| Objective:To evaluate the clinical characteristics,pathological subtype,diagnosis and treatment outcomes of primary thyroid lymphoma(PTL).Methods:We present 21 patients with PTL treated from September 2009 to June 2017 in the Second Affiliated Hospital of Dalian Medical University.The relationship between the biochemical index,pathological type,treatment and prognosis was analyzed.Results:Among the 21 patients,4 patients were males and 17 patients were females.The median age was 66 years.All patients showed a rapidly growing thyroid mass,and 12 patients with significant compressive symptoms.Among them,hoarseness in 6 cases,dyspnea in 8 cases,dysphagia in 9 cases.15 patients(71.4%)had a history of Hashimoto's thyroiditis.LDH increased in 17 cases(76.5%).?-2 microglobulin increased in 11 cases(52.4%).Thyroid peroxidase antibody increased in 11 cases(52.4%).Thyroglobulin antibody increased in 11 cases(52.4%).ECOG score 0-1 points in 16 cases(76.2%),ECOG score>2 points in 5 cases(23.8%).3 cases(14.3%)of B lymphoma symptoms.10 patients were confirmed by core needle biopsy and 11 patients were confirmed by postoperative pathology.14 patients(66.7%)had diffuse large B-cell lymphoma(DLBCL),4 patients(19.0%)had mucosa-associated lymphoma tissue(MALT),and 3 patients(14.3%)had follicular lymphoma(FL).Ultrasound revealed diffuse type in 11 cases(52.4%),mixed type in 4 cases(19.0%)and nodular type in 6 cases(28.6%).There were 12 patients(57.1%)with stage I E and 9 patients(42.9%)with stage ?E.Treatment modalities varied.Surgery alone in 3 cases(14.3%),chemotherapy(CT)alone in 5 cases(23.8%),radiotherapy(RT)alone in 2 cases(9.5%),surgery + CT in 6 cases(28.6%),surgery + CT+ RT in 2 cases(9.5%),CT+ RT in 3 cases(14.3%).The follow-up time ranged from 2-93 months,the median time was 24 months.As of the end of follow-up,18 patients survived and 3 patients died.Single factor analysis showed that tumor size(P=0.003),Ann Arbor staging(P=0.037)and ECOG score(P=0.006),"Double hit"(P= 0.006)were associated with prognosis.Age,sex,Hashimoto's thyroiditis,B symptoms,LDH,?-2 microglobulin,pathological type,and germinal or non-germinal center were not related to the prognosis.Conclusion:1.PTL commonly presents as an rapidly growing mass in the thyroid gland with obvious oppressive symptoms,such as hoarseness,dyspnea,dysphagia,etc.2.Hashimoto's thyroiditis is a high risk factor for developing PTL.PTL can be combined with hypothyroidism or subclinical hypothyroidism.LDH,?-2 microglobulin were always increased.3.Ultrasonography is a common method for preoperative diagnosis of PTL,which can be divided into nodular,diffuse,mixed type.4.Core needle biopsy can improve diagnostic accuracy.Surgical intervention can be considered if pathological biopsy is not clear.5.Single factor analysis showed that tumor size,Ann Arbor staging,ECOG score and "Double hit" were associated with prognosis.Age,sex,Hashimoto's thyroiditis,B symptoms,LDH,?-2 microglobulin,pathological type,and germinal or non-germinal center were not related to the prognosis.6.Treatment for PTL depends on histologic subtype and clinical stage:patients with indolent disease or with stage IE can be treated with surgery alone,radiotherapy,or a combination of the two;for patients with disseminated,aggressive disease commonly treated with a combination of radiotherapy and chemotherapy. |
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