【摘要】 目的 探讨原发性甲状腺淋巴瘤的诊断和治疗原则。方法 回顾分析、总结12例原发性甲状腺淋巴瘤的临床、病理特点和治疗、预后情况。结果 12例中女7例，男5例，平均年龄60岁，平均病程11个月； 8例甲状腺蛋白抗体和(或)微粒体抗体升高；病理证实黏膜相关淋巴组织B细胞淋巴瘤(MALT型)3例，黏膜相关淋巴组织B细胞淋巴瘤伴大细胞转化型(MALT伴大细胞转化型)4例，弥漫性大B细胞淋巴瘤(DLBCL型)5例，10例伴有慢性淋巴细胞甲状腺炎或桥本氏甲状腺炎；ⅠE期5例，ⅡE期2例，ⅢE 1例，ⅣE期4例。1例行手术切取活检术，11例行甲状腺腺体切除术，2例同时行气管造口术；10例术后明确行CHOP方案化疗等治疗。12例平均随诊31个月，1例ⅢE DLBCL型、1例ⅣE MALT伴大细胞转化型死亡，10例平均存活36个月。结论 对于老年、有慢性淋巴细胞性甲状腺炎或桥本氏甲状腺炎的病例，应积极处理其迅速出现的甲状腺结节或甲状腺肿大的情况；对于原发性甲状腺淋巴瘤，手术主要起明确诊断的作用，放化疗是其主要的治疗手段；MALT型、Ⅰ～Ⅱ期病例预后较好。

    【关键词】 淋巴瘤；甲状腺；原发性

    Diagnosis and treatment of primary thyroid lymphoma

    LI Xiao-yi, ZHONG Ding-rong, Gao Wei-sheng, et al.

    Department of General Surgery, PUMC Hospital,Beijing 100730, China

    【Abstract】 Objective To discuss the principles of diagnosis and treatment of primary thyroid lymphoma(PTL).Methods The clinical data, including clinicopathologic features, treatment and prognosis of 12 PTL patients were reviewed.Results The patients included 7 women and 5 men, with an average age of 60 years and symptoms duration of 11 months. The level of serum TGAb and TPOAb increased in 8 cases. Histopathology of the 12 patients determined 3 different subtypes: 3 had B-cell lymphoma of mucosal-associated lymphoid tissue(MALT), 5 diffuse large B cell lymphoma(DLBCL), 4 had DLBCL with MALT lymphoma. Hashimoto's disease or chronic lymphocytic thyroiditis were found in 10 cases. 5 cases were stage ⅠE, 2 stage ⅡE, 1 stage ⅢE, 4 cases were stage ⅣE. 1 patient had incisional thyroid biopsy, 11 patients had thyroidectomy with 2 having tracheostomy. 10 patients received chemotherapy after surgery, in which 6 cases were treated with combined-modality approaches. The median follow-up for 12 cases was 31 months, 10 were alive with median survival of 36 months. One patient with DLBCL stage ⅢE and one DLBCL with MALT lymphoma stage ⅣE died.Conclusion Symptoms of rapid thyroid enlargment or nodule in old patients with chronic lymphocytic thyroiditis or Hashimoto's disease should be emphasized. Surgery mainly plays a role of providing an adequate diagnostic biopsy for PTL. Chemotherapy and radiotherapy are the standard treatments for PTL. Patients with MALT lymphoma or stageⅠ～Ⅱ have a good prognosis. ......