primary thyroid malignant lymphoma
Introduction
Introduction to primary thyroid malignant lymphoma Primary thyroid malignant lymphoma (PTML) refers to a lymphoma that originates in the thyroid gland and is a rare thyroid malignancy. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: nodular goiter
Cause
Cause of primary thyroid malignant lymphoma
Causes:
The etiology of PTML has not yet been fully clarified and may be related to factors such as viral infection and immune deficiency. According to reports in the literature, 40%-85% of PTML can be combined with chronic lymphocytic thyroiditis (Hashimoto's thyroiditis, HT). It is believed that the pathogenesis of HT may occur due to respiratory virus infection, which leads to the body's immune response, which indirectly proves that PTML may The same pathogenic factors exist, but the relationship between the two has not yet been elucidated. Whether lymphocyte infiltration in thyroid lymphoma leads to the occurrence of HT, or the long-term chronic stimulation of lymphocytes in thyroiditis induces the occurrence of PTML. I believe that the clarification of the relationship between the two will definitely help to discover the cause of PTML.
Pathogenesis:
The vast majority of PTML is a non-Hodgkin's lymphoma derived from B cells. Occasionally, T cell sources are available. Previous thyroid small cell carcinomas have been classified as PTML. PTML is usually a moderately malignant diffuse large cell lymphoma. It has been confirmed that 69% of them are mainly mucosa-associated lymphoid tissue-derived lymphoma, and mucosa-associated lymphoid tissue (MALT) refers to a group of lymphoids with similar distribution characteristics and biological behavior confirmed by pathological immunology. Tissue, mainly located in the gastrointestinal tract, lung bronchus, pharyngeal mucosa, and its related immune activities are mainly located in the mucosa, with a typical "lymphocyte cycle" phenomenon, the thyroid is a preferentially settled MALT organ of circulating lymphocytes, and most of the PTML have MALT lymphoma. specialty.
Pathological classification: Following the pathological classification of NHL, Working Formulation is classified as follows:
(1) Highly malignant (lowly differentiated): large cell immunoblastic; lymphoblastic; no lobulated small cell.
(2) Moderate malignancy (moderate differentiation): diffuse, lobulated cells; diffuse, mixed large, small cells; diffuse large cells.
(3) Low malignancy (high differentiation).
Prevention
Primary thyroid malignant lymphoma prevention
Stay optimistic and happy. Long-term mental stress, anxiety, irritability, pessimism and other emotions will make the balance of the cerebral cortex excitatory and inhibition process imbalance, so you need to maintain a happy mood.
Complication
Primary thyroid malignant lymphoma complications Complications nodular goiter
Some patients can be combined with thyroid thyroiditis (HT), with a nodular goiter about 30%, from onset to symptoms for about 4 months, up to 3 years.
Symptom
Symptoms of primary thyroid malignant lymphoma Common symptoms Thyroid hypofunction Cervical lymphadenopathy Atmospheric tube compression Goiter dyspnea
The clinical manifestations of PTML often include:
1. Often occurring in middle-aged and elderly people, about 23% of them can also occur in young people younger than 40 years old. The average age of patients is about 59 years old.
2. Female patients are more than males, with a male to female ratio of 1:2.7.
3. Patients often show a rapid increase in the thyroid gland in a short period of time, and may have symptoms of trachea and throat compression. The literature reports that there are few fevers, night sweats, and obvious weight loss.
4. Most patients can touch the thyroid mass at the time of treatment. The size of the tumor is different. The texture is hard, often fixed, and the activity is poor. It can involve local lymph nodes and adjacent soft tissues, and 40% of cervical lymph nodes can be enlarged.
5.30% of patients have unclear speech.
6.20% of patients had hoarseness, 10% had dyspnea, and 7% had thyroid dysfunction.
7. Distant metastasis is more common in the mediastinum, visible bone and spleen invasion.
Examine
Examination of primary thyroid malignant lymphoma
1. Blood test: blood routine indicates whether there is anemia or neutropenia.
2. Thyroid function test: suggesting that TG, TM is significantly elevated.
3. Bone marrow puncture: exclude blood diseases.
4. Fine needle aspiration cytology (FNAC): Simultaneous immunological indicators and DNA flow cytology can be performed to further confirm the diagnosis. For example, immunohistochemical staining shows CD20 positive, suggesting B cell-derived lymphoma, sometimes It can be seen that elevated immunoglobulins, especially , light chain overexpression, immunoglobulin gene rearrangement detection suggest clonal aggregation, FNAC can meet the requirements of clinical diagnosis, if suspected HT is difficult to identify, it must be supplemented with the above immune indicators Test and perform a surgical biopsy if necessary.
5. X-ray chest radiograph: can show the mediastinum widening, tracheal compression, etc., and help to understand whether there is chest metastasis.
6. CT scan: chest and abdomen CT, help to understand the presence or absence of mediastinal, lymphoid tissue lesions inside and outside the abdominal cavity.
7. B-ultrasound: liver and spleen B-ultrasound, exclude liver and spleen invasion.
8. Lymphangiography: If lymphedema occurs, radionuclide lymphangiography is required to understand the location of the obstruction.
Diagnosis
Diagnosis and diagnosis of primary thyroid malignant lymphoma
diagnosis
Clinical diagnosis of PTML has certain difficulties. The preoperative diagnosis rate is less than 50%. In recent years, with the advancement of imaging technology and diagnostic technology, the preoperative diagnosis rate has been greatly improved.
1. Clinically, the following conditions should be highly suspected:
1 The thyroid mass rapidly increased in the short term, accompanied by cervical lymphadenopathy.
2 There was hoarseness in the early stage and difficulty breathing.
3 physical examination chest X-ray film suggests widening of the mediastinum, tracheal compression.
4 patients have a history of HT.
5 thyroid function tests suggest that TG, TM is significantly elevated.
2. Auxiliary examination: blood routine, bone marrow puncture, whole body bone scan can exclude blood diseases; fine needle aspiration cytology (FNAC), biopsy can confirm the diagnosis; X-ray examination, CT scan, B-ultrasound, etc. To help detect metastatic lesions.
Differential diagnosis
Benign thyroid nodules, such as adenomas, nodular goiter, common types of thyroid cancer, and thyroiditis, must be excluded before treatment. If necessary, FNAC and related immunological indicators can be used to eliminate them.
