Clinical Presentation and Diagnostic Challenges of Thyroid Lymphoma: A Cohort Study
Clinical Presentation and Diagnostic Challenges of Thyroid Lymphoma: A Cohort Study
复制标题
DOI：
10.1089/thy.2016.0095
复制
发表时间：
2016-08-01
期刊：
影响因子：
6.6
通讯作者：
Stan, Marius
中科院分区：
文献类型：
--
作者：
Sharma, Anu;Jasim, Sina;Stan, Marius
背景：甲状腺淋巴瘤是一种相对罕见的疾病，经常造成诊断的挑战。如果获得的活检材料不足以进行免疫组织化学分析，则达到最终诊断可能会延迟。本研究的目的是评估甲状腺淋巴瘤的临床、生化和放射学特征。方法：对2000年至2014年期间所有马约诊所评估的甲状腺淋巴瘤组织活检阳性患者进行回顾性分析。结果：75例受试者经活检证实为甲状腺淋巴瘤，62.7%为原发性甲状腺淋巴瘤。诊断时的中位年龄为67岁（范围20-90岁）。男性占50.7%，54.7%有桥本氏甲状腺炎病史。临床表现为颈部肿块（88%）、吞咽困难（45.3%）和声音嘶哑（37.3%）。典型的超声表现为实性、低回声肿块，血管丰富，边缘特征多变。70.7%的病例细针穿刺（FNA）活检结果异常，42%的病例显示为特定的淋巴瘤亚型。53.3%的诊断是通过穿刺活检，21.3%是通过甲状腺切除术（部分或全部），12%是通过切口活检，12%是通过淋巴结活检。与细针穿刺活检相比，穿刺活检的敏感性更高（93%比71%，p = 0.006）。影像学上，这通常表现为一个大的，单侧的，以甲状腺为中心的肿块，超声显示为低回声，并扩展到邻近的软组织。粗针穿刺活检应该是第一个诊断测试，以加快达到最终诊断，并减少额外的测试和干预患者的负担。
Background: Thyroid lymphoma is a relatively rare disease often posing a diagnostic challenge. Reaching the final diagnosis can be delayed if insufficient biopsy material is obtained for immunohistochemistry analysis. The aim of this study was to evaluate the clinical, biochemical, and radiological features of thyroid lymphoma.Methods: A retrospective analysis was conducted of all Mayo Clinic patients evaluated between 2000 and 2014 who had a tissue biopsy positive for thyroid lymphoma.Results: Seventy-five subjects had biopsy-proven thyroid lymphoma, and 62.7% were primary thyroid lymphomas. The median age at diagnosis was 67 years (range 20-90 years). A total of 50.7% were male, and 54.7% had a history of Hashimoto's thyroiditis. Presenting symptoms included neck mass (88%), dysphagia (45.3%), and hoarseness (37.3%). The typical ultrasound appearance consisted of a solid, hypoechoic mass with increased vascularity and variable edge characteristics. Fine-needle aspiration (FNA) biopsies were abnormal in 70.7% of cases, and 42% indicated a specific lymphoma subtype. The diagnosis was confirmed in 53.3% by core biopsy, in 21.3% by thyroidectomy (partial or total), in 12% through incisional biopsy, and in 12% by lymph node biopsy. Core biopsy had a higher sensitivity compared with FNA (93% vs. 71%, p = 0.006).Conclusion: A rapidly enlarging neck mass in the setting of Hashimoto's thyroiditis should raise suspicion for thyroid lymphoma. Radiologically, this usually presents as a large, unilateral, thyroid-centered mass, hypoechoic by ultrasound, and expanding into adjacent soft tissues. Core-needle biopsy should be the first diagnostic test to expedite reaching the final diagnosis and decrease patient burden of additional tests and interventions.