原发性甲状腺淋巴瘤的外科治疗（附10例报告）

目的：讨论原发性甲状腺淋巴瘤的诊断及治疗原则。方法：回顾分析、总结10例原发性甲状腺淋巴瘤的l晦床、病理特点和治疗、预后情况。结果：10例中女6例，男4例，平均年龄59岁，平均病程10个月。7例甲状腺蛋白抗体和（或）微粒体抗体升高；病理诊断为黏膜相关淋巴组织B细胞淋巴瘤（MALT型）3例，黏膜相关淋巴组织B细胞淋巴瘤伴大细胞转化型（MALT伴大细胞转化型）3例，弥漫性大B细胞淋巴瘤（DL．BCL型）4例，4例伴有慢性淋巴细胞性甲状腺炎。IE期4例，ⅡE期2例，ⅢE期2例，IVE期2例。本组2例行手术切取活检术，8例行甲状腺腺体切除术，1例同时行气管切开造口术。8例术后明确行CHOP方案化疗等治疗。10例平均随诊30个月，10例平均存活36个月。结论：对于慢性淋巴细胞性甲状腺炎病例，应积极处理其迅速出现的甲状腺结节或甲状腺肿大的情况。对于原发性甲状腺淋巴瘤，手术主要起明确诊断的作用，放、化疗是其主要的治疗手段，MALT型、I-Ⅱ期病例预后较好。     

甲状腺原发性非霍奇金淋巴瘤一例报告

甲状腺原发性非霍奇金淋巴瘤一例报告佛山市第一人民医院（佛山市５２８０００）胡维维发生于甲状腺组织内的恶性淋巴瘤大部分是转移性或周围原发病灶直接浸润的结果，而原发于甲状腺内的淋巴瘤则较为少见，且分化好者不易诊断，易与严重的慢性淋巴细胞性甲状腺炎等疾病相...     

甲状腺非何杰金氏淋巴瘤1例

甲状腺非何杰金氏淋巴瘤１例杨劫主治医师潘启深，谭羽灿，朱正广东省佛山市第一人民医院（５２８０００）原发性甲状腺恶性淋巴瘤很少见，我科收治一例甲状腺非何杰金工淋巴瘤，现报告如下。患者男，８２岁。因或颈部肿块，伴声嘶一周，以＂右甲状腺腺瘤囊性变＂而收入院...     

原发性甲状腺恶性淋巴瘤3例报告

原发性甲状腺恶性淋巴瘤３例报告许磊，陈钦恭，王建彪福建省肿瘤医院病理科（福州３５００１４）恶性淋巴瘤是较常见，然而原发于甲状腺的恶性淋巴瘤罕见。我院遇见３例，现报告如下：病例介绍例１，女，４４岁（住院号９０４１）。因颈前无痛性肿物一个月，进行性增大，...     

骨原发性恶性淋巴瘤的诊断治疗和预后

恶性淋巴瘤是原发于淋巴结和淋巴结外淋巴组织的恶性肿瘤。根据瘤细胞特点和瘤组织的结构成分，可将恶性淋巴瘤分为以RS细胞为特征的霍奇金病（Hodgkin disease，HD）和非霍奇金淋巴瘤（non-hodgkin lymphoma,NHL）两大类。骨原发性恶性淋巴瘤又称骨原发性非霍奇金淋巴瘤（Primary Non-hodgkin’s Lymphoma of Bone）指起源于骨髓腔的淋巴瘤，同时不伴区域淋巴结或内脏受累，是一种很少见的结外淋巴瘤。     

TNM 分期与Lugano分期在预测原发性胃肠道恶性淋巴瘤患者生存中的作用比较*

目的：比较TNM 与Lugano 分期系统在预测原发性胃肠道恶性淋巴瘤患者5 年生存率中的价值。方法：收集2001年2月至2013年8 月手术治疗的原发性胃肠道恶性淋巴瘤患者73例。所有患者分别使用TNM 及Lugano 系统进行分期。5 年生存率为生存比较的主要指标,Kaplan-Meier 法绘制生存曲线,并行Log-rank 检验。Cox 回归分析方法检验不同临床因素对患者生存的影响。结果：本组患者中位随访时间42.4（1.3～158.6）个月,5 年生存率77.82% 。使用TNM 系统分期时,Ⅰ、Ⅱ、Ⅲ期和Ⅳ期患者的5 年生存率分别为100.0% 、90.0% 、67.4% 和22.2%（χ2= 17.795 6,P = 0.000 5）。 使用Lugano 分期时,Ⅰ、Ⅱ、ⅡE 期和Ⅳ期患者的5年生存率分别为100.0% 、100.0% 、70.7% 和46.2%（χ2= 15.677 6,P = 0.001 3）。 Cox 分析提示肿瘤浸润深度（P = 0.018 1）和远处转移（P = 0.003）是原发性胃肠道恶性淋巴瘤患者生存的独立预后因素。结论：TNM 分期较Lugano 分期可以更好地预测原发性胃肠道恶性淋巴瘤患者的5 年生存率。     

