Clinical、Ultrasonic And Pathological Features Of Thyroid Lymphoma In Comparison With Anaplastic Thyroid Carcinoma

Objective:To explore the differences between thyroid lymphoma and anaplastic thyroid carcinoma in clinical,ultrasound and pathology,so as to improve the recognition and diagnostic accuracy of ultrasound physicians.Methods:A total of 41 patients with thyroid lymphoma confirmed by surgical pathology from January 2008 to August 2017 were selected.In addition,16 patients with anaplastic thyroid carcinoma confirmed by surgical pathology were selected.The clinical,ultrasonic and pathological findings of the two groups were analyzed retrospectively.Results:1 Clinical manifestationsThyroid lymphoma and anaplastic thyroid carcinoma are often shown as neck masses.The typical clinical manifestation is rapid enlargement of neck mass in the short term,with varying degrees of dyspnea,dysphagia or hoarseness.Comparison of two groups of clinical manifestations : the incidence of hoarseness(4.9% vs 31.3%,P=0.015)in the patients with thyroid lymphoma were lower than those in the anaplastic thyroid carcinoma group,and the difference between the two groups was statistically significant.There was no statistically significant difference between the two groups in terms of age,gender,rapid enlargement of neck mass,dyspnea anddysphagia in the two groups(P > 0.05).2 Sonographic findings41 cases of thyroid lymphoma: a total of 47 lesions,The maximum diameter of the lesions was 1.6 ~ 11.7 cm,the average(4.4±1.9)cm,showed focal or diffuse lesions.The lesions showed unclear boundary(87.2%,41/47),irregular margin(89.4%,42/47),marked hypoechogenicity(61.7%,29/47),strip like or grid like hyperechogenicity(74.5%,35/47),enhancement of posterior echo(89.4%,42/47),hypervascular(72.3%,34/47).Cervical lymph node enlargement(51.2%,21/41).16 cases of anaplastic thyroid carcinoma: a total of 21 lesions,The maximum diameter of the lesions was 2.7 ~ 6.6 cm,the average(5.1±1.6)cm.The lesions showed unclear boundary(100%,21/21),irregular margin(100%,21/21),marked hypoechogenicity(81.0%,17/21),calcification(57.1%,12/21),including the microcalcification and macrocalcification coexist(23.8%,5/21)and macrocalcification(33.3 %,7/21),cystic change(33.3%,7/21),hypervascular(71.4%,15/21).Cervical lymph node enlargement(62.5%,10/16).Comparison of two groups of Sonographic findings: Compared with the anaplastic thyroid carcinoma group,marked hypoechogenicity(61.7% vs 19%,P=0.001),strip like or grid like hyperechogenicity(74.5% vs 0%,P < 0.001)and enhancement of posterior echo(89.4% vs 0%,P < 0.001)were more common;calcification(0% vs 57.1%,P <0.001)and cystic change(0% vs 33.3%,P < 0.001)were less in thyroid lymphoma group,and the deference were statistically significant.There was no statistically significant difference between the two groups in the size of the lesion,boundary,margin,vascular and cervical lymph node enlargement(P > 0.05).3 Pathological manifestationsComparison of two groups of pathological features: the lesions were all infiltrative growth.It has the following differences:(1)thyroid lymphoma is monoclonal proliferation,and the size and shape of tumor cells are more consistent;anaplastic thyroid carcinoma has obvious structure and cell atypia,and the size of cancer cells are heterogeneous.(2)Thyroid lymphoma is usually associated with hashimoto thyroiditisand interstitial fibrosis.(3)anaplastic thyroid carcinoma can have different degrees of tumor necrosis.Conclusion:The clinical manifestations of TL and ATC were similar.The pathological features were significantly different.Sonographic features such as marked hypoechogenicity,strip like or grid like hyperechogenicity,enhancement of posterior echo,lack of calcification and cystic change to differentiate TL and ATC has important value.