Lai Yi, Ding Chenhuan, Shen Yanying, Zhao Ling, Li He
Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Traditional Chinese Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Transl Cancer Res. 2023 Mar 31;12(3):515-524. doi: 10.21037/tcr-22-2257. Epub 2023 Mar 3.
Primary thyroid lymphoma (PTL) is very rare. The aim of this study was to describe the clinical characteristics, pathological features, and survival outcomes of primary thyroid non-Hodgkin lymphoma, including the diagnostic value of clonal immunoglobulin (Ig) gene rearrangements in diagnosing mucosa-associated lymphoid tissue (MALT) lymphoma of the thyroid gland with co-existing Hashimoto thyroiditis (HT).
Paraffin-embedded tissues of patients diagnosed in our institute with PTL between 2007 and 2021 were collected. Clinicopathological features and follow-up data were retrospectively analyzed. Analysis of clonal Ig gene rearrangements were performed in patients with suspected PTL.
Of the 22 patients included in our study, 17 were female. The median age at diagnosis was 65.5 years (range, 44-80 years). We detected 11 cases of diffuse large B-cell lymphoma (DLBCL), 10 cases of MALT lymphoma, and 1 case of T-cell lymphoma. A total of 18 patients (81.8%) had early stage (I/II) disease. B-cell lymphoma showed diffuse positivity for CD20 but negative markers for thyroid-origin cells. Double-hit and triple-hit lymphomas were not found in the 8 DLBCL cases, and 2 cases of HT with lymphoid tissue dysplasia were diagnosed with MALT lymphoma with gene rearrangement testing. The median follow-up time was 47 months (range, 4-160 months), and the overall survival was 80% for MALT lymphoma (8 of 10), 72.7% for DLBCL lymphoma (8 of 11), and 100% for T-cell lymphoma (1 of 1). There was no significant difference between the groups.
PTL mostly affects middle-aged and older adult females with HT, and its main histological type is non-Hodgkin B-cell lymphoma. For patients with HT along with a histologically benign lymphoepithelial lesion, the identification of clonal Ig gene rearrangements is important for differential diagnosis. The prognosis between DLBCL and MALT is not statistically significant.
原发性甲状腺淋巴瘤（PTL）非常罕见。本研究旨在描述原发性甲状腺非霍奇金淋巴瘤的临床特征、病理特征和生存结果，包括克隆性免疫球蛋白（Ig）基因重排在诊断合并桥本甲状腺炎（HT）的甲状腺黏膜相关淋巴组织（MALT）淋巴瘤中的诊断价值。
收集2007年至2021年在我院诊断为PTL的患者的石蜡包埋组织。对临床病理特征和随访数据进行回顾性分析。对疑似PTL的患者进行克隆性Ig基因重排分析。
本研究纳入的22例患者中，17例为女性。诊断时的中位年龄为65.5岁（范围44 - 80岁）。我们检测到11例弥漫性大B细胞淋巴瘤（DLBCL）、10例MALT淋巴瘤和1例T细胞淋巴瘤。共有18例患者（81.8%）处于早期（I/II期）疾病。B细胞淋巴瘤CD20呈弥漫性阳性，但甲状腺来源细胞标记物呈阴性。8例DLBCL病例中未发现双打击和三打击淋巴瘤，2例HT伴淋巴组织发育异常经基因重排检测诊断为MALT淋巴瘤。中位随访时间为47个月（范围4 - 160个月），MALT淋巴瘤的总生存率为80%（10例中的8例），DLBCL淋巴瘤为72.7%（11例中的8例），T细胞淋巴瘤为100%（1例中的1例）。各组之间无显著差异。
PTL主要影响患有HT的中老年女性，其主要组织学类型为非霍奇金B细胞淋巴瘤。对于患有HT并伴有组织学上良性淋巴上皮病变的患者，克隆性Ig基因重排的鉴定对鉴别诊断很重要。DLBCL和MALT之间的预后无统计学差异。
