Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Primary thyroid lymphoma is a rare disease that accounts for about 5% of all thyroid neoplasms. It shows a female predominance, especially in women with a pre-existing Hashimoto.s disease. During a 15-year period, 11 patients were diagnosed with primary thyroid lymphoma at Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital. There were no records on associated Hashimoto.s thyroiditis in any of them, which is inconsistent with the international literature reporting on such association in 40%-80% of cases. Painless neck edema was the most common physical symptom for patient presentation. The diagnosis was based on fine needle aspiration cytology, while the spread of disease to other organ systems was ruled out by other studies (computed tomography, ultrasonography and gallium scintigraphy). However, it should be noted that diffuse or nodular lymphoma cannot always be classified only by aspiration cytology. The World Health Organization classification was used. Today, it has been generally accepted that thyroid lymphomas belong to a group of lymphomas associated with mucosa-associated lymphoid tissue (MALT). The most common form of nonHodgkin\u27s lymphoma (NHL) of the thyroid was B-cell phenotype lymphoma with a high malignancy grade. All patients were treated with chemotherapy according to the CHOP protocol (cyclophosphamide, doxorubicin, vincristine, prednisone). Eight patients underwent surgical treatment, three of them for compressive syndrome, followed by radiotherapy. The follow-up of patients with primary thyroid lymphoma revealed high disease aggressiveness and short survival, while complete remission was only occasionally recorded.Primarni limfomi štitnjače su rijetka bolest, a pojavljuju se u oko 5% slučajeva svih neoplazma štitnjače. Češće se javljaju kod žena, osobito onih s prethodno postojećom Hashimotovom bolešću. U Zavodu za hematologiju Kliničke bolnice "Sestre milosrdnice" u 15-godišnjem razdoblju dijagnosticirano je 11 bolesnika s primarnim limfomom štitnjače. Ni za jednog bolesnika, međutim, nije se znalo da boluje od pridruženog Hashimotovog tiroiditisa, što se ne uklapa u podatke iz svjetske znanstvene literature koji govore o 40%-80%. Najčešći simptom koji je doveo bolesnika na pregled liječniku bila je bezbolna oteklina vrata. Dijagnoza je postavljena putem aspiracijske citopunkcije, a ostalim pretragama (CT, UZV, scintigrafija tijela radiogalijem) isključena je proširenost bolesti u druge organske sustave (staging). Treba, međutim, napomenuti kako isključivo citopunkcijom nije uvijek moguće klasificirati difuzni i nodularni limfom. Klasifikacija je provedena prema Svjetskoj zdravstvenoj organizaciji. Danas je općenito prihvaćeno mišljenje da limfomi štitnjače pripadaju skupini limfoma pridruženih mukoznom limfatičnom tkivu (MALT, mucosa associated lymphoid tissue). Najčešći oblik ne-Hodgkinovog limfoma (NHL) štitnjače bio je B stanični fenotip visokog stupnja malignosti. Svi bolesnici su liječeni kemoterapijom po shemi CHOP (ciklofosfamid, doksorubicin, vinkristin, prednizon), a kod 8 bolesnika je primijenjen kirurški zahvat, od toga kod troje zbog kompresivnog sindroma, a potom je provedena radioterapija. Praćenjem bolesnika s primarnim limfomom štitnjače uočena je velika agresivnost bolesti i kratko preživljavanje, ali su rjeđe moguće i potpune remisije
