Department of Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de San Vicente, 88-132, 37007, Salamanca, Spain.
Instituto de Investigación Biomédica de Salamanca IBSAL, Salamanca, Spain.
Langenbecks Arch Surg. 2023 May 24;408(1):206. doi: 10.1007/s00423-023-02945-x.
Surgery of primary thyroid lymphoma (PTL) has been mostly limited to diagnostic work-up. This study aimed to further study its potential role.
This was a retrospective study from a multi-institutional registry of PTL patients. Clinical, diagnostic work-up (fine needle aspiration, FNA; core needle biopsy, CoreNB), contribution of surgery (open surgical biopsy, OpenSB; thyroidectomy), histology subtype, and outcome data were evaluated.
Some 54 patients were studied. Diagnostic work-up included FNA in 47 patients, CoreNB in 11, and OpenSB in 21. CoreNB yielded the best sensitivity (90.9%). Thyroidectomy was performed in 14 patients with other diagnosis (incidental PTL), in 4 for diagnosis and in 4 for elective treatment of PTL. Incidental PTL was associated with not performed FNA nor CoreNB (OR 52.5; P = 0.008), mucosa-associated lymphoid tissue (MALT) subtype (OR 24.3; P = 0.012), and Hashimoto's thyroiditis (OR 11.1; P = 0.032). Lymphoma-related death (10 cases) mostly occurred within the first year after diagnosis and was associated with diffuse large B-cell (DLBC) subtype (OR 10.3; P = 0.018) and older patients (OR 1.08 for every 1-year increase; P = 0.010). There was a trend towards lower mortality rate in patients receiving thyroidectomy (2/22 versus 8/32, P = 0.172).
Incidental PTL accounts for most of thyroid surgery cases and are associated with incomplete diagnostic work-up, Hashimoto's thyroiditis and MALT subtype. CoreNB appears to be the best tool for diagnosis. Most of PTL deaths occurred during the first year after diagnosis and mostly related to systemic treatment. Age and DLBC subtype are poor prognostic factors.
原发性甲状腺淋巴瘤（PTL）的手术治疗主要局限于诊断性检查。本研究旨在进一步探讨其潜在作用。
这是一项来自多机构 PTL 患者登记处的回顾性研究。评估了临床、诊断性检查（细针抽吸活检、CoreNB；开放性手术活检、OpenSB；甲状腺切除术）、组织学亚型和预后数据。
研究纳入了 54 名患者。诊断性检查包括 47 例患者的细针抽吸活检、11 例患者的 CoreNB 和 21 例患者的 OpenSB。CoreNB 的敏感性最高（90.9%）。甲状腺切除术在 14 例其他诊断（偶然 PTL）、4 例诊断和 4 例 PTL 择期治疗中进行。偶然 PTL 与未进行 FNA 或 CoreNB（OR 52.5；P = 0.008）、黏膜相关淋巴组织（MALT）亚型（OR 24.3；P = 0.012）和桥本甲状腺炎（OR 11.1；P = 0.032）相关。淋巴瘤相关死亡（10 例）主要发生在诊断后 1 年内，与弥漫性大 B 细胞（DLBC）亚型（OR 10.3；P = 0.018）和老年患者（每增加 1 年 OR 1.08；P = 0.010）相关。接受甲状腺切除术的患者死亡率较低（2/22 例与 8/32 例，P = 0.172）。
偶然 PTL 占甲状腺手术病例的大多数，与不完全的诊断性检查、桥本甲状腺炎和 MALT 亚型相关。CoreNB 似乎是诊断的最佳工具。大多数 PTL 死亡发生在诊断后 1 年内，主要与全身治疗有关。年龄和 DLBC 亚型是不良预后因素。
