Matsubayashi S, Tamai H, Morita T, Fukata S, Matsuzuka F, Suzuki T, Kuma K, Nagataki S, Volpé R
Department of Psychosomatic Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Clin Exp Immunol. 1990 Feb;79(2):170-4. doi: 10.1111/j.1365-2249.1990.tb05174.x.
Hashimoto's thyroiditis (HT) and lymphoma are sometimes difficult to distinguish between. Moreover, lymphoma sometimes develops in a thyroid gland from pre-existing HT. Open- or large-needle biopsy usually distinguishes between them; the specimen may be examined histologically and subjected to immunohistochemistry. Another possible method of examination is fine-needle aspiration biopsy (FNAB). The cells obtained may be evaluated cytologically, and subjected to flow cytometry, using various antibodies. In this study, anti-kappa and anti-lambda antibodies are especially important, as a gross predominance of kappa or lambda B lymphocytes infiltrating the thyroid is evidence for a B cell monoclone. In this study, 15 patients were selected because of their rapidly growing goitres. They all underwent FNAB. Five had cytology typical of HT, and no evidence of monoclonality on flow cytometry. They were diagnosed as HT without further histopathology. The remaining 10 patients had cytology suspected of lymphoma, or evidence of monoclonality on flow cytometry, or both. These patients underwent open- or large-needle biopsy. Only three of them were diagnosed histopathologically as lymphoma; the other seven were diagnosed histopathologically as HT, making 12 cases of HT in all. Five of these 12 cases, and one of the three cases of lymphoma showed flow cytometrical evidence of monoclonality; thus evidence of monoclonality from FNAB, while interesting, does not necessarily serve to differentiate between HT and lymphoma. Furthermore, the immunohistochemical assessment of monoclonality did not correlate with the flow cytometrical assessment. Follow-up evidence will be required to discover whether those patients with a B cell monoclone in their HT are the ones who develop a lymphoma.
桥本甲状腺炎（HT）和淋巴瘤有时难以区分。此外，淋巴瘤有时会在已存在的HT基础上于甲状腺中发生。开放性或粗针活检通常可区分二者；标本可进行组织学检查并进行免疫组织化学检测。另一种可能的检查方法是细针穿刺活检（FNAB）。所获取的细胞可进行细胞学评估，并使用各种抗体进行流式细胞术检测。在本研究中，抗κ和抗λ抗体尤为重要，因为浸润甲状腺的κ或λ B淋巴细胞明显占优势是B细胞单克隆性的证据。在本研究中，15例患者因甲状腺肿快速增大而入选。他们均接受了FNAB。5例患者的细胞学表现为典型的HT，流式细胞术检测无单克隆性证据。他们被诊断为HT，未进一步进行组织病理学检查。其余10例患者的细胞学表现怀疑为淋巴瘤，或流式细胞术检测有单克隆性证据，或二者皆有。这些患者接受了开放性或粗针活检。其中仅3例经组织病理学诊断为淋巴瘤；另外7例经组织病理学诊断为HT，总计12例HT。这12例HT中的5例以及3例淋巴瘤中的1例显示有流式细胞术单克隆性证据；因此，FNAB的单克隆性证据虽然有趣，但不一定能用于区分HT和淋巴瘤。此外，单克隆性的免疫组织化学评估与流式细胞术评估不相关。需要随访证据来确定HT中存在B细胞单克隆的那些患者是否会发展为淋巴瘤。
