原发性甲状腺恶性淋巴瘤的诊断与治疗:附23例报告  

Diagnosis and management of primary thyroid lymphoma: a report of 23 cases

作　　者：张平[1] 王志宏[1] 贺亮[1] 董文武[1] 张浩[1] 

机构地区：[1]中国医科大学附属第一医院普通外科,辽宁沈阳110001

出　　处：《中国普通外科杂志》2012年第11期1369-1372,共4页China Journal of General Surgery

基　　金：辽宁省"百千万人才工程"资助项目(2010921070);辽宁省教育厅创新团队资助项目(LT2010102)

摘　　要：目的:探讨原发性甲状腺恶性淋巴瘤(PTML)的诊断与治疗。方法:回顾性分析2000年1月—2011年12月收治的23例PTML患者的临床资料。结果:患者均存在颈部肿物快速增大病史。16例患者甲状腺过氧化物酶抗体(TPOAb)和/或甲状腺球蛋白抗体(TGAb)滴度明显升高。术前CT平扫肿物密度低于正常腺体及邻近肌肉,增强后强化不明显。全组行根治性切除术17例,姑息切除术6例。术后18例接受CHOP或COP辅助化疗,5例接受放疗。临床分期:IE期5例,IIE期17例,IIIES期1例。病理类型:弥漫性大B细胞淋巴瘤(DLBCL)14例,黏膜相关淋巴样组织淋巴瘤(MALT)9例。随访至2012年1月,17例存活(<1～>5年)。结论:在桥本氏甲状腺炎的基础上出现快速增大的颈部肿物,结合特征性CT表现有助于支持PTML的术前诊断。PTML的治疗应采取手术结合术后放、化疗的综合治疗方案。Objective： To investigate the diagnosis and treatment of primary thyroid malignant lymphoma （PTML）. Methods： The clinical data of 23 patients with PTML admitted from January 2000 to December 2011 were retrospectively analyzed. Results： All patients had a history of a rapidly growing thyroid mass. Sixteen PTML cases had markedly high titers of anti-thyroid peroxidase antibody （TPOAb） and/or increased antithyroglobulin antibody （TGAb）. Preoperative CT scan revealed that the mass was of lower density than the normal glandular and adjacent muscular tissues, and showed no evident enhancement on the contrast-enhanced scan. Of the entire group, 17 cases underwent radical resection and 6 cases had palliative operation. Eighteen patients received adjuvantchemotherapy （CHOP or COP regimen） and 5 patients underwent radiotherapy. The clinical stages were stage IE in 5 cases, IIE in 17 cases and IIIES in one case, respectively. Fourteen cases were diffuse large B cell lymphoma （DLBCL） and 9 cases were mucosa-associated lymphoid tissue （MALT） lymphoma with regardto the pathological classification. During the follow-up up to January 2012, 17 patients survived for periods from less than one year to more than 5 years. Conclusion： The rapidly enlarging thyroid mass in a background of Hashimoto＇s thyroiditis combined with the characteristic CT findings may tend to support the preoperative diagnosis of PTML. Surgical resection and postoperative radiotherapy or chemotherapy are the treatment modalities for this condition.

关 键 词：甲状腺肿瘤 外科学 淋巴瘤 诊断 鉴别 综合疗法 

分 类 号：R736.1[医药卫生—肿瘤]