Matsuzuka F, Fukata S, Kuma K, Miyauchi A, Kakudo K, Sugawara M
Kuma Hospital, Kobe, Japan.
World J Surg. 1998 Jun;22(6):558-61. doi: 10.1007/s002689900434.
Thyroid lymphoma occurs most commonly in the thyroid gland in association with Hashimoto's thyroiditis. Histologic findings occasionally cannot distinguish lymphoma from Hashimoto's thyroiditis, which creates a serious problem of whether treatment should be initiated. For this study, we examined 33 lymphoma tissues and 10 thyroid tissues from patients with Hashimoto's thyroiditis for the presence of gene rearrangement of immunoglobulin, which represents clonality of B-cell-derived tumors. Genomic DNA from thyroid tissues was digested with Bam H1 and Hind III restriction enzymes followed by electrophoresis. A Southern blot was performed with an IgH-JH probe or IgL-J kappa probe to detect gene rearrangement. Of the 33 lymphoma tissues, 27 (85%) showed gene rearrangement of immunoglobulin, whereas none of Hashimoto's thyroiditis tissue showed gene rearrangement. Five patients with a positive histologic diagnosis of lymphoma showed a negative gene rearrangement and were treated as having lymphoma. We encountered one case of lymphoma (plasmacytoma) in which gene rearrangement (not histologic findings) was diagnostic. Gene rearrangement of immunoglobulin can be used to detect thyroid lymphoma, particularly when the histologic diagnosis is inconclusive. The sensitivity of detecting thyroid lymphoma by the Southern blot method was about 85% in the present series.
甲状腺淋巴瘤最常发生于与桥本甲状腺炎相关的甲状腺。组织学检查结果有时无法区分淋巴瘤与桥本甲状腺炎，这就产生了是否应开始治疗的严重问题。在本研究中，我们检测了33例淋巴瘤组织和10例桥本甲状腺炎患者的甲状腺组织，以确定免疫球蛋白基因重排的存在，免疫球蛋白基因重排代表B细胞源性肿瘤的克隆性。用Bam H1和Hind III限制性内切酶消化甲状腺组织的基因组DNA，然后进行电泳。用IgH-JH探针或IgL-Jκ探针进行Southern印迹以检测基因重排。在33例淋巴瘤组织中，27例（85%）显示免疫球蛋白基因重排，而桥本甲状腺炎组织均未显示基因重排。5例组织学诊断为淋巴瘤阳性的患者基因重排为阴性，但仍按淋巴瘤进行治疗。我们遇到1例淋巴瘤（浆细胞瘤），其中基因重排（而非组织学检查结果）具有诊断意义。免疫球蛋白基因重排可用于检测甲状腺淋巴瘤，尤其是在组织学诊断不明确时。在本系列研究中，Southern印迹法检测甲状腺淋巴瘤的敏感性约为85%。
