原发性甲状腺恶性淋巴瘤22例临床分析

目的：总结原发性甲状腺恶性淋巴瘤（PTL）的临床表现、诊断、治疗和预后情况。方法回顾性分析我院2009年至2012年收治的22例PTL患者的临床和病理资料。22例患者均接受手术治疗，术中查8例病变局限于腺体内，14例侵及腺外组织。其中行甲状腺全切1例，双侧次全切除15例，单侧腺叶切除6例，3例同期行中央区淋巴结清扫术。6例患者因术前有气道狭窄在手术同期行气管切开术。结果22例患者术后病理证实为PTL。实验室检查均有甲状腺球蛋白抗体和／或微粒体抗体升高。病理类型为弥漫性大B细胞淋巴瘤（DLBCL型）和黏膜相关淋巴组织淋巴瘤（MALT型）。术后化疗效果良好。最长随访时间61个月。结论 PTL诊断较难，术后病理检查是明确诊断的有效方法。对于迅速增大并伴有压迫症状及抗体增高的甲状腺肿物术前应考虑PTL的可能性，并予以积极处理。甲状腺抗体检查在协助诊断上有一定意义。联合放化疗是临床上治疗的主要方法。两种病理类型淋巴瘤的患者在预后上未见明显差异。

Primary thyroid lymphoma:a clinical analysis of 22 cases

Objective To investigate clinical manifestations,diagnosis,treatment and prognosis ofprimary thyroid lymphoma（PTL）.Methods The clinical data of 22 PTL cases admitted to our hospitalfrom 2009 to 2012 were reviewed retrospectively.All patients received surgical treatment,including 8 caseswith limited lesion confined to the gland and 14 cases with extra gland invasions.There were 1 case of totalthyroidectomy,15 cases of bilateral subtotal thyroidectomy and 6 cases of unilateral gland lobectomy.At thesame time,three patients received central lymph node dissection and six patients received tracheotomy forpreoperative airway stenosis.Results Postoperative pathology confirmed the diagnosis of PTL in all cases.Laboratory tests showed elevation of thyroglobulin antibodies and（or）microsomal antibodies in all cases.Pathological types included diffuse large B cell lymphoma（DLBCL）and mucosal associated lymphoid tis sue（MALT）lymphoma.Patients showed good prognosis after postoperative chemotherapy.The longest fol low up time was 61 monthsConclusion Diagnosing of PTL is difficult and postoperative pathologic exami nation is an effective diagnostic method.If a patient presented as a rapidly growing thyroid nodule associat ed with oppression symptoms and increasing antibody level,surgeons should consider the possibility of PTLpreoperatively and deal with it actively.Thyroid antibody levels have significance in assisting diagnosis.Combined chemoradiotherapy is the main method for PTL.There is no significant difference in prognosisbetween patients with the two pathological types of PTL.