Department of Ultrasound, Peking University First Hospital, Beijing, China.
Department of Pathology, Peking University First Hospital, Beijing, China.
Front Endocrinol (Lausanne). 2022 Dec 16;13:1054584. doi: 10.3389/fendo.2022.1054584. eCollection 2022.
Mucosa-associated lymphoid tissue (MALT) lymphoma is an extranodal lymphoma with an indolent natural course. The thyroid gland is an uncommon site of involvement. We aimed to investigate serial ultrasound features and the disease progression during the clinical course of thyroid MALT lymphoma.
We searched our hospital's pathology database (5,418 patients with thyroid malignancy) between January 2000 and July 2022. The medical records and serial ultrasounds of 11 patients with 12 thyroid MALT lymphoma foci were analyzed retrospectively.
An enlarging neck mass, dyspnea, B symptoms, and neck lymphadenopathy were seen at diagnosis in 9 (9/11, 81.8%), 3 (3/11, 27.3%), 2 (2/11, 18.2%), and 9 (9/11, 81.8%) cases, respectively. Eleven cases were concomitant Hashimoto thyroiditis. Common ultrasound features included bilateral or unilateral asymmetric goiter or large, solid, and very hypoechoic nodules (11/12, 91.7%) interspersed with linear, reticular hyperechoic, and enhanced posterior echoes (11/12, 91.7%), and neck lymph node involvement (10/11, 90.9%). The Thyroid Imaging and Reporting Data System (TIRADS) categories showed higher diagnostic accuracy (11/12, 91.7%) than real-time ultrasound (2/12, 16.7%) in evaluating thyroid lesions for recommendation of fine-needle aspiration (FNA). Serial ultrasound showed self-limiting changes in three cases, relapse in three cases after subtotal thyroidectomy and chemotherapy, large cell transformation (LCT) in one case after left lobectomy, partial remission in one case, and complete remission after chemo/radiation in four cases; progression to enlarged thyroid nodules occurred in three cases without treatment, with no obvious change observed after diagnosis. Three patients died during follow-up.
On sonograms, solid large thyroid nodules or goiter with very hypoechoic and enhanced posterior echoes in the setting of Hashimoto thyroiditis should raise suspicion for MALT lymphoma. TIRADS categories can improve the ultrasound diagnostic efficacy for malignancy. Serial ultrasound examinations demonstrated self-limiting and indolent natures of thyroid MALT lymphoma.
黏膜相关淋巴组织（MALT）淋巴瘤是一种具有惰性自然病程的结外淋巴瘤。甲状腺是一种罕见的受累部位。我们旨在研究甲状腺 MALT 淋巴瘤临床病程中的连续超声特征和疾病进展。
我们在 2000 年 1 月至 2022 年 7 月期间在我们医院的病理数据库（5418 例甲状腺恶性肿瘤患者）中进行了搜索。回顾性分析了 11 例 12 个甲状腺 MALT 淋巴瘤病灶患者的病历和连续超声。
9 例（9/11，81.8%）、3 例（3/11，27.3%）、2 例（2/11，18.2%）和 9 例（9/11，81.8%）患者在诊断时出现颈肿块增大、呼吸困难、B 症状和颈部淋巴结病。11 例患者同时患有桥本甲状腺炎。常见的超声特征包括双侧或单侧不对称性甲状腺肿或大的、实性和极低回声结节（11/12，91.7%），伴有线性、网状高回声和增强的后回声（11/12，91.7%），以及颈部淋巴结受累（10/11，90.9%）。甲状腺成像和报告数据系统（TIRADS）分类在评估甲状腺病变以推荐细针抽吸（FNA）时显示出较高的诊断准确性（11/12，91.7%），优于实时超声（2/12，16.7%）。连续超声显示 3 例自行缓解，3 例在甲状腺次全切除和化疗后复发，1 例在左叶切除后发生大细胞转化（LCT），1 例部分缓解，4 例在化疗/放疗后完全缓解；3 例未经治疗的患者进展为甲状腺结节增大，诊断后无明显变化。3 例患者在随访期间死亡。
在超声图像上，桥本甲状腺炎背景下的实性大甲状腺结节或甲状腺肿伴极低回声和增强的后回声应提示 MALT 淋巴瘤。TIRADS 分类可以提高超声对恶性肿瘤的诊断效能。连续超声检查显示甲状腺 MALT 淋巴瘤具有自限性和惰性特征。
