Derringer G A, Thompson L D, Frommelt R A, Bijwaard K E, Heffess C S, Abbondanzo S L
Department of Hematopathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
Am J Surg Pathol. 2000 May;24(5):623-39. doi: 10.1097/00000478-200005000-00001.
We report a retrospective clinicopathologic study of 108 primary thyroid gland lymphomas (PTLs), classified using the REAL and proposed WHO classification schemes. The patients included 79 women and 29 men, with an average age of 64.3 years. All patients presented with a thyroid mass. The PTLs were classified as marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) or MZBL (n = 30), diffuse large B-cell lymphoma (DLBCL) with MZBL (n = 36), DLBCL without MZBL (n = 41), and follicle center lymphoma (FCL; n = 1). Excluding the FCL, features of lymphomas of MALT-type were identified in all groups, despite a follicular architecture in 23% of cases. Lymphocytic thyroiditis (LT) was identified in 94%. Ninety-one percent of patients presented with stage IE or IIE disease, whereas 69% had perithyroidal soft tissue infiltration. All patients were treated with surgical excision followed by adjuvant therapy (76%): chemotherapy (15%), radiation (19%), or a combination of radiation and chemotherapy (42%). Disease-specific survival was 82% at last follow up (mean, 82.8 mos) and 79% at 5 years. Statistically, stages greater than IE, presence of DLBCL, rapid clinical growth, abundant apoptosis, presence of vascular invasion, high mitotic rate, and infiltration of the perithyroidal soft tissue were significantly associated with death with disease. No patients with MZBL or stage IE disease died with disease. In summary, PTLs typically occur in middle- to older-aged individuals as a thyroid mass, with a predilection for females. Despite their histologic heterogeneity and frequent simulation of other lymphoma subtypes, virtually all PTLs are lymphomas of MALT-type arising in the setting of LT. Mixed DLBCL and MZBL are common. Overall, PTLs have a favorable outcome with appropriate therapy, but prognosis depends on both clinical stage and histology. MZBL and stage IE tumors have an excellent prognosis, whereas tumors with a large cell component or DLBCL or stage greater than IE have the greatest potential for a poor outcome.
我们报告了一项对108例原发性甲状腺淋巴瘤（PTL）的回顾性临床病理研究，这些病例采用了REAL分类法和WHO提议的分类方案进行分类。患者包括79名女性和29名男性，平均年龄为64.3岁。所有患者均表现为甲状腺肿块。PTL被分类为黏膜相关淋巴组织边缘区B细胞淋巴瘤（MALT）或MZBL（n = 30）、伴有MZBL的弥漫性大B细胞淋巴瘤（DLBCL，n = 36）、不伴有MZBL的DLBCL（n = 41）以及滤泡中心淋巴瘤（FCL；n = 1）。排除FCL后，所有组均发现了MALT型淋巴瘤的特征，尽管23%的病例具有滤泡结构。94%的患者发现有淋巴细胞性甲状腺炎（LT）。91%的患者表现为IE期或IIE期疾病，而69%的患者有甲状腺周围软组织浸润。所有患者均接受手术切除，随后进行辅助治疗（76%）：化疗（15%）、放疗（19%）或放疗与化疗联合（42%）。在最后一次随访时（平均82.8个月）疾病特异性生存率为82%，5年时为79%。从统计学上看，大于IE期、存在DLBCL、临床生长迅速、凋亡丰富、存在血管侵犯、有丝分裂率高以及甲状腺周围软组织浸润与疾病死亡显著相关。没有MZBL或IE期疾病的患者死于该疾病。总之，PTL通常发生于中老年个体，表现为甲状腺肿块，女性更易受累。尽管其组织学具有异质性且常模拟其他淋巴瘤亚型，但实际上所有PTL均为发生于LT背景下的MALT型淋巴瘤。混合性DLBCL和MZBL很常见。总体而言，PTL经适当治疗后预后良好，但预后取决于临床分期和组织学类型。MZBL和IE期肿瘤预后极佳，而具有大细胞成分或DLBCL或大于IE期的肿瘤预后最差。
