桥本甲状腺炎合并甲状腺原发性非霍奇金淋巴瘤14例临床病理观察

发布时间：2018-08-05 10:23

【摘要】：目的探讨桥本甲状腺炎(Hashimoto’s thyroiditis,HT)合并甲状腺原发性非霍奇金淋巴瘤(primary thyroid noHodgkin’s lymphoma,PTNHL)的临床病理学特征。方法回顾性分析14例HT合并PTNHL患者的临床资料、病理学及免疫表型,并复习相关文献。结果 14例HT合并PTNHL患者中女性11例,男性3例,年龄36~77岁,中位年龄61岁。患者均有颈部肿块病史,肿块近期迅速增大,B超示甲状腺低回声团块或混合性团块。术后病理检查示14例患者均在HT基础上合并了PTNHL,5例为弥漫大B细胞淋巴瘤(diffuse large B-cell lympgoma,DLBCL);5例为黏膜相关淋巴组织结外边缘区(mucosa-associated lymphoid tissue,MALT)淋巴瘤;1例为MALT淋巴瘤合并DLBCL;1例为滤泡性淋巴瘤;1例为MALT淋巴瘤伴浆细胞分化;1例为外周小T细胞淋巴瘤;免疫表型:14例CD45均阳性,CKpan、TG、EMA残留甲状腺滤泡上皮阳性,13例CD20弥漫阳性,1例CD3弥漫阳性。结论 HT合并PTNHL临床罕见,好发于中老年女性,临床表现缺乏特异性,易误诊、漏诊,确诊依赖术后病理组织学检查及免疫表型。
[Abstract]:Objective to investigate the clinicopathological features of Hashimoto's thyroid thyroiditis (HT) combined with primary thyroid non-Hodgkin 's lymphoma (primary thyroid noHodgkin's lymphoma PTNHL). Methods the clinical data, pathology and immunophenotype of 14 patients with HT complicated with PTNHL were analyzed retrospectively. Results among 14 patients with HT and PTNHL, 11 were female, 3 were male, the age was 36 ~ 77 years old, the median age was 61 years old. All patients had a history of cervical mass, and the mass was rapidly enlarged recently. B-ultrasound showed hypoechoic mass or mixed mass of thyroid gland. Pathological examination showed that all the 14 cases were complicated with diffuse large B-cell lymphoma (diffuse large B-cell lymphogoma) (5 cases) on the basis of HT. (1 case was MALT lymphoma with DLBCL). 5 cases were mucosa-associated lymphoid tissue extranodal region (mucosa-associated lymphoid tissue marginal area). 1 case was MALT lymphoma with DLBCLL. One case of alveolar lymphoma was MALT lymphoma with plasmacyte differentiation and 1 case was peripheral small T-cell lymphoma. The immunophenotype of 14 cases of CD45 were all positive. 13 cases of thyroid follicular epithelium were positive with CD20 diffuse positive and 1 case with CD3 diffusely positive. Conclusion HT combined with PTNHL is rare in clinic and prone to occur in middle-aged and elderly women. The clinical manifestations are lack of specificity, misdiagnosis is easy, missed diagnosis, the diagnosis depends on postoperative histopathological examination and immunophenotype.
【作者单位】：南京医科大学附属常州市第二人民医院病理科;
【分类号】：R581.4;R736.1

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