不同病理类型甲状腺淋巴瘤超声特征分析及临床意义

目的:探讨甲状腺淋巴瘤及其不同病理类型的超声特征。方法:回顾性分析2014年1月至2019年11月上海交通大学医学院附属瑞金医院病理证实为甲状腺淋巴瘤的患者30例。对其临床表现、声像图特征进行分析。并进一步比较不同病理类型的淋巴瘤超声图像特征之间的差异。结果:纳入分析的30例患者中,病理诊断为弥漫大B细胞淋巴瘤17例(56.7%),黏膜相关淋巴组织淋巴瘤8例(26.7%),滤泡性淋巴瘤3例(10.0%),灰区淋巴瘤1例(3.3%),淋巴母细胞淋巴瘤1例(3.3%)。临床表现有短期内颈部肿大(60.0%),伴有压迫症状(46.7%),Ⅲ/Ⅳ区颈部淋巴结肿大(63.3%),甲状腺功能异常(10.0%),合并桥本甲状腺炎(63.3%)。弥漫大B细胞淋巴瘤与黏膜相关淋巴组织淋巴瘤之间在病灶的纵径(P=0.036)、回声特征(P=0.036)以及病灶边缘(P=0.005)上的差异有统计学意义。不同侵袭性之间在回声特征(P=0.005)以及病灶边缘(P=0.020)上的差异有统计学意义。结论:发现桥本甲状腺炎患者短期内增大明显的甲状腺内极低回声肿块,且伴有颈部Ⅲ/Ⅳ区淋巴结肿大时,应怀疑甲状腺淋巴瘤发病。边缘不规则的极低回声病灶伴片状高回声是弥漫大B细胞淋巴瘤的特征性表现,边缘规则的极低回声病灶伴网格状回声是黏膜相关组织淋巴瘤的特征性表现。

Ultrasonographic features of different pathological types of thyroid lymphoma and its clinical features

Objective To investigate the ultrasonographic features of thyroid lymphoma and its different pathological types.Methods The clinical manifestations and sonographic findings were analyzed retrospectively in 30 patients with pathological confirmed thyroid lymphoma from January 2014 to November 2019 in Ruijin Hospital Affiliated to the Shanghai Jiao Tong University of Medicine.Ultrasonographic features of different pathological types of thyroid lymphoma were compared.Results There were 30 patients included in the study.All the lesions were pathologically diagnosed as diffuse large B-cell lymphoma(17/30,56.7%),mucosa-associated lymphoma(8/30,26.7%),follicular lymphoma(3/30,10.0%),gray zone lymphoma(1/30,3.3%),and lymphoblastic lymphoma(1/30,3.3%).Clinical features included short-term neck enlargement(60.0%),with compression symptoms(46.7%),Ⅲ/Ⅳcervical region lymphadenopathy(63.3%),thyroid dysfunction(10.0%),combined with Hashimoto′s thyroiditis(63.3%).Statistical differences were found in the longitudinal diameter of the lesion(P=0.036),ultrasonographic features(P=0.036),and the margin of the lesion(P=0.005)between diffuse large B-cell lymphoma and mucosa-associated lymphoid tissue lymphoma.Ultrasonographic features(P=0.005)and lesion edges(P=0.020)differed significantly between different aggressiveness.Conclusions Patients with Hashimoto′s who have noticed a short-term enlargement of extremely low echogenic mass in the thyroid gland and lymphadenopathy in the neckⅢ/Ⅳregion should be suspected of having thyroid lymphoma.Very low echo lesions with irregular edges and flaky hyperechoes are characteristic features of diffuse large B cell lymphoma,and very low echo lesions with rims and grid echoes are characteristics of mucosa-associated lymphoma.