Kikuchi Masahiro, Shinohara Shogo, Fujiwara Keizo, Yamazaki Hiroshi, Kanazawa Yuji, Kurihara Risa, Kishimoto Ippei, Harada Hiroyuki, Naito Yasushi
Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe.
Nihon Jibiinkoka Gakkai Kaiho. 2011 Nov;114(11):855-63. doi: 10.3950/jibiinkoka.114.855.
We analyzed open biopsy in diagnosing primary thyroid lymphoma (PTL) and tumor management with compression symptoms and therapy.
We retrospectively studied 24 subjects diagnosed with PTL from December 1997 to June 2010.
Open biopsy was done in 23 of 24 subjects. Incisional biopsy was done in 14, 13 of whom yielded sufficient materials in the first biopsy. Excisional biopsy was done in the remaining 9, 2 of whom developed permanent recurrent laryngeal nerve palsy after biopsy. The five with airway obstruction underwent incisional biopsy followed by immediate steroid administration of dexamethasone or methylprednisolone. All had histopathologically confirmed diagnosis and airway symptoms were resolved within a few days. Multidisciplinary therapy including chemotherapy, radiotherapy, and surgery was applied in 20 of 24 subjects. Single therapy was done in 4-chemotherapy in 2 and radiotherapy and surgery in 1 each. Overall results were satisfactory, with a 92% 10-year disease-free survival rate and an 86% 10-year overall survival rate based on the Kaplan-Meier method with 46-month median follow up.
When diagnosing PTL, especially large tumors spreading into extrathyroid tissue, incisional biopsy is more advantageous in histopathological diagnosis than excisional biopsy due to the lower risk of surgical complications. In a case involving a small intrathyroidal nodule, excisional biopsy is safer and more diagnostically accurate. In an airway obstruction emergency, once a definitive diagnosis is made, steroid administration plus endotracheal intubation, if necessary, for airway management is optimal management. Subjects with stage IE mucosa-associated lymphoid tissue (MALT) lymphomas can be treated with radiotherapy or surgery alone. Those with diffuse large B-cell lymphoma (DLBCL) or greater than stage IE MALT lymphoma, however, should be treated with multidisciplinary therapy because they have a potentially poor outcome.
我们分析了开放性活检在原发性甲状腺淋巴瘤（PTL）诊断中的应用以及伴有压迫症状的肿瘤管理和治疗情况。
我们回顾性研究了1997年12月至2010年6月期间诊断为PTL的24例患者。
24例患者中有23例行开放性活检。其中14例行切开活检，13例在首次活检时获取了足够的组织样本。其余9例行切除活检，其中2例在活检后出现永久性喉返神经麻痹。5例气道阻塞患者先进行切开活检，随后立即给予地塞米松或甲泼尼龙类固醇治疗。所有患者经组织病理学确诊，气道症状在数天内得到缓解。24例患者中有20例接受了包括化疗、放疗和手术在内的多学科治疗。4例患者接受单一治疗，其中2例接受化疗，1例接受放疗，1例接受手术。总体结果令人满意，根据Kaplan-Meier方法，中位随访46个月，10年无病生存率为92%，10年总生存率为86%。
在诊断PTL时，尤其是肿瘤扩散至甲状腺外组织的大肿瘤，切开活检在组织病理学诊断方面比切除活检更具优势，因为手术并发症风险较低。对于甲状腺内小肿块的情况，切除活检更安全且诊断准确性更高。在气道阻塞紧急情况下，一旦确诊，类固醇治疗加必要时的气管插管以进行气道管理是最佳治疗方法。IE期黏膜相关淋巴组织（MALT）淋巴瘤患者可单独接受放疗或手术治疗。然而，弥漫性大B细胞淋巴瘤（DLBCL）或超过IE期的MALT淋巴瘤患者应接受多学科治疗，因为他们的预后可能较差。
