Hamburger J I, Miller J M, Kini S R
Ann Intern Med. 1983 Nov;99(5):685-93. doi: 10.7326/0003-4819-99-5-685.
In 24 of 30 patients with lymphoma of the thyroid, the diagnosis was made preoperatively or without surgery; undifferentiated or poorly differentiated carcinoma was suspected in 3 other patients. Thirteen patients were under 60 years of age; 7 were under 40. An increase in the ratio of men to women was seen among younger patients. At presentation, a discrete nodule was found in 19 patients, and multinodular or diffuse goiters in 11. Seventy-six percent of patients with solitary nodules had enlargement of extranodular tissue. Imaging showed "cold" nodules, cold areas in diffuse goiters, or patchy uptake. Nine patients had obstructive complaints; 12 patients had subnormal thyroid function; 24 patients had coexistent Hashimoto's thyroiditis. Lymphoma of the thyroid was suggested by fine-needle biopsy results in 17 of 28 patients (undifferentiated carcinoma was suspected in 2); and by large-needle biopsy results in 21 of 23 (undifferentiated or poorly differentiated carcinoma was suspected in 2). Biopsy of diffuse Hashimoto's goiters is indicated for cold imaging defects, enlarging tender goiter, or goiter enlarging on thyroid hormone. Early diagnosis may improve prognosis for lymphoma of the thyroid, so that surgery or chemotherapy can be avoided.
在30例甲状腺淋巴瘤患者中，24例在术前或未手术的情况下即得以确诊；另外3例怀疑为未分化或低分化癌。13例患者年龄在60岁以下；7例在40岁以下。年轻患者中男性与女性的比例有所增加。初诊时，19例患者发现有单个结节，11例为多结节或弥漫性甲状腺肿。76%的单发结节患者有结节外组织增大。影像学检查显示“冷”结节、弥漫性甲状腺肿中的冷区或散在性摄取。9例患者有梗阻性症状；1例患者甲状腺功能低下；24例患者并存桥本甲状腺炎。28例患者中有17例细针穿刺活检结果提示为甲状腺淋巴瘤（2例怀疑为未分化癌）；23例中有21例粗针穿刺活检结果提示为甲状腺淋巴瘤（2例怀疑为未分化或低分化癌）。对于弥漫性桥本甲状腺肿，若出现冷成像缺损、甲状腺肿增大且有触痛或甲状腺肿在甲状腺激素作用下增大，则需进行活检。早期诊断可能改善甲状腺淋巴瘤的预后，从而避免手术或化疗。
