%(10/110)、纵隔7.27%(8/110)、其他少见部位41.82%(46/110);首发表现以原发器官肿大或肿块为主(77.27%),无特异性;90例患者国际预后指教(IPI)评分:低、中、高危组分别占41.11%、44.44%、14.44%.93例进行免疫分型:B细胞型69.90%,T细胞型30.10%;95例接受治疗,CR 61.05%,PR 16.84%,总有效率77.89%,中位生存时间30个月(2～86个月),5年总生存率27%.24例原发胃肠道非霍奇金淋巴瘤(PGIL),其临床特征与非原发胃肠道组比较无统计学差异,治疗23例,CR 65.21%,PR 17.39%,总有效率82.60%,中位生存时间24个月(2～78个月),5年总生存率30%.结论:本组资料中PE-NHL比例高达60.11%,超过结内淋巴瘤;其首发部位广泛,临床表现多样但无特异性;全面认识本病、遵循合理的诊治模式是提高疗效的关键.     

Primary Pulmonary Lymphoma: Relationship between Clinical Features and Pathologic Findings in 24 Cases

To elucidate the relationship between the clinical featuresand pathologic findings of primary pulmonary lymphoma, we reviewed24 patients with this disease. The pulmonary lymphomas weredivided into four groups: (1) B-cell lymphoma composed of smallto medium-sized lymphoid cells (19 cases); (2) B-cell lymphomacomposed of large lymphoid cells (three cases); (3) T-cell lymphoma(one case); (4) malignant lymphoma of lymphomatoid granulomatosis(LYG) type (one case). Radiographs of the first group revealeda predominance of infiltration associated with ill-defined tumormargins upon gross pathology, corresponding histologically tolymphangitic spread. Air bronchogram and pleural tail or abutmentwere additional radiographic features.Characteristics of thesecond group were a nodule or mass evident on radiographs andwell- , circumscribed tumor margins upon gross pathology. Lackof air bronchogram was an another radiographic feature in thisgroup. Seventeen patients in these two.groups underwent completeresection of the tumors and survived without recurrence, whereasfour received chemotherapy after biopsy and survived with disease.These results indicate that primary pulmonary B-cell lymphomais a low-grade malignancy and that complete resection is theonly therapy which leads to cure.In a single patient with T-celllymphoma, the radiographic and pathologic features of the tumorwere indistinguishable from those in the first group, but thepatient had an unfavorable prognosis. We consider that, froma prognostic viewpoint, it is important to determine the T-or B-immunophenotype of the tumor cells for diagnosis of primarypulmonary lymphoma.The only patient in this series with pulmonarylymphoma of LYG type showed distinctive clinicopathologic findings.We consider that this uncommon disease should be separated fromother types of primary pulmonary lymphoma.     

原发性肺淋巴瘤11例临床特点分析

目的探讨原发性肺淋巴瘤的发病情况、临床特点、影像学特点、治疗及预后情况。方法回顾性分析了11例原发性肺淋巴瘤的临床资料及随访情况。结果11例患者中,霍奇金淋巴瘤2例,非霍奇金淋巴瘤9例（B细胞性4例,T细胞性4例,未分型1例）。临床症状多表现为咳嗽,咳痰,胸背部疼痛。影像学多表现为肺部肿块,边缘不规则,增强可强化,部分伴有肺不张。9例非霍奇金淋巴瘤患者中6例化疗的同时接受了放疗,3例仅接受了化疗,2例霍奇金淋巴瘤只接受了化疗。除了1名患者因各种因素造成脱落随访外,剩余10例随访患者的总生存期为15～102个月（中位生存期为84．5个月）。结论肺内淋巴瘤患者临床表、影像学检查无特异性．易误诊．治疗以化疗为主．辅以放疗．     

硬脊膜外原发性恶性淋巴瘤

本文报告5例原发于脊髓硬膜外腔的恶性淋巴瘤,病人均为男性,年龄20～63岁。肿瘤均发生于胸段。发病时,病人多有类似感冒症状或背腰部疼痛等征,继而下肢麻木及瘫痪等。脊椎X线摄片和椎管碘油造影检查有助于某些椎管内疾患的鉴别诊断,但确诊需依赖病理检查。治疗可采用广泛切除肿瘤及术后补加放疗或化疗。     

结外原发非霍奇金淋巴瘤55例临床分析

本文报告了1990～1995年间经穿刺细胞学病理诊断的结外非霍奇金淋巴瘤55例。发病部位以咽淋巴环和胃肠道为多，占50．90％；其临床表现复杂多样，易误诊和漏诊。我们认为穿刺细胞学病理诊断对减少误诊率、提高治愈率具有重要作用。     

