Li Jun-He, He Hong-Hong, Cheng Yuan, He Wen-Jing
From the Department of Oncology (J-HL, H-HH, YC), First Affiliated Hospital of Nanchang University, Nanchang; Department of Endocrinology (W-JH), First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Medicine (Baltimore). 2016 May;95(20):e3460. doi: 10.1097/MD.0000000000003460.
Most thyroid lymphomas are B-lineage, and T-cell lymphomas are rare. None of primary thyroid extranasal NK/T-cell lymphoma (NKTCL) has been reported in the literature. Here, we report a case of extranasal NKTCL exclusively arising in the thyroid in an 18-year-old Chinese.The patient presented with rapid anterior swelling at the neck and aggravated dyspnea for 2 months. Neck computer tomography scan revealed diffuse thyroid enlargement in the left lobe compressing the trachea. The thyroid function test was indicative of hypothyroidism. Gastroscopy demonstrated chronic nonspecific gastritis. Subtotal thyroidectomy was performed. Histological examination showed a diffuse infiltration of neoplastic lymphoid cells with an angiodestructive behavior. Immunophenotype is positive for CD2, CD56, CD43, and TIA-1, and typically negative for surface CD3. Epstein-Barr virus-encoded small RNAs were detected in tumor cells. A diagnose of primary thyroid extranasal NKTCL-N lymphoma was confirmed by the findings.The patient was treated with CHOP-L combination chemotherapy followed by local radiotherapy, and tolerated the modality well. The patient has been in remission for 28 months so far.To our knowledge, this is the first case report of primary extranasal NKTCL exclusively arising in the thyroid. The case has a relatively good treatment outcome with timely diagnosis and multimodality approach.
大多数甲状腺淋巴瘤为B细胞系，T细胞淋巴瘤较为罕见。文献中尚未报道过原发性甲状腺鼻外NK/T细胞淋巴瘤（NKTCL）。在此，我们报告一例18岁中国患者，其鼻外NKTCL仅发生于甲状腺。患者出现颈部前方迅速肿胀并伴有进行性加重的呼吸困难2个月。颈部计算机断层扫描显示左叶甲状腺弥漫性肿大，压迫气管。甲状腺功能检查提示甲状腺功能减退。胃镜检查显示慢性非特异性胃炎。行甲状腺次全切除术。组织学检查显示肿瘤性淋巴细胞呈弥漫性浸润，具有血管破坏行为。免疫表型CD2、CD56、CD43和TIA-1呈阳性，表面CD3通常为阴性。在肿瘤细胞中检测到爱泼斯坦-巴尔病毒编码的小RNA。根据这些发现确诊为原发性甲状腺鼻外NKTCL-N淋巴瘤。患者接受CHOP-L联合化疗，随后进行局部放疗，对该治疗方式耐受性良好。患者迄今已缓解28个月。据我们所知，这是首例仅发生于甲状腺的原发性鼻外NKTCL病例报告。该病例通过及时诊断和多模式治疗方法取得了相对较好的治疗效果。