原发性甲状腺恶性淋巴瘤27例临床分析

  【摘要】　目的　探讨原发性甲状腺恶性淋巴瘤的临床特点及治疗方法。方法　回顾性分析27例原发性甲状腺恶性淋巴瘤患者的临床资料。结果　27例原发性甲状腺恶性淋巴瘤病理类型均为B细胞型,多为低度恶性的结外边缘区B细胞淋巴瘤,临床分期均为Ⅰ、Ⅱ期,予以合理综合治疗,预后相对较好。结论　原发性甲状腺恶性淋巴瘤应强调综合治疗,外科手术主要起协助诊断的作用,术后放疗与化疗是必要的。     

原发性胃肠道非霍奇金淋巴瘤的临床研究

目的：回顾性分析原发性胃肠道非霍奇金淋巴瘤（PGI NHL）的形态学和病理类型、临床特征、治疗及预后。方法：收集病理确诊的原发性胃肠道非霍奇金淋巴瘤89例，行常规病理和免疫组化染色（CD3、CD5、CD7、CD10、CD20、CD23、CD45RO、Kappa、Lambda、Cyclin D1、Ki-67），按照WHO分类方法重新分类，借以探讨其临床特征。结果：①ⅠE期24例，ⅡE期33例，ⅢE期19例，ⅣE期13例。②T细胞性和B细胞性PGI NHL各17例和72例。③MALT淋巴瘤共15例，其中胃MALT瘤14例，小肠1例。④3、5年总生存率直接法计算分别为77.0%（57/74）和53.6（30/56）。其中ⅠE期24例，3、5年总生存率分别为100%（19/19）和85.7%（12/14），ⅡE期33例，3、5总生存率分别为85.2%（23/27）和65%（13/20），ⅢE期19例，3、5年总生存率分别为58.8%（10/17）和30.8%(4/13),ⅣE期13例，3、5年总生存率分别为45.5%（5/11）和11.1%(1/9)。结论：PGI NHL临床表现无特异性，容易延误诊断；胃癌发生率最高，临床分期以ⅠE、ⅡE期为主，病理分型以中度恶性和B细胞性为主，ⅠE期和ⅡE期临床预后明显比ⅢE期好，B细胞性临床预后较T细胞性好；根治性手术和术后正规化疗，必要时加用放疗是取得长期生存的重要措施。     

原发性睾丸非霍奇金淋巴瘤11例临床分析

目的：探讨原发性睾丸非霍奇金淋巴瘤的治疗方法及预后。方法：对11例睾丸非霍奇金淋巴瘤的临床病理资料进行回顾性分析。结果：睾丸非霍奇金淋巴瘤占同期恶性淋巴瘤的2.34%,占结外淋巴瘤的8.33%,第1年死亡3例（高度恶性2例,中度恶性1例;T细胞3例;ⅣE1例,ⅢE2例,）,3年存活8例,3年生存率为72.7%（8/11）,5年存活4例（其中3例为术后化、放疗的病例,ⅠE3例,ⅡE1例）,5年生存率为36.4%（4/11）。结论：高度恶性、T细胞者预后较差,分期越早预后越好,术后化疗加局部放射治疗预后较好。     

肾脏原发性恶性淋巴瘤1例报告

 肾脏原发性恶性淋巴瘤1例报告杨金英，赵立新，姜虹肾脏恶性淋巴瘤一般都是全身性病变的表现之一，而肾脏原发性恶性淋巴瘤少见。肾原发性恶性淋巴瘤应符合以下三个标准：（1）肿瘤局限于肾包膜内。（2）周围淋巴结阴性。（3）全身其他部位未找到肿瘤证据。现将本院收…     

