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摘要:
目的 探讨原发性甲状腺淋巴瘤(primary thyroid lymphoma, PTL)的超声特征及超声引导甲状腺活检的诊断价值。 方法 回顾性分析2003年至2013年北京协和医院22例经病理证实的PTL患者的临床资料(年龄32~81岁, 中位年龄61岁)、超声声像图表现及活检方式, 将PTL超声表现分为3型, 即弥漫型、结节型和混合型。 结果 22例PTL患者的主要病理类型为黏膜相关淋巴组织B细胞淋巴瘤(45.5%, 10/22)和弥漫性大B细胞淋巴瘤(36.4%, 8/22)。16例PTL患者(72.7%)首发症状为颈部肿物近期明显增大。22例PTL患者中16例(72.7%)超声诊断为恶性或可疑恶性, 6例(27.3%)超声诊断为良性。10例行超声引导细针抽吸活检, 其中仅2例诊断可疑PTL; 9例行超声引导组织活检, 其中8例获得明确病理诊断。15例PTL患者接受外科手术活检, 获得病理诊断。PTL超声声像图特征分为弥漫型(45.5%, 10/22)、结节型(40.9%, 9/22)和混合型(13.6%, 3/22)。 结论 超声声像图特征有助于PTL诊断, 尤其是对有近期颈部肿物迅速增大病史的患者。超声引导组织活检安全、准确, 是诊断PTL的首选方法。 Abstract:Objective To explore the sonographic findings of primary thyroid lymphoma (PTL) and evaluate the role of ultrasound-guided core-needle biopsy in diagnosing this disease. Methods The clinical data, sonographic, and biopsy modes of 22 patients (age range, 32-81 years; median, 61 years) with pathologically confirmed PTL were retrospectively analyzed. The sonographic findings of PTL were divided into three types:diffuse type, nodular type, and mixed type. Results The main pathologic types of PLT in these 22 patients included mucosa-associated lymphoid tissue lymphoma (n=10, 45.5%) and diffuse large B-cell lymphoma (n=8, 36.4%). In 16 patients (72.7%), the initial symptom was enlarged neck mass. Among the 22 patients with a diagnosis of PTL, 16 (72.7%) were sonographically diagnosed as malignancies or suspected malignancies and 6 (27.3%) as benign lesions. In 10 patients who had received ultrasound-guided fine-needle aspiration biopsy, only 2 were diagnosed as suspected malignancies. In 9 patients who had received ultrasound-guided core-needle biopsy, 8 (88.9%) achieved definitive pathological diagnoses. In 15 patients who had undergone surgical biopsy, pathological diagnoses were obtained in all of them. The distribution of the sonographic findings of PTL was asfollows:diffuse type, n=10 (45.5%); nodular type, n=9 (40.9%); and mixed types, n=3(13.6%). Conclusions Ultrasonography is helpful for PTL diagnosis, especially in patients with rapid thyroid enlargement. Ultrasound-guided core-needle biopsy is safe and accurate, and therefore remains a preferred method for diagnosing thyroid lymphoma. -
Key words:
- lymphoma /
- thyroid neoplasm /
- thyroid biopsy /
- ultrasound guidance
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表 1 22例原发性甲状腺淋巴瘤患者的临床特征、超声表现及活检诊断结果
病例 性别 年龄
(岁)超声分型 病变范围
(cm)FNA CNB 手术 临床
分期治疗 随访情况 1 女 62 弥漫型 双侧 未做 可疑 MALT 不详 化疗 失访 2 女 48 弥漫型 双侧 不能诊断 未做 MALT Ⅳ 化疗 失访 3 女 72 弥漫型 双侧 不能诊断 MALT 未做 Ⅳ 放疗+化疗 3程化疗后,呼吸衰
竭,死亡4 男 32 弥漫型 右侧 未做 外周T细胞
型淋巴瘤未做 Ⅳ 化疗 良好 5 女 53 弥漫型 双侧 不能诊断 弥漫大B 弥漫大B Ⅱ 化疗 良好 6 女 69 弥漫型 右侧 未做 MALT 未做 不详 不详 失访 7 男 72 弥漫型 右侧 不能诊断 MALT 未做 不详 不详 失访 8 女 46 弥漫型 双侧 未做 未做 MALT Ⅲ 甲状腺切除+化疗 干细胞移植术后1年,良好 9 女 73 弥漫型 左侧 可疑 MALT 未做 不详 化疗 气道梗阻,呼吸衰竭
死亡10 男 81 弥漫型 双侧 未做 未做 弥漫大B 不详 甲状腺切除+化疗 失访 11 女 34 结节型 左侧(2.1) 未做 未做 弥漫大B Ⅱ 甲状腺切除+化疗 自体干细胞移植,良好 12 男 67 结节型 右侧(5.1) 未做 未做 弥漫大B Ⅱ 甲状腺切除+化疗 良好 13 男 40 结节型 右侧(6.3) 不能诊断 未做 NHL(具体不详) 不详 不详 死亡 14 男 55 结节型 左侧(8.4) 不能诊断 未做 弥漫大B Ⅳ 化疗 化疗后缩小,失访 15 女 67 结节型 右侧(6.0) 未做 未做 弥漫大B Ⅱ 化疗 失访 16 男 62 结节型 左侧(3.5) 未做 未做 MALT Ⅱ 甲状腺切除+化疗 良好 17 男 75 结节型 左侧(6.6) 可疑 NHL(具体
不详)未做 不详 化疗 良好 18 男 81 结节型 左侧(7.3) 未做 未做 MALT Ⅱ 甲状腺切除+化疗 良好 19 女 65 结节型 左侧(3.2) 未做 未做 弥漫大B Ⅳ 甲状腺切除+化疗 良好 20 男 81 混合型 右侧(8.8) 不能诊断 未做 NHL(具体不详) 不详 化疗 失访 21 女 51 混合型 左侧(4.4) 不能诊断 弥漫大B 未做 不详 不详 失访 22 女 56 混合型 双侧(5.0) 未做 未做 MALT Ⅳ 化疗 良好 FNA:细针抽吸活检; CNB:超声引导组织活检;MALT:黏膜相关淋巴组织B细胞淋巴瘤;NHL:非霍奇金淋巴瘤 -
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