Andrysiak-Mamos Elżbieta, Becht Rafał, Sowińska-Przepiera Elżbieta, Pobłocki Jakub, Syrenicz Justyna, Zdziarska Barbara, Karpińska-Kaczmarczyk Katarzyna, Syrenicz Anhelli
Department of Endocrinology, Metabolic Diseases and Internal Diseases, Pomeranian Medical University, ul, Unii Lubelskiej 1, 70-252, Szczecin, Poland.
Thyroid Res. 2013 Jan 2;6(1):1. doi: 10.1186/1756-6614-6-1.
The article presents a case of 57-year-old woman with the infiltration of rare small lymphocytic B cell lymphoma in the thyroid gland. Initially, the patient was followed-up due to chronic lymphocytic B-cell leukemia diagnosed on the basis of histopathological examination of cervical lymph node. Eight months later, general symptoms occurred along with lymphocytosis and exacerbation of lesions in lymph nodes, and therefore, chemotherapy was started according to COP regimen. After four chemotherapy cycles, further progression of the disease was observed during chemotherapy. Computed tomography (CT) performed at that time showed generalized lymphadenopathy and the presence of an irregular area in left thyroid lobe. On palpation, the thyroid was asymmetrical, with enlarged left lobe and palpable lymph node packages on the left side of the neck. The levels of thyroid hormones and anti-thyroid antibodies were normal. Ultrasound examination of the thyroid gland showed non-homogeneous hypoechogenic structure of the left lobe and complete focal remodeling. Cytological examination of left-lobe lesion obtained during fine needle aspiration biopsy showed multiple small lymphoid cells, suggestive of small lymphocytic lymphoma. To confirm this diagnosis, flow cytometry of the biopsy material sampled from the left lobe was performed showing B cellimmunophenotype: CD19+/CD20+/CD22 dim/FMC-7, CD23+/CD5+, sCD79b-+, CD38-, CD10-, kappa and lambda-/weak reaction. The results of flow cytometry of the thyroid bioptate and blood were nearly identical, confirming leukemic nature of the infiltration in left thyroid lobe. Cytogenetic findings included the presence of 17p deletion (TP53 gene). The patient received immunochemotherapy with alemtuzumab. The progression of the disease occurred in the sixth week of therapy. The treatment was discontinued after 8 weeks due to worsening of patient's general status. The patient died 15 months after the diagnosis.
本文介绍了一例57岁女性，其甲状腺出现罕见的小淋巴细胞B细胞淋巴瘤浸润。最初，患者因根据颈部淋巴结组织病理学检查诊断为慢性淋巴细胞B细胞白血病而接受随访。八个月后，出现全身症状，伴有淋巴细胞增多和淋巴结病变加重，因此开始按照COP方案进行化疗。四个化疗周期后，化疗期间观察到疾病进一步进展。当时进行的计算机断层扫描（CT）显示全身淋巴结肿大，左甲状腺叶有一个不规则区域。触诊时，甲状腺不对称，左叶肿大，颈部左侧可触及淋巴结包块。甲状腺激素和抗甲状腺抗体水平正常。甲状腺超声检查显示左叶低回声结构不均匀，有完全的局灶性重塑。细针穿刺活检获取的左叶病变细胞检查显示多个小淋巴细胞，提示小淋巴细胞淋巴瘤。为确诊，对从左叶采集的活检材料进行流式细胞术检测，显示B细胞免疫表型：CD19+/CD20+/CD22 dim/FMC-7、CD23+/CD5+、sCD79b-+、CD38-、CD10-、kappa和lambda-/弱阳性反应。甲状腺活检组织和血液的流式细胞术结果几乎相同，证实左甲状腺叶浸润具有白血病性质。细胞遗传学检查结果包括存在17p缺失（TP53基因）。患者接受了阿仑单抗免疫化疗。治疗第六周疾病进展。由于患者一般状况恶化，8周后停止治疗。患者在诊断后15个月死亡。
