Wozniak R, Beckwith L, Ratech H, Surks M I
Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10467, USA.
J Clin Endocrinol Metab. 1999 Apr;84(4):1206-9. doi: 10.1210/jcem.84.4.5642.
We report the case of a 42-yr-old man with primary thyroid lymphoma arising from mucosa-associated lymphoid tissue (MALT-lymphoma, maltoma). The patient underwent a hemithyroidectomy for a growing mass in the right lobe of the thyroid while being treated with 1-thyroxine for Hashimoto's thyroiditis. The clinical diagnosis of Hashimoto's disease was confirmed by aspiration biopsy of the mass during the course of L-thyroxine treatment. Postoperatively, histology showed atypical lymphoproliferative infiltrates suspicious of low-grade non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue-type, coexisting with a reactive process typical of chronic lymphocytic thyroiditis. Immunophenotyping showed a mixed B- and T-lymphocyte population, which was nondiagnostic. However, Southern blot analysis revealed a clonal rearrangement of the Ig heavy chain gene. This case demonstrates that cytology or histology may not distinguish between reactive or low-grade lymphomatous thyroid processes. The use of molecular technique was essential to prove clonality and the presence of lymphoma.
我们报告了一例42岁男性原发性甲状腺淋巴瘤病例，该淋巴瘤起源于黏膜相关淋巴组织（MALT淋巴瘤，即黏膜相关淋巴组织肿瘤）。该患者因甲状腺右叶肿物增大接受了甲状腺半切除术，当时正接受左甲状腺素治疗桥本甲状腺炎。在左甲状腺素治疗过程中，通过肿物穿刺活检确诊了临床诊断的桥本氏病。术后，组织学检查显示非典型淋巴细胞增生浸润，怀疑为黏膜相关淋巴组织型低级别非霍奇金淋巴瘤，同时并存慢性淋巴细胞性甲状腺炎典型的反应性病变。免疫表型分析显示为B淋巴细胞和T淋巴细胞混合群体，无法确诊。然而，Southern印迹分析显示免疫球蛋白重链基因发生了克隆性重排。该病例表明，细胞学或组织学检查可能无法区分反应性或低级别淋巴瘤性甲状腺病变。分子技术的应用对于证实克隆性及淋巴瘤的存在至关重要。
