Malignant lymphoma of the thyroid gland - A clinicopathologic study of 108 cases
Malignant lymphoma of the thyroid gland - A clinicopathologic study of 108 cases
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DOI：
10.1097/00000478-200005000-00001
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发表时间：
2000-05-01
影响因子：
5.6
通讯作者：
Abbondanzo, SL
中科院分区：
文献类型：
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作者：
Derringer, GA;Thompson, LDR;Abbondanzo, SL
我们报告了108例原发性甲状腺淋巴瘤（PTL）的回顾性临床病理研究，采用真实的和WHO分类方案进行分类。患者包括79名女性和29名男性，平均年龄为64.3岁。所有患者均表现为甲状腺肿块。PTL分为粘膜相关淋巴组织（MALT）或MZBL边缘区B细胞淋巴瘤（n = 30）、弥漫性大B细胞淋巴瘤（DLBCL）伴MZBL（n = 36）、DLBCL不伴MZBL（n = 41）和滤泡中心淋巴瘤（FCL; n = 1）。排除FCL，MALT型淋巴瘤的特点，确定在所有组中，尽管在23%的情况下，滤泡结构。淋巴细胞性甲状腺炎（LT）被确定在94%。91%的患者表现为IE或IIE期疾病，而69%的患者有甲状腺周围软组织浸润。所有患者均接受手术切除，然后进行辅助治疗（76%）：化疗（15%），放疗（19%）或放疗和化疗联合治疗（42%）。末次随访时疾病特异性生存率为82%（平均82.8个月），5年时为79%。统计学上，大于IE的分期、DLBCL的存在、快速临床生长、大量凋亡、血管浸润的存在、高有丝分裂率和甲状腺周围软组织浸润与疾病死亡显著相关。无MZBL或IE期疾病患者死于疾病。总之，PTL通常发生在中年至老年人的甲状腺肿块，女性好发。尽管它们的组织学异质性和其他淋巴瘤亚型的频繁模拟，但几乎所有的PTL都是在LT背景下产生的MALT型淋巴瘤，混合DLBCL和MZBL是常见的。总的来说，PTLs在适当的治疗下具有良好的结局，但预后取决于临床分期和组织学。MZBL和IE期肿瘤预后良好。而具有大细胞成分或DLBCL或大于IE期的肿瘤具有最大的不良结果的可能性。
We report a retrospective clinicopathologic study of 108 primary thyroid gland lymphomas (PTLs), classified using the REAL and proposed WHO classification schemes. The patients included 79 women and 29 men, with an average age of 64.3 years. All patients presented with a thyroid mass. The PTLs were classified as marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) or MZBL (n = 30), diffuse large B-cell lymphoma (DLBCL) with MZBL (n = 36), DLBCL without MZBL (n = 41), and follicle center lymphoma (FCL; n = 1). Excluding the FCL, features of lymphomas of MALT-type were identified in all groups, despite a follicular architecture in 23% of cases. Lymphocytic thyroiditis (LT) was identified in 94%. Ninety-one percent of patients presented with stage IE or IIE disease, whereas 69% had perithyroidal soft tissue infiltration. All patients were treated with surgical excision followed by adjuvant therapy (76%): chemotherapy (15%), radiation (19%), or a combination of radiation and chemotherapy (42%). Disease-specific survival was 82% at last follow up (mean, 82.8 mos) and 79% at 5 years. Statistically, stages seater than IE, presence of DLBCL, rapid clinical growth, abundant apoptosis, presence of vascular invasion, high mitotic rate, and infiltration of the perithyroidal soft tissue were significantly associated with death with disease. No patients with MZBL or stage IE disease died with disease. In summary, PTLs typically occur in middle- to older-aged individuals as a thyroid mass, with a predilection for females. Despite their histologic heterogeneity and frequent simulation of other lymphoma subtypes, virtually all PTLs are lymphomas of MALT-type arising in the setting of LT, Mixed DLBCL and MZBL are common. Overall, PTLs have a favorable outcome with appropriate therapy, but prognosis depends on both clinical stage and histology. MZBL and stage IE tumors have an excellent prognosis. whereas tumors with a large cell component or DLBCL or stage greater than IE have the greatest potential for a poor outcome.