Surgical treatment of primitive thyroid lymphoma
Surgical treatment of primitive thyroid lymphoma
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DOI：
10.1177/030089160909500613
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发表时间：
2009-11-01
期刊：
影响因子：
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通讯作者：
Puma, Francesco
中科院分区：
文献类型：
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作者：
Avenia, Nicola;Ragusa, Mark;Puma, Francesco
目标和背景。原始甲状腺淋巴瘤虽然罕见，但越来越常见。其发病率正在增加，从六十年代的0.5%增加到今天占所有甲状腺肿瘤的1-5%。这种肿瘤的诊断并不总是简单的。事实上，它往往是一个明显的良性疾病切除腺体的病理结果。手术解剖可能比标准的甲状腺切除术更复杂，因为腺体囊和周围结构之间可能存在紧密的粘连。在包膜浸润的情况下，术后外部局部放疗是指征。我们进行了一项回顾性观察分析，以确定与术前诊断准确的患者相比，因其他病理原因行甲状腺全切除术的偶发性甲状腺淋巴瘤患者是否有严重的手术并发症和更差的预后结果。回顾性分析了6例甲状腺淋巴瘤，其中弥漫性大B细胞淋巴瘤4例，MALT淋巴瘤2例。其中，2例在术前通过细针抽吸活检正确识别，4例在组织学上意外发现：3例因桥本甲状腺炎患者的巨大甲状腺功能减退性甲状腺肿而进行甲状腺全切除术，1例因桥本甲状腺炎患者的未分化癌而进行甲状腺全切除术。结论。根据我们的经验，正确的术前诊断是非常困难的（33%）。在接受细针穿刺的患者中，66%的病例得到了正确的诊断。所有接受甲状腺全切除术的IE期淋巴瘤患者的手术并发症和预后相当。
Aims and background. Primitive thyroid lymphoma, although rare, is becoming more frequent. Its incidence is increasing, from 0.5% in the sixties to 1-5% of all thyroid neoplasms today. The diagnosis of such neoplasms is not always straightforward. In fact, it is often the result of pathologic findings on a gland resected for an apparently benign disease. Surgical dissection may prove more complicated than in standard cases of thyroidectomy for the possible tight adhesions existing between the gland's capsule and the surrounding structures. In cases of capsular infiltration, postoperative external local radiotherapy is indicated.Methods. A retrospective observational analysis was performed to establish whether patients with incidental thyroid lymphomas who underwent total thyroidectomy for another pathology had major surgical complications and worse prognostic results than patients with an accurate preoperative diagnosis.Results. Six cases of thyroid lymphoma were retrospectively reviewed: 4 diffuse large B-cell lymphomas and 2 MALT lymphomas. Of these, 2 were correctly preoperatively identified by fine-needle aspiration biopsy and 4 were an unexpected finding at histology: 3 cases of total thyroidectomy carried out for huge hypothyroid goiter in patients affected by Hashimoto's thyroiditis and in 1 case of total thyroidectomy carried out for anaplastic carcinoma in a patient affected by Hashimoto's thyroiditis.Conclusions. In our experience, a correct preoperative diagnosis was extremely difficult (33%). In patients who underwent fine-needle aspiration, a correct diagnosis was made in 66% of cases. All patients with stage IE lymphoma who underwent total thyroidectomy had equivalent surgical complications and prognosis.