| Objective: To investigate the clinical,biochemical,imaging,pathological features,and diagnosis and treatment of primary thyroid lymphoma cases,in order to improve clinicians' understanding of the disease,more accurately diagnose thyroid lymphoma,and avoid misdiagnosis and mistreatment.Methods:(1)The clinical data of 11 cases of primary thyroid lymphoma treated in our hospital were retrospectively analyzed.(2)The relevant literatures were reviewed,and the cases were analyzed in accordance with the recent research status at home and abroad.Results: There were 11 patients with PTL in this study,2 males and 9females.The median age was 56 years.They all had a history of progressive enlargement of the anterior cervical mass,6 cases of dyspnea,1 case of hoarseness,3 cases of type B symptoms,2 of which had normal thyroid function and 2 cases of elevated thyroid stimulating hormone(TSH).In 9 cases with Hashimoto's thyroiditis,?-2 microglobulin(?-2MG)increased in 7 cases,and lactate dehydrogenase(LDH)increased in 2 cases.Ultrasound prompt: 9cases(9/11)of nodular type,1 case of diffuse type and mixed type.In all patients with PTL,compared with residual thyroid tissue,the color Doppler imaging of tumor showed significantly lower echo and enhanced echo behind tumor.(11/11),no calcification(micro-calcification and large-calcification)formation was observed(0/11),the majority were rich in blood supply(9/11),5cases of lymph node metastasis were confirmed by ultrasound.Six patients in this group underwent preoperative puncture,3 were diagnosed as NHL with thick needle aspiration,3 with fine needle aspiration were uncharacterized,and5 were directly operated on.All 11 patients with thyroid lymphoma had CD20+,and T cell markers CD3 and CD5(-),EB virus-associated lymphoma patients EBER +,and thyroid follicular epithelial-derived tumor cell markers CKpan,thyroglobulin,and TTF-1(-),However,the remaining follicular epithelium and medullary thyroid cancer marker calcitonin(-)were shown.The Ki-67 positive index of 11 cases of thyroid lymphoma was 30% to 90%.There were 1 case in stage I,4 cases in stage II,1 case in stage III,2 cases in stage IV,and the remaining 2 patients had completed incomplete examination and completed staging.Ten patients received adjuvant chemotherapy and applied CHOP regimen,R-CHO regimen,or CHOP-E for 1-9 cycles,all of which achieved complete remission,and 1 case was simply operated.The follow-up time ranged from 8 to 50 months.Seven patients survived and four died.Conclusions: In elderly patients with enlarged neck masses in the short term under the background of Hashimoto's thyroiditis,clinicians should be highly alert to the possibility of PTL and further refer to suspicious ultrasound manifestations: markedly low echo,enhanced rear echo,rich blood flow without calcification,and necrosis.Increased serum LDH and ?2-MG levels are important for diagnosis and prognostic evaluation.CNB should be used as the first diagnostic measure to minimize unnecessary surgery,avoid misdiagnosis,and intervene earlier.If the initial FNA is not diagnosed or the subtype is determined,CNB should be performed as soon as possible.PTL is highly invasive,and the prognosis of patients is related to the type of histopathology,clinical stage,and age. |
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