Hodgkin lymphoma
Introduction
Introduction to Hodgkin's lymphoma Hodgkin Lymphoma, formerly known as Hodgkin's disease, Hodgkin's disease, or Hodgkin's lymphoma. It is a cancer that stems from lymphocytes. The name "Hodgkin" is derived from Thomas Hodgkin's first description of the unique malignant disease of this lymphatic system in 1832. It often begins in a group of lymph nodes and then spreads to other lymph nodes or extranodal organs and tissues. Its histopathological features are the appearance of malignant Reed-Sternberg cells. At present, the application of chemotherapy, radiotherapy and bone marrow transplantation in the treatment of Hodgkin's lymphoma has made it a curable tumor. basic knowledge The proportion of sickness: 0.0004%-0.0007% Susceptible people: no special people Mode of infection: non-infectious Complications: nausea and vomiting
Cause
Hodgkin's lymphoma cause
Viral infection (50%):
The cause of Hodgkin's lymphoma is unknown, and the etiology of Epstein-Barr virus is the most concerned. Epstein-Barr virus genome fragments can be detected in RS cells of about 50% of patients. In 1964, epstein and barr successfully established the burkitt African childhood lymphoma cells by in vitro suspension culture, and found the herpes virus particles by electron microscopy in the cell smears.
Genetic factors (25%):
Clinical statistics show that patients with monozygotic twin Hodgkin's lymphoma have a 99-fold increased risk of siblings, probably due to the same genetic susceptibility and/or the same immune abnormalities for the cause.
Autoimmune deficiency (20%):
It is known that patients with immunodeficiency and autoimmune diseases have an increased risk of developing Hodgkin's lymphoma.
Prevention
Hodgkin's lymphoma prevention
Hematological malignancies include major measures for the prevention of malignant lymphoma, and care should be taken to avoid the onset of the disease.
1, prevention of viral infections, such as EB virus, adult T lymphocytic leukemia virus, HIV, etc., in the spring and autumn to prevent colds, strengthen their own protection, overcome bad habits.
2, remove environmental factors, such as avoiding exposure to various rays and some radioactive materials. Avoid contact with related toxic substances such as benzene, vinyl chloride, rubber, arsenic, gasoline, organic solvent coatings, etc.
3. Prevention and treatment of autoimmune deficiency diseases, such as low immune status after various organ transplants, autoimmune diseases, and various cancers after chemotherapy. Graft-versus-host disease or immunosuppressive agents can activate the virus and induce lymphoid hyperplasia.
4, long-term survival patients should regularly check the chest and breast, early detection of treatment-related complications and the possibility of a second tumor.
5, maintain an optimistic, confident health mentality, appropriate physical exercise, help the body's immune function stability, timely removal of external factors.
6. For early-stage diagnosis and early comprehensive treatment for dangerous people or those with risk factors. The treatment of this disease should be comprehensive, in addition to the treatment of the cause, but also nutritional supplements, if necessary, for central venous intubation and parenteral nutrition, supplement blood products as needed.
The success or failure of comorbidity prevention often has a major impact on the prognosis of the disease, especially the prevention and treatment of opportunistic infections in the immunosuppressive phase. Pay special attention to tuberculosis, fungal infections, hepatitis and cytomegalovirus infection.
Complication
Hodgkin's lymphoma complications Complications, nausea and vomiting
Hodgkin's lymphoma is one of the most common malignancies among young people. Lesions mainly occur in lymph nodes, with cervical lymph nodes and supraclavicular lymph nodes being the most common, followed by mediastinal, retroperitoneal, and para-aortic lymph nodes. The lesion begins with one or a group of lymph nodes and usually manifests a regular spread from the primary tumor along the lymphatic to the adjacent lymph nodes. In the advanced stage, hematogenous spread can occur, invading blood vessels, involving the spleen, liver, bone marrow and digestive tract.
Symptom
Hodgkin's lymphoma symptoms Common symptoms Lymphatic outflow herpes lymphadenopathy thrombocytopenia Skin itching immune hemolysis dry cough loss of appetite weight loss sclera yellow stain
The common clinical manifestations of Hodgkin's lymphoma are as follows:
1. Lymph node enlargement is the most common clinical manifestation of Hodgkin's lymphoma. 90% of patients have lymph node enlargement, about 70% have cervical lymphadenopathy, and 50% have mediastinal lymphadenopathy. Lymph node enlargement is often painless and progressive. Lymph node enlargement can impair dysfunction and corresponding clinical manifestations of adjacent organ tissues. Such as one side of the body edema, chest and ascites, oliguria.
2, the clinical manifestations of involvement of extranodal organs: Hodgkin's lymphoma primary lymph node organs or tissues are rare (<10%), primary or extranodal involvement of lymph node organs can cause anatomical and dysfunction of the corresponding organs , causing a variety of clinical manifestations. Common sites are the small intestine, stomach and pharyngeal lymphatic rings. Can involve the nervous system to cause paraplegia, involving bone fractures, can invade bone marrow, breast, thyroid and so on.
3, systemic symptoms can occur in 55% of patients at the time of initial diagnosis, 20% to 30% of patients with fever, night sweats, weight loss. Fever can be low fever, and 1/6 of patients have periodic fever (Pel-Ebstein heat), which is characterized by a gradual increase in body temperature within a few days, reaching 38~40 °C, gradually decreasing after several days, after 10 days or more. During the period, the body temperature rises again and again, and the interval is gradually shortened. In addition, it may have itching, fatigue, and lymph node pain after drinking.
