Peixoto Rita, Correia Pinto João, Soares Virgínia, Koch Pedro, Taveira Gomes António
Resident of General Surgery of Pedro Hispano Hospital, Matosinhos, Portugal.
Resident of Pathology of Pedro Hispano Hospital, Matosinhos, Portugal.
Ann Med Surg (Lond). 2016 Dec 21;13:29-33. doi: 10.1016/j.amsu.2016.12.023. eCollection 2017 Jan.
A rapidly enlarging mass of the anterior compartment of the neck with compressive symptoms may represent, among other diagnosis, a neoplasm of the thyroid gland.
We describe the case of a 59-year-old woman referred to the endocrine surgical unit because of compressive cervical symptoms for 3 months. The cervical ultrasound revealed a sub-sternal goiter with heterogeneous echo structure and the fine-needle aspirating cytology was inconclusive. Given the large impact of symptoms on life quality, she was submitted to a total thyroidectomy. Histological examination of the surgical specimen revealed the presence of a Diffuse Large B Cell Lymphoma of the thyroid.
Primary thyroid lymphomas are rare and there are few randomized studies for diagnostic and therapeutic guidance. New immunohistochemical and molecular techniques have improved the diagnostic accuracy with corebiopsy limiting the role of surgery. The treatment should first include the control of local disease with radiotherapy and/or surgery combined with chemotherapy to control obscure or disseminated disease. Palliative surgery may be needed to relieve airway compression symptoms. Under these circumstances, surgery should be performed by a specialized surgeon to decrease the associated morbidity. The prognosis of patients depends on the histological classification of the tumor and the stage of the disease.
Due to the rarity of the disease, each case must be evaluated and treated individually, since there is not a consensual therapeutic approach.
颈部前间隙迅速增大且伴有压迫症状的肿物，在其他诊断中，可能提示为甲状腺肿瘤。
我们描述了一名59岁女性的病例，该患者因颈部压迫症状3个月而转诊至内分泌外科。颈部超声显示胸骨后甲状腺肿，回声结构不均匀，细针穿刺细胞学检查结果不明确。鉴于症状对生活质量影响较大，她接受了全甲状腺切除术。手术标本的组织学检查显示存在甲状腺弥漫性大B细胞淋巴瘤。
原发性甲状腺淋巴瘤较为罕见，针对诊断和治疗指导的随机研究较少。新的免疫组织化学和分子技术提高了诊断准确性，粗针活检限制了手术的作用。治疗应首先包括通过放疗和/或手术控制局部疾病，并联合化疗控制隐匿或播散性疾病。可能需要进行姑息性手术以缓解气道压迫症状。在这种情况下，应由专业外科医生进行手术以降低相关并发症。患者的预后取决于肿瘤的组织学分类和疾病分期。
由于该病罕见，每个病例都必须单独评估和治疗，因为目前尚无一致的治疗方法。
