Klyachkin M L, Schwartz R W, Cibull M, Munn R K, Regine W F, Kenady D E, McGrath P C, Sloan D A
Department of Surgery, University of Kentucky Chandler Medical Center, Lexington 40536-0084, USA.
Am Surg. 1998 Mar;64(3):234-8.
The role of surgery in the treatment of Stage I and II non-Hodgkin's thyroid lymphoma (NHTL) is not well defined. At our institution, we have treated seven patients (six women and one man) with NHTL during the past 6 years. Three patients (43%) had a prior history of thyroid disease, usually lymphocytic thyroiditis. Clinical symptoms included a rapidly enlarging neck mass (86%), dysphagia (71%), dyspnea (71%), and hoarseness (71%). Five patients (71%) had hypothyroidism; one patient, hyperthyroidism; and one patient, normal thyroid function. Five patients underwent fine-needle aspiration (FNA) at our institution. In three instances, FNA results were indicative of NHTL; the remaining FNA tests yielded no diagnosis. Surgical procedures were varied: incisional biopsy (n = 4), limited tumor debulking with tracheostomy (n = 2), and thyroidectomy (n = 1). Each of the seven patients was found to have large cell lymphoma. Treatment consisted of combination chemotherapy with consolidative irradiation. All tumors dramatically decreased in size soon after the initiation of therapy. One patient refused radiotherapy. All patients except one are still alive (median follow-up, 24 months). In conclusion, 1) a diagnosis of NHTL, although rare, should be considered when patients have rapidly growing goiters; 2) FNA is a useful first step in diagnosing NHTL; 3) NHTL is exquisitely sensitive to both chemotherapy and radiation; 4) surgical intervention is generally confined to incisional biopsy with occasional limited pretracheal tumor debulking; and 5) when a biopsy is obtained from a patient suspected of having NHTL, immediate processing by the pathologist is recommended so that material can be obtained for special studies as needed.
手术在Ⅰ期和Ⅱ期非霍奇金甲状腺淋巴瘤（NHTL）治疗中的作用尚不明确。在我们机构，过去6年里我们共治疗了7例NHTL患者（6名女性和1名男性）。3例患者（43%）既往有甲状腺疾病史，通常为淋巴细胞性甲状腺炎。临床症状包括颈部肿块迅速增大（86%）、吞咽困难（71%）、呼吸困难（71%）和声音嘶哑（71%）。5例患者（71%）有甲状腺功能减退；1例患者有甲状腺功能亢进；1例患者甲状腺功能正常。5例患者在我们机构接受了细针穿刺抽吸活检（FNA）。3例FNA结果提示为NHTL；其余FNA检查未得出诊断结果。手术方式多样：切开活检（n = 4）、行气管切开术的局限性肿瘤减瘤术（n = 2）和甲状腺切除术（n = 1）。7例患者均被诊断为大细胞淋巴瘤。治疗包括联合化疗及巩固性放疗。治疗开始后不久，所有肿瘤大小均显著减小。1例患者拒绝放疗。除1例患者外，所有患者仍存活（中位随访时间为24个月）。总之，1）尽管NHTL罕见，但当患者出现迅速增大的甲状腺肿时应考虑该诊断；2）FNA是诊断NHTL的有用的第一步；3）NHTL对化疗和放疗均极为敏感；4）手术干预一般仅限于切开活检，偶尔进行有限的气管前肿瘤减瘤术；5）当对疑似患有NHTL的患者进行活检时，建议病理学家立即进行处理，以便根据需要获取材料进行特殊研究。