AIDS-Related Non-Hodgkin Lymphoma: Imaging Feature Analysis of 27 Cases and Correlation with Pathologic Findings

Background: Some tumor types are related to HIV, including non-Hodgkin lymphoma (NHL). The morbidityand mortality of NHL has remained high, even after highly active antiretroviral therapy (HAART) was introduced.We collected cases of AIDS with NHL, and evaluated the imaging features and strategies for diagnosis. Materialsand Methods: There were 27 patients with AIDS and tumors confirmed by pathology. There were 9 patients withBurkitt lymphoma, 16 with diffuse large B cell lymphomas (DLBCLs), and 2 with primary central nervous system(PCNS) lymphomas. All of the patients underwent a series of imaging studies. Three radiologists analyzed theimages, and any disagreement was discussed until consensus was reached. Results: The radiologic manifestationsof AIDS with NHL were mainly masses and lymphadenopathy, 3 patients having one mass and 12 two or moremasses. 7 patients had lymphadenopathy in one site and 3patients had lymphadenopathy in two or more sites.Coarse mucosal folds, thickening of the gastrointestinal wall, and lumen narrowing were typical manifestationsof NHL within the gastrointestinal tract. There were 4 patients with masses and 5 with lymphadenopathyinthe 9 with Burkitt lymphoma, and 11 patients with masses 5 with lymphadenopathy in the 16 with DLBCLs.Conclusion: NHL is a malignancy that usually occurs in patients with AIDS. Imaging is an important method bywhich to evaluate lesions, masses, and lymphadenopathy. Fine needle aspiration biopsy and stereotaxis biopsyare useful methods by which to diagnose NHL.     

原发性结外淋巴瘤136例临床分析

目的 探讨原发性结外淋巴瘤(PENL)的临床特点、诊断及治疗。方法 回顾性分析136例PENL的临床资料。结果 136例患者均为非霍奇金淋巴瘤(NHL)，PENL占同期收治恶性淋巴瘤病例的52．9％(136／257)。41.2％(56／136)的PENL病灶在头颈部，26．5％(36／136)的PENL病灶在胃肠道，86．0%(117／136)的PENL表现为原发器官肿大或局部肿块形成，接受化疗、放疗等治疗的患者病情均有不同程度好转。结论 PENL主要为非霍奇金淋巴瘤，PENL好发于头颈部及胃肠道，患者主要表现为原发器官的肿大及局部肿块形成，化疗及放疗有较好疗效。     

5例乳腺原发性恶性淋巴瘤临床病理学观察

目的：观察乳腺原发性恶性淋巴瘤（PBL）的临床病理特点。方法：采用HE和免疫组化技术对5例PBL进行病理组织学观察。结果：5例BPL临床都被误诊为乳腺癌,术后随访4年,其中1例于术后1年死亡,余4例存活。PBL的病理组织学特征为边界清楚的肿块,HE切片显微镜观察见淋巴瘤细胞灶性浸润导管／小叶上皮,免疫组化染色瘤细胞LCA、CD20阳性。结论：淋巴瘤细胞灶性浸润导管／小叶上皮是PBL的重要特征,应也乳腺典型髓样癌;乳腺假淋巴瘤鉴别。     

Thyroid Lymphoma: Recent Advances in Diagnosis and Optimal Management Strategies

Primary thyroid lymphoma is rare, composing approximately 5% of all thyroid malignancies and less than 3% of all extranodal lymphomas. It typically presents as a rapidly enlarging goiter with associated compressive symptoms. Thyroid ultrasound and fine needle aspiration cytology, using flow cytometry and immunohistochemistry, remain the main modalities used to confirm the presence of lymphoma. The increasing use of an ultrasound‐guided core biopsy to achieve an accurate diagnosis has further limited the role of surgery. An open surgical biopsy may still be required not only for definitive diagnosis but also to confirm the subtype of lymphoma. There are limited numbers of randomized or prospective trials to guide management, and controversy remains over optimal treatment. Treatment and prognosis of this disease can be dichotomized into two separate groups: pure mucosa‐associated lymphoid tissue (MALT) lymphoma and diffuse large B‐cell lymphoma (DLBCL) or mixed subtypes. Early stage (stage IE) intrathyroidal MALT lymphomas typically have an indolent course and may be treated with single‐modality surgery, radiotherapy, or a combination of both. DLBCLs are more aggressive, and survival outcomes are highest with multimodal therapy incorporating monoclonal antibodies, chemotherapy, and radiotherapy. The prognosis is generally excellent but can be varied because of the heterogeneous nature of thyroid lymphomas. The aim of this paper is to discuss the changes in diagnostic modalities and to focus on the recent alterations in the management of this rare disease, including targeted therapies as well as the more limited role of the endocrine surgeon.