| Objective: To investigate the clinical characteristics,diagnosis,treatment and prognostic factors of primary thyroid lymphoma(PTL)in order to improve the understanding of this disease.Methods: The clinical information and follow-up data of 18 patients with PTL treated in the First Affiliated Hospital of Guangxi Medical University from January 2010 to December 2020 were collected.The clinical manifestations,imaging and pathological features,therapeutic effect and prognosis of PTL were analyzed retrospectively.Results: 1.12 cases accounts for aggressive lymphoma,including 10 cases of diffuse large B-cell lymphoma(DLBCL),1 case of B-cell lymphoma that cannot be classified between DLBCL and Burkitt lymphoma,1 case of Grade 3b of follicular lymphoma(FL).6 cases accounts for indolent lymphoma,all of which were mucosal-associated lymphoid tissue(MALT)extranodal marginal zone lymphoma.There were 7 males and 11 females.The ratio of male to female was 1:1.571.The age of onset was 15～74 years,and the median age of onset was 57.5(46.5,69.3)years.2.Among 18 cases of PTL,17 cases(17/18,94.4%)showed a painless and progressively enlargement of the neck,15 cases(15/18,83.3%)were complicated with Hashimoto thyroiditis,and 1 case(1/18,5.6%)with Graves disease.7 cases(7/18,38.9%)with hypothyroidism,and 1 case(1/18,5.6%)with hyperthyroidism.There were 7 cases(7/18,38.9%)in stage IE,7 cases(7/18,38.9%)in stage IIE,and 4 cases(4/18,22.2%)in IV stage according to Ann Arbor stage at the first diagnosis.The proportion of high/ medium and high risk group in the prognostic stratification,the proportion of elevated LDH,tumor size and Ki67(%)of aggressive lymphoma were significantly greater than indolent lymphoma(P < 0.05).3.Among 12 cases of aggressive lymphomas,8 cases received surgery combined with chemotherapy,2 cases received surgery combined with radiotherapy and chemotherapy,1 case received chemotherapy alone,and 1 case received surgery alone.Among 6 cases of indolent lymphomas,3 cases received surgery alone,2 cases received surgery combined with chemotherapy,and 1 case received surgery combined with radiotherapy.18 patients were followed up to May 11,2021,the maximum follow-up time was 92 months,and the median survial was 36.5(10.25,68.0)months.At the end of follow-up,a total of 14 cases were alive including 1 case of recurrence,3 cases died of lymphoma progression,and 1 case was lost to follow-up.The 1,3 and 5 year overall survival rates were 88.2%,88.2%,and 68.2% respectively,while of indolent lymphoma were all 100%.Kaplan-Meier univariate analysis for aggressive lymphoma showed that Hashimoto thyroiditis,airway obstruction,tumor size,chemotherapy and chemotherapy course were important factors affecting the prognosis of patients(P < 0.05).Whether surgery was performed and the operation method had no significant effect on the prognosis(P = 0.629).Conclusions: PTL is more common in middle-aged and elderly women,and usually manifests as a rapidly enlarged painless masses in the neck.The pathogenesis may be closely related to Hashimoto thyroiditis.DLBCL is the most common pathological type,followed by MALT lymphoma.Radiotherapy alone or Surgery alone is recommended for early indolent lymphoma.Comprehensive treatment based on chemotherapy is recommended for aggressive lymphoma,surgical treatment is suitable for assisting pathological diagnosis and relieving airway obstruction.Expanding the scope of surgery may not benefit the prognosis. |
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