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目的:探讨甲状腺原发性结外NK/T细胞淋巴瘤的临床病理特征、免疫表型和鉴别诊断。方法:报道1例罕见甲状腺原发性结外NK/T细胞淋巴瘤,并结合相关文献对其临床表现、组织形态学、免疫组化及治疗预后进行分析。结果:患者,男性,84岁。声嘶1个月余,加重伴呼吸困难20 d。扪及双侧甲状腺肿物6 cm×5 cm大小,手术取出灰白灰褐色碎组织大小约为8 cm×4 cm×3 cm,质地中等。切面实性,灰白灰红色,质地嫩,呈鱼肉样外观。镜下甲状腺组织被破坏,可见中等大小的异型瘤细胞弥漫浸润,并见地图样凝固性坏死和围血管破坏。免疫组化:瘤细胞LCA、CD3、CD43、CD2、CD56、Gr B、Ti A-1和CD30均为(+),Ki-67阳性指数(90%)。CK、EMA、S-100、Syn、Cg A、CD20、CD79a、PAX-5、CD21、Bcl-6、Mum-1和ALK均为(-)。结论:甲状腺原发性结外NK/T细胞淋巴瘤是一种罕见肿瘤,恶性度高,确诊需依靠病理学形态特点和免疫组化指标综合判断。鉴别诊断包括未分化癌、神经内分泌癌、PNET、小细胞恶性黑色素瘤。
Objective: To investigate the clinicopathological characteristics, immunophenotype and differential diagnosis of primary thyroid nodular NK / T cell lymphoma. Methods: A rare case of primary extranodal NK / T cell lymphoma of the thyroid was reported. The clinical manifestations, histomorphology, immunohistochemistry and prognosis were analyzed in combination with related literatures. Results: Patient, male, 84 years old. Hoarseness more than 1 month, aggravated with dyspnea 20 d. Palpable bilateral thyroid tumor size of 6 cm × 5 cm, removal of gray-white gray-brown tissue size of about 8 cm × 4 cm × 3 cm, medium texture. Section solid, gray gray red, texture tender, was a fish-like appearance. Microscopic thyroid tissue was destroyed, showing that medium-sized heterotypic tumor cells diffuse infiltration, and see map coagulation necrosis and perivascular destruction. Immunohistochemistry: The tumor cells LCA, CD3, CD43, CD2, CD56, Gr B, Ti A-1 and CD30 were both positive (+) and Ki-67 positive (90%). CK, EMA, S-100, Syn, Cg A, CD20, CD79a, PAX-5, CD21, Bcl-6, Mum-1 and ALK are all (-). Conclusions: The primary thyroid nodular NK / T cell lymphoma is a rare tumor with high malignancy. The diagnosis depends on the pathological features and immunohistochemical evaluation. Differential diagnosis includes undifferentiated carcinoma, neuroendocrine carcinoma, PNET, small cell malignant melanoma.