Pereira F O, Graf H, Nomura L M, Neto J Z, Collaço L M, Boguszewski C L
SEMPR, Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil.
Thyroid. 2000 Sep;10(9):833-5. doi: 10.1089/thy.2000.10.833.
We report an uncommon case of a 20-year-old man, who noted a painless, growing mass in his neck, which appeared in a weekend, associated with moderate dysphagia and weakness. Laboratory examination revealed an elevated serum thyrotropin of 25 mU/L, normal serum triiodothyronine and thyroxine levels, and high titers of antithyroglobulin and antithyroid peroxidase antibodies. The neck lesion showed a depressed iodine uptake in the left thyroid lobe, which had an asymmetrical pseudocystic pattern associated with poor vascularization in the ultrasound scan. Cytologic examination showed a lymphocyte thyroiditis in association with lymphoma of large cell arising from mucosa-associated lymphoid tissue (MALT-lymphoma or maltoma). The patient underwent a left thyroid lobectomy while being treated with levothyroxine for Hashimoto's thyroiditis, and the surgical treatment was further complemented with chemotherapy using fludarabine. The histologic examination confirmed the cytologic findings and the immunohistochemistry showed a B-cell type maltoma. Additional investigation provided no evidence of disease in other tissues. The clinical course has been favorable in the first 2 years of follow-up, with no evidence of local or systemic recurrence of the disease.
我们报告了一例罕见病例，患者为一名20岁男性，他发现颈部有一个无痛性、不断增大的肿块，该肿块在一个周末出现，伴有中度吞咽困难和乏力。实验室检查显示血清促甲状腺激素升高至25 mU/L，血清三碘甲状腺原氨酸和甲状腺素水平正常，抗甲状腺球蛋白和抗甲状腺过氧化物酶抗体滴度高。颈部病变显示左甲状腺叶碘摄取降低，超声扫描显示其具有不对称的假囊肿样表现且血管化不良。细胞学检查显示淋巴细胞性甲状腺炎合并源于黏膜相关淋巴组织的大细胞淋巴瘤（MALT淋巴瘤或黏膜相关淋巴组织淋巴瘤）。患者在接受左甲状腺叶切除术时，因桥本甲状腺炎正在接受左甲状腺素治疗，手术治疗后进一步使用氟达拉滨进行化疗。组织学检查证实了细胞学检查结果，免疫组织化学显示为B细胞型黏膜相关淋巴组织淋巴瘤。进一步检查未发现其他组织存在疾病证据。在随访的前两年，临床病程良好，无疾病局部或全身复发的证据。
