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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: There was a rapid history of neck mass enlargement in all patients. Titers of thyroid peroxidase (TPOAb) and / or thyroglobulin antibody (TGAb) were significantly increased in 16 patients. Preoperative CT scan mass density is lower than normal glands and adjacent muscles, enhanced enhancement was not obvious. The group of radical resection in 17 cases, palliative resection in 6 cases. Eighteen patients underwent CHOP or COP adjuvant chemotherapy and 5 received radiotherapy. Clinical stage: IE in 5 cases, IIE in 17 cases, IIIES in 1 case. Pathological types: diffuse large B cell lymphoma (DLBCL) in 14 cases, mucosa associated lymphoid tissue lymphoma (MALT) in 9 cases. Follow-up to January 2012, 17 patients survived (<1 to> 5 years). CONCLUSIONS: The rapid enlargement of cervical masses on the basis of Hashimoto’s thyroiditis, combined with the characteristic CT findings, can help support the preoperative diagnosis of PTML. PTML treatment should be combined surgery and radiotherapy and chemotherapy combined treatment.