14例肺原发性黏膜相关淋巴组织淋巴瘤疗效分析

目的 分析肺原发性黏膜相关淋巴组织淋巴瘤的临床特征和预后。方法 回顾分析1999—2012年间14例肺原发性黏膜相关淋巴组织淋巴瘤患者临床资料,其中Ⅰ_E期8例、Ⅱ_E期5例、Ⅲ_E期1例。4例单纯手术治疗,5例术后放疗或化疗,3例化放疗,2例单纯化疗。结果 中位年龄为55岁,男女之比为1∶1.33。中位随访时间为48.3个月。全组患者均存活,3例患者出现治疗失败。全组患者2、4年无进展生存率分别为91%和69%。治疗失败发生在疗后25~37个月,失败部位为双肺、纵隔淋巴结、右肺和脑膜。结论 肺原发黏膜相关淋巴组织淋巴瘤为惰性淋巴瘤,预后良好;临床上可根据患者病变范围和身体状况选择适当治疗。     

Primary gastric lymphoma: A review of 45 cases

Primary gastric lymphoma accounts for about 2% of gastric neoplasms. The prognosis of patients affected with non-Hodgkin's gastric lymphoma appear better than for other lymphatic sites.In a retrospective study, the authors have analyzed 45 patients, by evaluating the histopathologic characteristics and relative prognostic factors.The main factors significantly influencing 5-yr survival are: serosal penetration (31.17% vs. 71.2%, P < 0.05), regional lymph node involvement (53.07% vs. 68%), and clinical stage of disease (I_E: 85.6%, IV_E:10%, P < 0.001). The histologic characteistics, the high or low grade of malignancy, and patient age can also be considered important prognostic factors, but not statistically significant in our series of cases.Comparison between overall survival and disease-free survival of patients in stages I_E and II_E who underwent surgery alone, with those who had chemotherapy and/or radiotherapy after surgery shows a higher survival (85.6%) of the group who had combined treatments, even though this difference is not statistically significant.     

原发性甲状腺淋巴瘤的超声表现病理及其他影像学特征分析

  目的   探讨分析原发性甲状腺淋巴瘤超声、病理及其他影像学特征,加强临床医师对本病的深入认识。   方法   回顾性复习天津医科大学肿瘤医院放治的20例经手术病理证实的原发性甲状腺淋巴瘤。对该20例患者的临床、超声、病理及相关CT、MRI特征进行分析。   结果   20例原发性甲状腺淋巴瘤均为非霍奇金淋巴瘤（Non-Hodgkin lymphoma,NHL）。超声表现为12例甲状腺双叶受累,8例单侧叶受累。主要特征为:甲状腺弥漫性增大,双叶或单侧一叶回声减低,粗糙不均,内可见多个低回声团块,其中16例颈部伴有多发肿大淋巴结。5例表现肿物侵及气管,1例出现食管与气管同时受压。   结论   原发性甲状腺淋巴瘤的临床及影像学表现缺乏特异性,最后确诊依靠病理学。如临床发现颈部肿物短时间迅速增大,且超声表现为桥本氏甲状腺炎基础上的恶性征象,应考虑到淋巴瘤,及时做针吸或切取活检,以便临床选择恰当的治疗方案。       

原发韦氏环黏膜相关淋巴组织淋巴瘤的临床特点和长期治疗结果

目的 分析原发韦氏环黏膜相关淋巴组织(MALT)淋巴瘤的临床特点和长期治疗结果。方法 回顾分析本院初治的 10例原发韦氏环MALT淋巴瘤,其中男 1例、女 9例,Ⅰ_E期 7例、Ⅱ_E期 3例。单纯放疗 3例,7例在放疗前加 1~4周期化疗或再加辅助化疗。放疗中位剂量40 Gy,化疗方案以CHOP方案为主。结果 中位年龄 58岁,均无全身症状,只有 1例乳酸脱氢酶升高。疗后完全缓解率100%。中位随访90个月,全组 5年总生存率、疾病相关生存率和无进展生存率分别为90%、100%和80%。1例死于直肠癌肝转移,1例脑部复发经放疗挽救治愈。结论 韦氏环MALT淋巴瘤与其他胃外MALT淋巴瘤有类似临床特点,放疗为主的治疗取得了出色的长期疗效。     

