背景:我们报告了一例罕见的甲状腺粘膜相关淋巴组织淋巴瘤(MALT淋巴瘤),其甲状腺模仿无痛性亚急性(DeQuervain)甲状腺炎。
方法:有甲状腺功能减退症病史的患者表现为巨大的非触痛性甲状腺肿,压迫症状和窒息,没有淋巴结肿大.超声(US)显示大的甲状腺叶。有一个小的低回声结节,和非特异性淋巴结病。右侧甲状腺结节细针穿刺/细胞学检查(FNAC)显示滤泡细胞稀少,丰富的多态淋巴细胞,上皮样组织细胞,和可辨认的身体巨噬细胞,提示DeQuervain(肉芽肿性)甲状腺炎。由于压迫症状和巨大的甲状腺肿,决定进行甲状腺全切除术。
结论:术中,甲状腺巨大,没有粘连到束带肌肉/气管。进行甲状腺全切除术和淋巴结活检。没有并发症。术后,病人病情稳定,呼吸正常,脖子上的伤口很干净.PTH为11pg/mL,钙为2.16mmol/L,提示即将发生的短暂性低钙血症。组织病理学显示淋巴上皮病变为甲状腺滤泡上皮(MALT球)内的淋巴细胞簇。免疫组织化学染色显示,肿瘤淋巴细胞为B细胞,B细胞标志物CD20和PAX5染色阳性,但CyclinD1和T细胞标志物CD3,CD5和CD43均阴性。在淋巴瘤MDT会议上对患者进行了讨论,并决定开始患者接受放疗。
结论:甲状腺MALT淋巴瘤可以模拟无痛性亚急性甲状腺炎。非触痛性甲状腺肿大的三联征,在短期内出现压迫症状;FNAC的发现提示甲状腺炎;而US显示甲状腺叶增大可能会使毫无戒心的从业者感到困惑。切除后的组织病理学提供了明确的诊断。
BACKGROUND: We report a rare case of mucosa-associated lymphoid tissue lymphoma (MALT lymphoma) in the thyroid mimicking painless subacute (De Quervain\'s) thyroiditis.
METHODS: Patient with history of hypothyroidism presented with huge non-tender goiter, compression symptoms and choking, no lymphadenopathy. Ultrasound (US) showed large thyroid lobes. There was a small hypoechoic nodule, and nonspecific lymphadenopathy. Fine needle aspiration/cytology (FNAC) of right thyroid nodule showed scant follicular cells, abundant polymorphic lympocytes, epithelioid histiocytes, and tingible body macrophages, suggestive of De Quervain\'s (granulomatous) thyroiditis. Total thyroidectomy was decided due to compression symptoms and huge goiter.
CONCLUSIONS: Intraoperative, thyroid was huge with no adhesions to the strap muscles/trachea. Total thyroidectomy with lymph node biopsy was undertaken. There were no complications. Postoperatively, the patient\'s condition was stable, breathing normally, and neck wound was clean. PTH was 11 pg/mL and calcium was 2.16 mmol/L, suggesting impending transient hypocalcemia. Histopathology showed lymphoepithelial lesions as clusters of lymphocytes within the thyroid follicles epithelium (MALT Balls). Immunohistochemical staining showed that the neoplastic lymphocytes were B cells and stained positive with B-cell markers CD20 and PAX5, but were negative for Cyclin D1 and for T cell markers CD3, CD5 and CD43. The patient was discussed at the lymphoma MDT meeting and the decision was to start the patient on radiotherapy which the patient received.
CONCLUSIONS: Thyroid MALT lymphoma can mimic painless subacute thyroiditis. The triad of a large swelling of non-tender goiter with compression symptoms during a short period; FNAC findings suggestive of thyroiditis; and US showing enlarged thyroid lobes might cause confusion to the unsuspecting practitioner. Histopathology after excision provides definitive diagnosis.