Fujikawa M, Okamura K, Sato K, Mizokami T, Tanabe S, Ikenoue H, Okamura S, Ohta M, Fujishima M
Second Department of Internal Medicine, Kyushu University, Fukuoka, Japan.
Clin Endocrinol (Oxf). 1998 Aug;49(2):191-6. doi: 10.1046/j.1365-2265.1998.00496.x.
The surface phenotypes of intrathyroidal lymphocytes have been studied in various thyroid diseases. In most of the previous reports, intrathyroidal lymphocytes were obtained by surgical operation. We evaluated the usefulness of surface phenotype study of intrathyroidal lymphocytes obtained by fine needle aspiration in the diagnosis of Graves' disease, chronic thyroiditis, and malignant lymphoma of the thyroid.
Eighty-seven untreated patients including 24 with Graves' disease, 59 with chronic thyroiditis, and 4 with malignant lymphoma of the thyroid, and 2 treated patients with malignant lymphoma of the thyroid were studied. Surface phenotypes of the peripheral lymphocytes and the intrathyroidal lymphocytes obtained by fine needle aspiration were analyzed using a FACScan and the monoclonal antibodies: anti-Leu5b/CD2, Leu4/CD3, Leu3a/CD4, Leu2a/CD8, and Leu12/CD19. Percentages of cells positive for each monoclonal antibody were calculated. In one case with malignant lymphoma, monoclonal antibodies to surface-immunoglobulin markers were also studied.
In peripheral lymphocytes, the percentage of positive cells in each phenotype was almost normal in each disease. In intrathyroidal lymphocytes, the percentage of CD19 positive cells was increased, and the percentage of CD2 and CD3 positive cells was reduced compared to those of peripheral lymphocytes in each disease. The percentage of intrathyroidal CD19 positive cells was remarkably high in malignant lymphoma, constituting more than 70% of cells. In Graves' disease, a relative decrease in the percentage of intrathyroidal CD4 positive cells and an increase in CD8 positive cells compared to peripheral lymphocytes were observed. In 2 treated patients with malignant lymphoma of the thyroid, the intrathyroidal CD19 positive cells almost disappeared in a patient shortly after successful treatment, and reappeared to constitute 76% of cells in a patient in relapse. In one case with malignant lymphoma in which monoclonal antibodies to surface-immunoglobulin markers were studied, the clonality of the affected cells could be demonstrated; more than 70% of the cells were positive for kappa light-chain and mu and delta heavy-chain. This finding was proved by subsequent immunohistochemical study based on open biopsy.
Surface phenotype study of intrathyroid lymphocytes obtained by fine needle aspiration has limited utility in the evaluation or diagnosis of Graves' disease and chronic thyroiditis. However, this simple rapid method is very helpful in the diagnosis and follow up of malignant lymphoma of the thyroid.
已对各种甲状腺疾病中甲状腺内淋巴细胞的表面表型进行了研究。在大多数先前的报告中，甲状腺内淋巴细胞是通过外科手术获取的。我们评估了通过细针穿刺获取的甲状腺内淋巴细胞表面表型研究在格雷夫斯病、慢性甲状腺炎和甲状腺恶性淋巴瘤诊断中的实用性。
对87例未经治疗的患者进行了研究，其中包括24例格雷夫斯病患者、59例慢性甲状腺炎患者和4例甲状腺恶性淋巴瘤患者，以及2例接受治疗的甲状腺恶性淋巴瘤患者。使用FACScan和单克隆抗体：抗-Leu5b/CD2、Leu4/CD3、Leu3a/CD4、Leu2a/CD8和Leu12/CD19分析外周淋巴细胞和通过细针穿刺获取的甲状腺内淋巴细胞的表面表型。计算每种单克隆抗体阳性细胞的百分比。在1例甲状腺恶性淋巴瘤患者中，还研究了针对表面免疫球蛋白标志物的单克隆抗体。
在外周淋巴细胞中，每种疾病中各表型阳性细胞的百分比几乎正常。在甲状腺内淋巴细胞中，与每种疾病中外周淋巴细胞相比，CD19阳性细胞的百分比增加，而CD2和CD3阳性细胞的百分比降低。甲状腺内CD19阳性细胞的百分比在恶性淋巴瘤中显著升高，占细胞的70%以上。在格雷夫斯病中，观察到与外周淋巴细胞相比，甲状腺内CD4阳性细胞的百分比相对降低，而CD8阳性细胞增加。在2例接受治疗的甲状腺恶性淋巴瘤患者中，1例患者成功治疗后不久，甲状腺内CD19阳性细胞几乎消失，而在复发患者中重新出现，占细胞的76%。在1例研究了针对表面免疫球蛋白标志物单克隆抗体的甲状腺恶性淋巴瘤患者中，可证明受影响细胞的克隆性；超过70%的细胞κ轻链以及μ和δ重链呈阳性。这一发现通过随后基于开放性活检的免疫组织化学研究得到证实。
通过细针穿刺获取的甲状腺内淋巴细胞表面表型研究在格雷夫斯病和慢性甲状腺炎的评估或诊断中的实用性有限。然而，这种简单快速的方法在甲状腺恶性淋巴瘤的诊断和随访中非常有帮助。