Outcomes of primary thyroid non-Hodgkin’s Lymphoma

Primary non-Hodgkin’s lymphoma (NHL) of the thyroid gland is a rare disease with an incidence of 0.5 per 100,000 population. Stages IE and IIE thyroid NHL have been traditionally treated by surgical resection; however, modern treatment consists of chemotherapy and local radiotherapy, and surgery is often reserved for tissue diagnosis and relief of airway compression. We retrospectively reviewed the management and outcomes of nine consecutive patients with thyroid NHL, eight females and one male (median age 63 yr, range 34-71 yr) treated between 1994 and 1999. Five patients had disease stage IE and 4 stage IIE. Median follow-up was 72 mo. Pathohistology and immunohistochemistry identified two patients with mucosa-associated lymphoid tissue (MALT), three follicular center cell lymphoma (FCC), two patients large B-cell lymphoma (BLCL), one a marginal zone lymphoma (MZL), and one patient a peripheral T-cell lymphoma (PTCL). Total thyroidectomy was performed in three patients and subtotal thyroidectomy in four. One (MALT) patient underwent surgery alone; three patients surgery, radiotherapy, and chemotherapy (two FCC, one PTCL); three patients surgery and chemotherapy (one MALT, one FCC, one LBCL); and two chemotherapy alone (one LBCL, one MZL). Median survival was 79 mo (range 13–124 mo). The PTCL patient, a 34-yr-old man, died from disseminated disease at 13 mo despite secondary chemotherapy, and one LBCL patient with extensively invasive local disease died from stroke 17 mo after diagnosis. The remaining seven patients remain in remission with no local or systemic relapse at a mean of 86 mo. With appropriate therapy primary thyroid NHL has a favorable course; however, prognosis depends on the histology, local spread, and the stage of the disease at presentation, as well as the patient’s performance status. Surgery in combination with chemotherapy and/or radiotherapy is still warranted for intermediate and high-grade thyroid NHLs, with over 77% of patients achieving long-term remission. Peripheral T-cell lymphoma carries a poor prognosis.     

False-positive finding on 18F-FDG PET after chemotherapy for primary diffuse large B-cell lymphoma of the thyroid: a case report

Primary non-Hodgkin lymphoma of the thyroid is an uncommon disease. It is a potentially aggressive disease and diffuse large B-cell lymphoma of the thyroid may result in 5 year survival rates <50%. Hence adequate follow-up and multimodality treatment for recurrent or persistent disease are required. Since 18F-FDG PET is considered the imaging method of choice for the detection and staging of lymphoma, this was used for restaging of a case of diffuse large B-cell lymphoma of the thyroid after chemotherapy and its diagnostic value is questioned in the present case report. In fact, PET showed a false-positive finding which led to unnecessary surgery.     

130例鼻腔和韦氏环NK/T细胞淋巴瘤放化疗预后分析

目的 观察鼻腔、韦氏环NK/T细胞淋巴瘤放化疗疗效,并分析影响预后的因素。
方法2000-2010年本院共收治经免疫组化确诊130例鼻腔、韦氏环NK/T细胞淋巴瘤,其中鼻腔的109例、韦氏环的21例。Ann Arbor分期Ⅰ_E期116例、Ⅱ_E期14例。单纯放疗30例,单纯化疗2例,放化疗联合98例。
结果 随访率100%,随访时间满5年者78例。完全缓解率全组为89.2%,Ⅰ_E、Ⅱ_E期的分别为88.8%、92.9%(χ²=0.02,P=0.837),单纯放疗、放化疗联合的分别为86%、96%(χ²=1.44,P=0.230)。全组5年总生存(OS)和无瘤生存(DFS)率分别为58.0%和57.2%,Ⅰ_E、Ⅱ_E期患者5年OS分别为60.6%、36.3%(χ²=0.25,P=0.615),5年DFS分别为59.7%、36.3%(χ²=0.21,P=0.648);单纯放疗、放化联合的5年OS分别为70%、48%(χ²=0.01,P=0.933),5年DFS分别为66%和48%(χ²=0.09,P=0.764)。单纯放疗、放化联合的主要3、4级不良反应总发生率分别为6.7%、54.1%(χ²=41.38,P=0.002)。原发灶照射剂量(χ²=3.18,P=0.005)、ECOG评分(χ²=2.97,P=0.008)与OS相关。
结论 Ⅰ_E、Ⅱ_E期鼻腔、韦氏环NK/T细胞淋巴瘤放化联合与单纯放疗疗效相似,但不良反应较重;原发灶照射剂量、ECOG评分是影响OS的因素。     

Non-Hodgkin's Lymphoma of the Thyroid: A clinical study of twenty-two cases

Non-Hodgkin's lymphoma (NHL) of the thyroid gland is a rare disease. In the present study, the survival rate and characteristics were retrospectively analyzed in 22 patients with stage IE and IIE thyroid NHL treated with radiotherapy with or without combination chemotherapy. Seventeen NHL had histological evidence of lymphoma of mucosa-associated lymphoid tissue (MALT) type. The 5-year survival rate was 85% in all patients, with 100% and 63% respectively, for stage IE and stage IIE patients. The highly significant factor correlated with decreased determinate survival was concomitant stridor.     