4, the clinical manifestations of different histological types: nodular lymphocytes dominated by 4% to 5% of HL. The median age of onset was 35 years old, more common in men, and the ratio of men to women was 3:1. The lesion usually involves the surrounding lymph nodes. Most of the initial lesions are early localized lesions, and about 80% belong to stage I and II. The natural course is slow and the prognosis is good. The complete response rate for treatment is 90%, and the 10-year survival rate is about 90%. However, patients with advanced stage (III, IV) have a poor prognosis. The lymphocyte-rich classic Hodgkin's lymphoma accounts for about 6%, and the average age is larger, which is more common in men. The clinical features are between nodular lymphocyte-based and classic Hodgkin's lymphoma, often showing early limited lesions, rare massive lesions, mediastinal lesions and B symptoms, with a good prognosis, but the survival rate is better. NLPHL is low. The nodular sclerosis of classical Hodgkin's lymphoma is the most common in developed countries, accounting for 60% to 80%. More common in young adults and adolescents, slightly more women. Often manifested in the mediastinum and other parts of the lymph node lesions. The prognosis is good. Mixed cell types account for 15% to 30% in European and American countries. It can occur on different ages. Clinical manifestations of abdominal lymph node and spleen disease are common changes, about half of the patients have been in the advanced stage (stage III, IV), the prognosis is poor. Lymphocyte depletion is rare, about 1%. More common in the elderly and human immunodeficiency virus (HIV) infection. Often involved in the abdominal lymph nodes, spleen, liver and bone marrow, usually spread widely in the diagnosis, prone to blood spread. Often accompanied by systemic symptoms, the disease progresses rapidly and the prognosis is poor.
Clinical stage
The lesions of Hodgkin's lymphoma range from the Ann Arbor staging system:
Stage I: The lesion is limited to 1 lymph node area or a single extranodal organ (IE) involvement.
Stage II: The lesion involves two or more lymph nodes in the ipsilateral side of the diaphragm, or the lesion is localized to invade the lymph node and more than one lymph node (IIE) on the same side of the diaphragm.
Stage III: There are lymph node lesions on both sides of the diaphragm. May be associated with spleen involvement (IIIS), extranodal organ involvement (IIIE), or spleen and localized extranodal involvement (IIISE).
Stage IV: One or more extranodal organs are extensively disseminated, with or without lymphadenopathy. The liver or bone marrow is in stage IV as long as it is involved.
Group A: no systemic symptoms
Group B: Systemic symptoms: including unexplained fever (>38 ° C for three consecutive days) or night sweats or weight loss (decreased by more than 10% within 6 months).
Examine
Hodgkin's lymphoma examination
Laboratory inspection
(1) Blood shows that anemia is more common in advanced patients, and it is positive pigment and positive cell anemia. Occasionally, hemolytic anemia, 2% to 10% of patients with positive Coombs test. In a few cases, neutrophilia may occur with immunological thrombocytopenic purpura. Whole blood cell reduction is seen in patients with advanced disease or lymphocyte depletion. Peripheral blood lymphocyte reduction (<1.0×10 9 /L), increased erythrocyte sedimentation rate, and elevated serum lactate dehydrogenase can be used as indicators for disease monitoring. Biochemical examination can be seen high blood calcium, high blood sugar and so on.
(2) Immunological examination suggests that the disease has cellular immunodeficiency, showing a delayed skin immune response and a decrease in CD4+ cells.
Image examination
(1) X-ray plain film: Asymmetrical nodular shadows can usually be seen in the bilateral anterior and superior mediastinum.
(2) CT: multiple soft tissue masses can be seen, without necrosis, hemorrhage or cystic changes, and enhanced post-intensification scan. A swollen nodule can eventually lead to a significant mass effect.
(3) MR: A uniform signal lumps showing low T1WI signals and high T2WI signal intensity due to edema and inflammation. A low T2WI signal can help rule out the possibility of recurrence after treatment.
(4) PET-CT: The combination of FDG distribution and CT can effectively assess the extent of disease and the degree of recurrence. Testing after two courses of chemotherapy is an important basis for evaluating whether there are high risk factors for treatment failure and whether such patients can benefit from intensive treatment.
(5) Check bone X-ray and bone scan when suspected bone invasion.
Diagnosis
Diagnosis and differentiation of Hodgkin's lymphoma
diagnosis
The diagnosis of Hodgkin's lymphoma depends mainly on the pathological examination of the diseased tissue, so it is particularly important to perform a biopsy of the diseased lymph node or a thick needle biopsy of the deep tissue. After pathological diagnosis, the extent of the lesion should be determined according to systemic symptoms, physical examination, laboratory examination and imaging examination, and the clinical stage should be defined. Accurate staging is an important basis for developing a correct treatment plan.
Differential diagnosis
The differential diagnosis of this disease often needs to be differentiated from lymphatic tuberculosis, viral infections such as infectious mononucleosis, sarcoidosis and non-Hodgkin's lymphoma. And should pay attention to the identification of metastatic cancer. Cervical lymphadenopathy should exclude nasopharyngeal carcinoma, thyroid cancer, etc., mediastinal masses need to exclude lung cancer, thymoma, axillary lymphadenopathy should be differentiated from breast cancer. The identification of the above diseases mainly depends on histopathological examination. Clinicians should make a comprehensive diagnosis based on the patient's clinical manifestations and pathological findings, including the pathological type and clinical stage grouping of Hodgkin's lymphoma.
