原发性甲状腺淋巴瘤诊治策略

doi:10.19538/j.cjps.issn1005-2208.2025.09.21

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (09) : 1071-1075. DOI: 10.19538/j.cjps.issn1005-2208.2025.09.21

讲座

原发性甲状腺淋巴瘤诊治策略

黄静，张攀，刘嘉烨，申兵兵，李志辉

作者信息 +

文章历史 +

摘要

原发性甲状腺淋巴瘤（PTL）是一种罕见的甲状腺结外淋巴瘤，占甲状腺恶性肿瘤的1%～5%，多见于中老年女性，80%以上合并桥本甲状腺炎。病人常表现为短期内迅速增大的甲状腺肿块，可伴压迫症状或B症状，临床与甲状腺未分化癌及甲状腺炎相似，易误诊。病理类型以弥漫大B细胞淋巴瘤（DLBCL）最常见，其次为黏膜相关淋巴组织淋巴瘤（MALT），不同亚型侵袭性及预后差异显著。超声引导下粗针穿刺活检联合免疫组化（如CD20、Ki67）及荧光原位杂交（FISH）检测（MYC、BCL2、BCL6）是确诊金标准。治疗策略以病理分型和分期为基础，DLBCL多采用R-CHOP方案化疗联合放疗，而MALT多局限于甲状腺者可行根治性放疗。手术主要用于紧急气道管理或诊断困难病例。预后评估依赖国际预后指数（IPI）、乳酸脱氢酶（LDH）水平及正电子发射计算机断层扫描（PET/CT）。高龄、DLBCL亚型、高IPI评分、TP53突变等为不良预后因素。总体上，PTL对放化疗敏感，早期MALT预后极佳，而侵袭性DLBCL预后较差。多学科协作是提高诊治效果和改善病人生存质量的关键。

Abstract

Primary thyroid lymphoma (PTL) is a rare form of extranodal lymphoma of the thyroid, accounting for 1%-5% of thyroid malignancies. It occurs predominantly in middle-aged and elderly women, with more than 80% of cases associated with Hashimoto’s thyroiditis. Patients typically present with a rapidly enlarging thyroid mass within a short period, often accompanied by compressive symptoms or B symptoms. Its clinical manifestations resemble those of anaplastic thyroid carcinoma or thyroiditis, leading to frequent misdiagnosis. Histologically, diffuse large B-cell lymphoma (DLBCL) is the most common subtype, followed by mucosa-associated lymphoid tissue (MALT) lymphoma, with significant differences in aggressiveness and prognosis between subtypes. Ultrasound-guided core needle biopsy combined with immunohistochemistry (e.g., CD20, Ki-67) and fluorescence in situ hybridization (FISH) for MYC, BCL2, and BCL6 constitutes the diagnostic gold standard. Treatment strategies are based on pathological subtype and disease stage. DLBCL is usually managed with R-CHOP chemotherapy combined with radiotherapy, while localized MALT lymphoma confined to the thyroid may be cured with definitive radiotherapy. Surgery is mainly reserved for urgent airway management or diagnostically challenging cases. Prognostic assessment relies on the International Prognostic Index (IPI), serum lactate dehydrogenase (LDH) levels, and positron emission tomography-computed tomography (PET/CT). Advanced age, DLBCL subtype, high IPI score, and TP53 mutation are adverse prognostic factors. Overall, PTL is highly sensitive to radiotherapy and chemotherapy; early-stage MALT lymphoma has an excellent prognosis, whereas aggressive DLBCL carries a poorer outcome. Multidisciplinary collaboration is essential to improve therapeutic efficacy and enhance patient survival and quality of life.

导出引用

黄静, 张攀, 刘嘉烨, 申兵兵, 李志辉. 原发性甲状腺淋巴瘤诊治策略[J]. 中国实用外科杂志. 2025, 45(09): 1071-1075 https://doi.org/10.19538/j.cjps.issn1005-2208.2025.09.21

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