Roldán-Valadez E, Ortega-López N, Cervera-Ceballos E, Valdivieso-Cárdenas G, Vega-González I, Granados-García M
PET/CT Unit, Department of Radiology, Medica Sur Hospital and Clinical Foundation, Mexico City, Mexico.
Rev Esp Med Nucl. 2008 Jan-Feb;27(1):34-9. doi: 10.1157/13114368.
An 82-year-old female patient with hypothyroidism and Hashimoto's thyroiditis noted three years ago to have a small asymmetric goiter (left > right). Nevertheless, a rapid growth of the thyroid over 3-6 months caused dysphagia and shortness of breath. Ultrasound and a thyroid gammagram showed an image consistent with multinodular goiter with a hyperfunctioning nodule in the right lobe. Due to the history of Hashimoto's thyroiditis and a rapid increase in size of the thyroid gland, diagnoses of thyroid lymphoma and anaplastic thyroid cancer were considered. Thyroidectomy was attempted at an outside facility to relieve compressive symptoms. Fine needle aspiration was insufficient for diagnosis, and the product of thyroidectomy confirmed the diagnosis of diffuse large B-cell lymphoma. A positron emission tomography/computed tomography scan was performed in our institution for staging, revealing nodal and extranodal metastasis. Chemotherapy using cyclophosphamide, vincristine and dexamethasone (COP modified) led to a dramatic response of the tumor and a complete resolution of compressive symptoms.
一名82岁女性患者，患有甲状腺功能减退症和桥本甲状腺炎，三年前发现有一个小的不对称甲状腺肿（左侧>右侧）。然而，甲状腺在3至6个月内迅速生长，导致吞咽困难和呼吸急促。超声和甲状腺闪烁扫描显示的图像与多结节性甲状腺肿一致，右叶有一个功能亢进结节。由于有桥本甲状腺炎病史且甲状腺大小迅速增加，考虑诊断为甲状腺淋巴瘤和间变性甲状腺癌。在外院尝试进行甲状腺切除术以缓解压迫症状。细针穿刺活检不足以确诊，甲状腺切除术后的标本确诊为弥漫性大B细胞淋巴瘤。在我院进行了正电子发射断层扫描/计算机断层扫描以进行分期，发现有淋巴结和结外转移。使用环磷酰胺、长春新碱和地塞米松（改良COP方案）进行化疗使肿瘤产生显著反应，压迫症状完全缓解。