Outcome analysis for stage IE and IIE thyroid lymphoma

Previous reports have revealed modest results in the management of thyroid lymphoma with radiotherapy alone. This retrospective report evaluates the outcome of patients treated for thyroid lymphoma with radiotherapy alone and with combined modality therapy (chemotherapy and radiotherapy) at a single institution. Twenty-seven patients with stages IE and IIE non-Hodgkin's lymphoma of the thyroid gland were treated between 1960 and 1998 at Barnes-Jewish Hospital, of which 14 patients were stage IE and 13 patients were stage IIE. The median age at diagnosis was 67 years, and there were 21 females and 6 males evaluated. The median follow-up time was 38 months (range: 3-279 months). All patients had histologically proven non-Hodgkin's lymphoma, of which 22 patients (81%) were intermediate grade. Treatment consisted of radiotherapy alone in 19 patients and a combined modality therapy in 8 patients. The median radiation dose to the thyroid bed was 44 Gy, and most patients received a doxorubicin-containing regimen administered prior to radiotherapy. Patient, tumor, and treatment-related characteristics were evaluated using Cox regression analysis. Local-regional tumor control, disease-free survival (DFS), and overall survival (OS) were calculated using the Kaplan-Meier method. Four patients had local relapse in this series, with a crude local tumor control rate of 85%. No factor was determined to be significant for local tumor control. The actuarial 5-year DFS and OS for the entire cohort were 57%, and 56%, respectively. In terms of DFS, both age and stage were statistically significant. The 5-year actuarial DFS for patients less than age 65 years was 83% versus 37% for those more than this age (p = 0.024). Furthermore, the 5-year actuarial DFS for patients with stage I and II disease was 69% and 45%, respectively (p = 0.022). In multivariate analysis, age continued to be significant for DFS (p = 0.049). Overall survival analysis revealed age, local tumor control, and stage to be significant in univariate analysis. Multivariate analysis was further carried out using Cox proportional hazard model, and it revealed age (p = 0.006) and local tumor control (p = 0.007) to be significant. Primary thyroid gland lymphomas have a favorable outcome with appropriate therapy, but prognosis depends on both clinical stage and age at presentation. Because of the risk of both local-regional and distant failure, combined modality approaches that use chemotherapy with radiotherapy are warranted for intermediate- and high grade thyroid lymphoma.     

Non-Hodgkin's lymphoma of the thyroid: A retrospective review of all patients diagnosed in Nottinghamshire from 1973 to 1992

The pathological and clinical features were reviewed of all primary non-Hodgkin's lymphomas (NHL) of the thyroid gland diagnosed between 1973 and 1992 in the population (1.1 million) served by the Nottingham and North Nottinghamshire Health Authorities. Of the 43 patients with histologically proven NHL, three had low grade mucosa associated lymphoid tissue (MALT) lymphomas (Stage I_eA, 2; Stage II_eA, 1), 35 had intermediate or high grade lymphomas, Stage I_ea or II_eA (intermediate MALT, 2; high grade MALT, 14; B-cell diffuse centroblastic, 17; anaplastic large cell (Ki-1) of null cell type, 1; high grade unclassifiable, 1), and one had unclassifiable NHL Stage II_eA. One patient had Stage III_eA disease (high grade MALT) and three had stage IVA disease (high grade MALT, 2; B-cell diffuse centroblastic, 1). The median age was 68 years (range 45–86) with a female : male ratio of 6:1. For the 35 patients with intermediate or high grade thyroid NHL (Stages I_eA and II_eA) the 5- and 10-year cause specific survival was 60%. The 21 patients treated between 1985 and 1992 initially with chemotherapy (except stage I_eA (<5 cm diameter) had a 5-year cause specific survival of 69% (95% CI 48–90) compared with 46% (95% CI 19–73) for the 14 patients treated between 1973 and 1984 with initial radiotherapy (χ² = 1.62). The survival of those patients with intermediate or high grade MALT lymphomas was not significantly greater than of those patients with B-cell diffuse centroblastic NHL.