25例原发性甲状腺淋巴瘤临床病理特点  

Clinicopathological features of 25 cases of primary thyroid lymphoma

作　　者：李国莉 杨道华[1] 臧丽娟[1] 童茵[3] 林军[1] LI Guoli;YANG Daohua;ZANG Lijuan;TONG Yin;LIN Jun(Department of Pathology,Shanghai General Hospital,Shanghai 200080;Department of Pathology,Maternal and Child-Care Hospital of Zunyi,Zunyi Guizhou 563000;Department of Hematology,Shanghai General Hospital,Shanghai 200080,China)

机构地区：[1]上海市第一人民医院病理科,上海200080 [2]遵义市妇幼保健院病理科,贵州遵义563000 [3]上海市第一人民医院血液科,上海200080

出　　处：《临床与病理杂志》2021年第5期998-1005,共8页Journal of Clinical and Pathological Research

基　　金：国家自然科学基金(81670139)。

摘　　要：目的:探讨原发性甲状腺淋巴瘤(primary thyroid lymphoma,PTL)的临床病理特点、诊断与鉴别诊断。方法:回顾性分析2009年至2018年上海市第一人民医院收治的25例PTL的临床病理资料,通过光镜观察及免疫组织化学分析其病理学特征、免疫表型。结果:全部病例均经术后病理确诊,男性10例,女性15例,平均发病年龄56.3岁;19例(76.0%)伴有桥本甲状腺炎(Hashimoto’s thyroiditis,HT)病史;乙肝病毒感染阳性12例(66.7%);25例甲状腺淋巴瘤均为B细胞淋巴瘤,其中弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)15例,黏膜相关淋巴组织结外边缘区B细胞淋巴瘤(marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue,MALT)8例,MALT伴DLBCL和MZBL混合2例;PTL以甲状腺结构的破坏为基本形态特点,瘤细胞免疫组织化学表达CD20(cluster of differentiation 20)等B细胞标记。结论:PTL常见于合并HT的中老年女性,多为B细胞来源的非霍奇金淋巴瘤;诊断需与甲状腺炎症、甲状腺未分化癌及髓样癌等鉴别;各病理类型在形态学、生长方式以及预后上有一定差异,故诊断时应明确病理类型,以供临床随访、治疗。Objective:To investigate the clinicopathologic features,diagnosis and differential diagnosis of primary thyroid lymphoma(PTL).Methods:The clinicopathologic data of 25 cases of PTL collected in Shanghai General Hospital from 2009 to 2018 were analyzed retrospectively.Microscopic examination and immunohistochemistry were performed for studying its pathologic characteristics and immunophenotyping.Results:Totally 25 cases were diagnosed with PTL by pathologic examination after a surgical operation,including 10 males and 15 females whose average age was 56.3 years.A total of 19(76.0%)patients had a clinical history with Hashimoto’s thyroiditis(HT),and 12(66.7%)cases were positive for hepatitis B virus infection.Totally 25 cases were diagnosed with B cell lymphomas,including diffuse large B-cell lymphoma(DLBCL,15 cases),marginal zone B-cell lymphoma of mucosa-associated lymphoma tissue(MALT,8 cases),marginal zone B-cell lymphoma of MALT-type with large cell transformation(mixed DLBCL and MZBL,2 cases).Morphologic features of PTL characterised the destruction of thyroid structure.Tumor cells immunohistochemically express cluster of differentiation 20(CD20)which was a marker of B cell lymphoma.Conclusion:PTL mostly affects middle aged and old female with HT,and its main histologic type is non-Hodgkin B cell lymphoma.PTL should be differentiated from thyroiditis,thyroid undifferentiated carcinoma and medullary carcinoma etc.Different vary greatly in pathologic features,growth pattern and prognosis,so the determination of pathological types of the tumor at diagnosis is critical for clinic follow-up and treatment.

关 键 词：甲状腺淋巴瘤 病理分型 预后 

分 类 号：R736.1[医药卫生—肿瘤]