| Objective: To improve the understanding of PTL,reduce the missed diagnosis rate and misdiagnosis rate,and improve the clinical therapeutic effect and prognosis by retrospective analysis of the clinical symptoms,auxiliary examination,pathological types,and treatment options of patients with primary thyroid lymphoma(PTL)and literature review.Methods: The clinical data of PTL for the First Affiliated Hospital of Guangxi Medical University from January 2009 to December 2019 were collected,and the clinical manifestations,imaging,pathological features,treatment and prognosis were retrospectively analyzed,and the relevant literature was reviewed.Result: There were 9 cases of thyroid lymphoma,4 males and 5 females,with a male to female ratio of 0.8:1.PTL accounted for 0.032% of hospitalized thyroid diseases and 0.44% of lymphomas in our hospital during the same period.PTL predisposed to middle-aged and elderly women,and the median incidence of PTL in our hospital was 60.0(21-78)years.The disease course was < 2 months,2-5months and > 5 months in 5 cases,2 cases and 2 cases,accounting for 55.6%(5/9),22.2%(2/9)and 22.2%(2/9),respectively.Hashimoto’s thyroiditis was suggested in 4 cases,accounting for 44.4%(4/9).9 cases of PTL had a history of neck mass,of which 7 cases had no special discomfort,accounting for 77.8%(7/9),1 case had swelling pain in the neck mass,accounting for 11.1%(1/9),and 1 case had dyspnea,hoarseness and dysphagia,accounting for 11.1%(1/9).There were 3cases and 6 cases of thyroid enlargement of II ° and III °,accounting for 33.3%(3/9)and 66.7%(6/9),respectively.There were 3 cases,2 cases and 4 cases with hard texture,tough texture and moderate texture of thyroid gland,accounting for33.3%(3/9),22.2%(2/9)and 44.4%(4/9),respectively.One of patients had palpable cervical lymphadenopathy,accounting for 11.1%(1/9).Thyroid fine needle aspiration cytology(FNAC)was performed in 3 cases,and malignancy was suspected in the diagnosis,but the diagnosis was not confirmed.Diagnosis of9 cases was confirmed by surgery.There were 6 cases of diffuse large B-cell lymphoma(DLBCL),accounting for 66.7%(6/9),of which 1 case showed DLBCL with mucosa-associated tissue lymphoma(MALT)to DLBCL conversion.One patient had MALT lymphoma,accounting for 11.1%(1/9),and one patient,accounting for 11.1%(1/9),had B-cell lymphoma,which was characterized by diffuse large B-cell lymphoma and Burkitt’s disease.Follicular lymphoma(FL)occurred in 1 case,accounting for 11.1%(1/9).There were 2 cases of hypothyroidism,accounting for 22.2%(2/9),2 cases of subclinical hypothyroidism,accounting for 22.2%(2/9),and 1 case of hyperthyroidism,accounting for 11.1%(1/9).Anti-thyroglobulin antibody,anti-thyroid microsomal antibody and thyroid-stimulating hormone receptor antibody were examined in 4cases,and 50%(2/4)were positive.Ultrasonography was performed in 7 cases,and the lesions showed nodular,diffuse,and mixed types in 2,3,and 2 cases,accounting for 28.6%(2/7),42.9%(3/7),and 28.6%(2/7),respectively.Malignant tumors were suspected in 2 cases for ultrasonography,with an accuracy of 28.6%.Thyroid CT was performed in 7 cases,including 3 cases of CT,4 cases of CT +enhanced CT,which 2 cases was of solitary nodular type,3 cases of multiple nodular type and 2 cases of diffuse type,accounting for 28.6%(2/7),42.9%(3/7)and 28.6%(2/7),respectively.CT diagnosis suggested malignant tumor in 5 cases,with an accuracy of 71.4%(5/7).The tumor diameter size was < 4 cm,4 – 6 cm,and > 6 cm in 1,7,and 1 case,accounting for 11.1%(1/9),77.8%(7/9),and 11.1%(1/9),respectively.The lesions were located in the left lobe of thyroid gland in 3cases,left lobe + right lobe in 4 cases,left lobe + angina in 1 case,and right lobe in 1 case,accounting for 33.3%(3/9),44.4%(4/9),11.1%(1/9),and 11.1%(1/9),respectively.According to Ann Arbor criteria,there were 2 cases of stage IE and7 cases of stage IIE,accounting for 22.2%(2/9)and 77.8%(7/9),respectively,and 1 case of B symptoms,accounting for 11.1%(1/9)of the total cases.For treatment,there were 2 cases of total thyroidectomy + chemotherapy,1 case of total thyroidectomy + chemotherapy + radiotherapy,2 cases of modified radical thyroidectomy + total thyroidectomy + chemotherapy,2 cases of total thyroidectomy + chemotherapy,1 case of total thyroidectomy + chemotherapy +radiotherapy,and 1 case of total thyroidectomy + unilateral subtotal thyroidectomy.For overall survival(OS),2 cases were > 18 months,1 case > 42 months,and 1 case > 60 months.Two patients died,one of whom had an OS of 5months,one of whom had 36 months.Three cases were lost to follow-up.Conclusions: 1.PTL accounted for 0.032% of hospitalized thyroid diseases in our hospital during the same period,and 0.44% of lymphoma in the same period.It often Occurs in middle-aged and elderly women.When there is a rapid increase in neck mass in the short term,with symptoms such as dyspnea,dysphagia,fever,night sweats,and weight loss,PTL should be suspected;2.FNAC can be used as the preferred technique for the pathological evaluation of thyroid lesions,but there is a risk of false negative.when combined with immunohistochemistry,flow cytometry and other new techniques,it can improve the accuracy;3.For the diagnosis of more difficult pathological types or suspected mixed pathological subtypes,surgical biopsy is still the key;4.The common pathological types of PTL are DLBCL and MALT,which the former is aggressive and the prognosis is poor,while the latter is indolent lymphoma and the prognosis is better;5.The treatment of PTL is based on the pathological type and stage.For IE MALT lymphoma,radiotherapy alone or surgery can be used,while aggressive,nonlocalized PTL lymphoma can be treated with chemoradiotherapy;6.Surgery is mainly used to confirm the diagnosis and relieve compression symptoms,which does not improve the prognosis of PTL and blindly operate. |
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