benign lymphoepithelial disease
Introduction
Introduction to benign lymphoepithelial disease Benignlymphoepitheliallesion (benignlymphoepitheliallesion), also known as Mikulicz disease, is a diffuse infiltration of lymphocytes in the lacrimal gland and parotid gland. It also has lacrimal ductal myoepithelial hyperplasia, a benign lesion of lymphoid and epithelial cells. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: eyeballs
Cause
Causes of benign lymphoid epithelial disease
Causes:
The cause is unknown. The cause of this disease needs further study. It belongs to a kind of idiopathic inflammation, which may be an autoimmune lesion limited to the lacrimal gland and parotid gland.
Pathogenesis
May be an idiopathic inflammation associated with autoimmunity, the specific pathogenesis is unclear.
Prevention
Prevention of benign lymphoepithelial disease
1. Rodent control is the most important measure to prevent bites by rats or other animals. The laboratory staff who are in contact with the rats should pay attention to protection and wear gloves. In case of being bitten, in addition to topical treatment, penicillin should be injected immediately.
2, reasonable nutrition, physical exercise, physical fitness, prevention of colds are also beneficial to the prevention of streptococcosis.
3, Chinese medicine believes that physical decline, drinking, food, depression, over-eating fat and so on, may cause streptococcosis.
Complication
Benign lymphatic epithelial complications Complications
The position of the eyeball caused by the swelling of the lacrimal gland is abnormal in the state of motion, such as the protrusion of the eyeball, and the movement of the eyeball in some directions is abnormal.
Symptom
Symptoms of benign lymphoid epithelial disease Common symptoms Eye pain Eyeball prominent lacrimal gland enlargement
The disease can occur at any age, more common on both sides, the history of the progressive lacrimal gland enlargement, painless, swelling of the upper eyelid skin, lumps and masses outside the eyeball, prominent eyeballs, middle-aged women with lacrimal gland enlargement, at the same time When there is dry mouth and bilateral parotid gland enlargement, benign lymphoid epithelial lesions of lacrimal gland should be considered. The lacrimal gland gradually enlarges, soft and elastic, no tenderness, swelling of the upper eyelid skin, obvious to the lateral side, without eye red pain, lacrimal gland Swelling can cause the eyeball of the affected side to protrude and shift to the lower part of the nose. The patient has limited up-turning. Some patients may have refractive changes due to oppression of the eye caused by lacrimal gland masses. The general lacrimal gland is not affected, and the patient may have no dry eye. Symptoms such as eye pain and foreign body sensation. Because the bilateral parotid glands are involved at the same time, the patient may have bilateral parotid gland enlargement, accompanied by dry mouth, dry throat and other symptoms.
Examine
Examination of benign lymphoepithelial disease
1. Circulating immune complex (CIC).
2. IgM, IgG, IgA.
3. Antinuclear antibodies (ANA), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR).
4. PCR: PCR detection of IgH gene rearrangement confirmed that lymphocytes were polyclonal, L26 positive for B lymphocytes, and UCHL positive for T lymphocytes, indicating that lymphoid lesions are composed of B and T lymphocytes.
5. Pathological examination: The benign lymphatic epithelial disease is limited by the lacrimal gland capsule. The inflammation mainly occurs in the lacrimal gland. There are more lymphocytes infiltrating in the lacrimal gland matrix. The muscle epithelium of the duct grows to form the so-called myoepithelial island. The island seems to be Floating in the ocean of lymphocytes, lacrimal gland parenchyma rarely occurs, parenchymal lymphoid follicles are not obvious, which is different from lacrimal gland pseudotumor formation, in inflammatory pseudotumor, a variety of inflammatory cell infiltration, lymphatic filtration The vesicles were obvious, the parenchymal fibrosis was obvious, immunohistochemical staining, positive lymphocyte , staining, indicating double light chain expression, positive for Keratin staining of myoepithelial island, indicating that the island cells are epithelial sources, and Desmin staining confirmed that these cells have muscle fibers. The characteristic, myoepithelial island is not a unique pathological feature of benign lymphoepithelial neoplasia. In 30% to 50% of cases of Sjögren syndrome, muscle epithelial islands are also formed due to residual ductal myoepithelial hyperplasia, and myoepithelial islands are found in lacrimal gland biopsy. In the case of clinical manifestations, approximately 25% of patients may be Sjögren combined with the remaining patients with benign lymphatic epithelial lesions.
6. Both B-ultrasound and MRI can detect the mass above the iliac crest, mostly bilateral; the size of both sides is similar, but the size can be different; the shape of the mass is different, mostly long flat, regular, can surround the eyeball, lump Obviously strengthen; the lesion adjacent to the external rectus muscle can be thickened, the thickening of the muscle bundle can be extended to its stopping point, should be combined with clinical dry eye, dry eye symptoms diagnosis.
7. Orbital CT scan: It can show the soft tissue mass enlargement in the lacrimal gland above the bilateral eyelids, the density is uniform, the boundary is clear, and there is no sacral destruction sign.
Diagnosis
Diagnosis and differentiation of benign lymphoepithelial disease
diagnosis
Unilateral lacrimal gland enlargement with bilateral parotid gland enlargement without ocular dryness and other systemic lesions, suspected of benign lymphoproliferative disease, biopsy if necessary, lymphocytic infiltration in the lacrimal gland, also seen in myoepithelial When the island is formed, the disease can be diagnosed. The CT scan shows the soft tissue mass above the eyelid, the density is uniform, the boundary is clear, and the humerus is not damaged.
Differential diagnosis
1. Inflammatory pseudotumor: Inflammatory pseudotumor causes lacrimal gland enlargement, but the parotid gland is not swollen. There is no myoepithelial island in histopathological examination of inflammatory pseudotumor. It is characterized by various inflammatory cell infiltration and fibrous tissue hyperplasia. These pathological changes are different from benign lymphoproliferative diseases. Lymphoma can also enlarge the lacrimal gland, but the tumor is not limited to the growth of the capsule. The tumor can invade the fat in the sputum. There are a lot of lymphocytes in the tumor tissue, but there is no myoepithelial island. .
2. Castleman's disease: Castleman's disease can cause painless enlargement of lacrimal gland, swollen parotid gland, hepatosplenomegaly, its pathological features are lymphocyte infiltration, lymphoid follicle formation, and there may be transparent blood vessels in the germinal center, but no Myoepithelial island.
