甲状腺髓外浆细胞瘤1例并文献复习

Thyroid Extramedullary Plasmacytoma: A Case Report and Literature Review

摘要: 目的：通过对原发于甲状腺的髓外浆细胞瘤的病例报道并且进行相关的文献检索及复习，提高临床医师对该疾病的认识和诊断水平。方法：患者为中老年男性，因发现甲状腺结节20余年伴喘憋、声嘶20余天收入院。经B超检测并行甲状腺细针穿刺，后随即进行甲状腺切除术和相关病理诊断。结果：镜下可见细胞有丰富的嗜碱性细胞浆，细胞核偏位，无核仁，可见核周空晕，免疫组化结果显示CD79a(+)、CD38(+)、kappa(+)、CK(−)、TTF-1(−)、CD138(−)，病理诊断为甲状腺髓外浆细胞瘤。术后各项指标恢复正常，未行辅助治疗，随访3年无复发。结论：髓外浆细胞瘤多数发生在包括眼部、小肠和腮腺等软组织在内的消化道及头颈部等部位中。原发于甲状腺的髓外浆细胞瘤较为罕见，在诊断时应与甲状腺髓样癌及其他发生于甲状腺的淋巴造血系统疾病进行鉴别，鉴别方法大多采用免疫组织化学染色检查来进行。

Abstract: Objective: To improve the diagnostic level of primary thyroid extramedullary plasma cell tumor by case report and literature search and review. Methods: The patient was an elderly male who was admitted to the hospital due to thyroid nodules for more than 20 years with wheezing and hoarse-ness for more than 20 days. B-mode ultrasonography and fine-needle thyroid puncture were per-formed, followed by thyroidectomy and pathologic diagnosis. Results: Microscopically, the cells showed abundant basophil cytoplasm, dislocated nuclei, no nucleoli, and perinuclear halos. Im-munohistochemical results showed CD79a(+), CD38(+), kappa(+), CK(−), TTF-1(−), CD138(−), and pathological diagnosis was extramedullary plasmacytoma. All indexes returned to normal after surgery, no adjuvant therapy was performed, and no recurrence was observed for 3 years. Conclu-sion: Extramedullary plasmacytoma mostly occurs in the digestive tract, head and neck, including soft tissues such as eyes, small intestine and parotid gland. The primary thyroid extramedullary plasmacytoma is rare, and needs to be differentiated from medullary thyroid carcinoma and other lymphohematopoietic system diseases, which can be differentiated by immunohistochemical stain-ing and morphological observation.