Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Thyroid. 2010 Sep;20(9):1019-23. doi: 10.1089/thy.2010.0089.
Lymphoma involving the thyroid gland is rare. Diffuse large B-cell lymphoma and mucosa-associated lymphoid tissue lymphoma are the two most common histologic subtypes of primary thyroid lymphoma. Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) presenting initially as a thyroid abnormality is extremely rare, with very few reported cases in the literature.
We report a case of a patient with a long history of Hashimoto's thyroiditis and goiter who presented with a recent enlargement of her thyroid gland. The sonographic finding of a distinct thyroid nodule in the heterogeneous background of chronic lymphocytic thyroiditis led to the performance of a fine-needle aspiration biopsy and flow cytometry, with a high index of suspicion for thyroid lymphoma. Subsequent surgical removal of the thyroid gland, prompted by the patient's history of head and neck radiation, confirmed the diagnosis of CLL/SLL. The patient's systemic illness was recognized only after the management of her thyroid disease. Although thyroiditis has long been associated with lymphoma arising in the thyroid gland, CLL/SLL involving the thyroid has not been linked to chronic lymphocytic thyroiditis. Therefore, the patient also had coexisting thyroiditis.
Due to the rarity of thyroid lymphomas, our experience in the detection and management of this disease is limited. Primary thyroid lymphoma should be suspected in a patient with a history of chronic lymphocytic thyroiditis presenting with a rapidly enlarging neck mass. The initial diagnostic method for thyroid lymphoma should consist of a fine-needle aspiration biopsy with the use of ancillary techniques such as flow cytometry and immunohistochemistry for improved diagnostic accuracy. Although controversial, the treatment of thyroid lymphoma is typically guided by the histologic subtype and extent of disease. CLL/SLL is one of the rarest subtypes of lymphoma that can involve the thyroid gland. Diagnosis of this entity is difficult, particularly before the recognition of systemic involvement, requiring the expertise of a multidisciplinary team for early detection and optimal management.
甲状腺淋巴瘤少见。弥漫性大 B 细胞淋巴瘤和黏膜相关淋巴组织淋巴瘤是原发性甲状腺淋巴瘤最常见的两种组织学亚型。慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL/SLL）最初表现为甲状腺异常极为罕见，文献中报道的病例很少。
我们报告了一例患有桥本甲状腺炎和甲状腺肿的患者，近期甲状腺肿大。慢性淋巴细胞性甲状腺炎的不均匀背景下存在明显甲状腺结节的超声表现，促使进行细针抽吸活检和流式细胞术检查，高度怀疑甲状腺淋巴瘤。由于患者有头颈部放疗史，随后行甲状腺切除术，确诊为 CLL/SLL。仅在处理甲状腺疾病后才发现患者的全身疾病。虽然甲状腺炎长期以来与甲状腺内淋巴瘤的发生有关，但 CLL/SLL 累及甲状腺与慢性淋巴细胞性甲状腺炎无关。因此，该患者还同时患有甲状腺炎。
由于甲状腺淋巴瘤罕见，我们对该病的检测和治疗经验有限。对于有慢性淋巴细胞性甲状腺炎病史、出现快速增大的颈部肿块的患者，应怀疑原发性甲状腺淋巴瘤。甲状腺淋巴瘤的初始诊断方法应为细针抽吸活检，并结合流式细胞术和免疫组织化学等辅助技术，以提高诊断准确性。虽然存在争议，但甲状腺淋巴瘤的治疗通常取决于组织学亚型和疾病范围。CLL/SLL 是一种罕见的可累及甲状腺的淋巴瘤亚型。该实体的诊断困难，尤其是在未发现全身受累之前，需要多学科团队的专业知识进行早期发现和最佳管理。
