primary bone lymphoma
Introduction
Introduction to primary bone lymphoma Primary bone lymphoma (PBL) refers to lymphoma with lesions limited to the skeletal system, or surrounding soft tissue infiltration, but no systemic symptoms. This disease is rare, accounting for only 5% of extranodal lymphoma lesions. 7% of primary bone tumors. In 1928, Oberling first reported the occurrence of this case. In 1939, Parker and Jackson studied 17 cases that were then called "primary bone reticulum sarcoma" and renamed it primary bone lymphoma. The peak incidence of primary bone lymphoma is around the 1950s. Clinically, it is characterized by localized bone pain, or touching a gradually increasing mass. Pathological fractures in the later stage of the disease may be accompanied by swelling of the surrounding soft tissue. Generally, there are no systemic symptoms such as fever, weight loss, night sweats, etc. CT or MRI can detect the lesion. However, a local biopsy is needed to confirm the diagnosis. Epidemiology: The incidence of men is slightly larger than that of women. The ratio of male to female is 1.6:1. The average age of onset is about 46 years old. The disease is more common in Europe and the United States, rare in China, and has been reported in recent years. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: fracture
Cause
Primary bone lymphoma cause
Pathogenesis
The early pathology of primary bone lymphoma is defined as reticulocyte sarcoma, but with more and further research on these diseases, the recently revised European and American classification criteria have removed this definition, The pathology of most primary bone lymphomas is diffuse large B-cell lymphoma.
According to the study, in 12 cases, all tumor cells have phenotypes of CD45 and CD20+, and 8 cases are monoclonal immunoglobulins (6 IgG, 2 IgM; 7 and 1 ), another Studies of immunophenotypic studies have shown that the response of diffuse large non-cleavable cell lymphoma cells and mature B cell antigens is positive, ie the immunophenotype is CD19+, CD20+, CD22+, + or +, CD5-, CD10- , CD1-, CD2-, CD3-, CD4-, CD7-, CD8-, in a large-scale Mayo clinical study, 75% of primary bone lymphomas are moderately malignant (diffuse mixed or large cell lymphoid) In the other study, 21 of the 27 cases were diffuse large cell lymphoma.
Therefore, the pathological type of primary bone lymphoma is B-cell type, and most of them are diffuse large cell, but due to the low incidence of PLB and the small number of statistics, further research is needed.
Prevention
Primary bone lymphoma prevention
1. Patients with malignant lymphoma should strictly control the intake of high-energy foods such as protein, and eat more green vegetables, which is beneficial to control the further development of lymphoma.
2, patients with malignant lymphoma should also prevent extra-lymphatic diseases. Such as tonsil, oral, nasopharynx, thyroid, gastrointestinal tract, bone, liver, gallbladder and other organ diseases.
3, do not overwork, especially those with gastrointestinal, bone, liver and other diseases, otherwise they will damage these organs, thereby stimulating lymph node hyperplasia.
4, the patient does not drink alcohol, the heat of the wine can cause lymph node pain and hyperplasia.
Complication
Primary bone lymphoma complications Complications
The most common treatment complication of this disease is fracture. The fracture can be caused by the disease itself, or the side effects of radiotherapy, bone vascular necrosis after chemotherapy. In one study, 32 patients received chemotherapy and radiotherapy, and 7 had fractures. However, the dose of radiation (5000 cGy) did not increase the incidence of fractures.
Symptom
Primary bone lymphoma symptoms common symptoms tenderness of the lower sternum, soft tissue swelling, bone pain
The clinical manifestations of primary bone lymphoma are various, generally only local lesions, but no systemic symptoms, patients with local bone pain, skin swelling, movement disorders, or touching the mass, the mass is progressively increased Large, a small number of patients with pathological fractures, the clinical manifestations of the disease, the severity of the disease, the development of the disease in the case of a large difference, and more lesions, disease and complications.
Bone pain is the most common clinical manifestation. Most patients have only osseous infiltration and manifest as simple bone pain. About 1/3 of patients have 2 or more lesions, and 1/3 of patients have only 1 At the site of the lesion, some patients showed both bone pain and local soft tissue swelling and pain, and a small number of patients had local soft tissue changes before the bone lesions.
Long bone is the most common site of lesions. The most common sites are femur, tibia, vertebrae, maxilla, ribs, mandible and so on.
Examine
Primary bone lymphoma examination
Laboratory examination of primary bone lymphoma is radiographic examination, including CT, MRI, radionuclide scanning, etc., while other examinations generally have no special changes, unless in the advanced stage of the disease, further spread of the tumor, or various complications Cause changes in the blood system, bone marrow, nervous system, etc.
X-ray inspection
The X-ray findings of primary bone lymphoma are mostly osteolytic, and the "phagocytic" changes. There is a clear boundary between normal bone tissue and diseased tissue. Some patients have bone cortical damage and defects, but There is little periosteal reaction, and some patients show bone separation, that is, the normal part of the bone tissue is separated from the lesion, and it can also be a pathological fracture.
2. Radionuclide scanning
The Te nuclide scan can find that the density of the lesion area is reduced, and the density of the peripheral area is increased. The Ga nuclear scan shows that the density of the lesion area is increased and the periphery is decreased.
3.MRI
The lesions of the skeletal system are osteoclast, osteolytic, partially osteolytic and partially sclerosing and cortical changes. MRI is more sensitive to the diagnosis of primary bone lymphoma, and other tests can be found negative. Primary bone lymphoma, at the same time, it can detect lesions around the connective tissue.
4. Bone biopsy
The biopsy of PLB can be performed by fine needle aspiration and surgical biopsy. Because of the large amount of artificial crushing damage, fine needle aspiration is more likely to fail. Therefore, surgical biopsy is currently used. Before the surgical biopsy, the doctor should have suspected PLB. The diagnosis is to clarify the location and number of biopsy to avoid blind surgical biopsy, which causes the failure of the operation and requires surgery again to aggravate the patient's pain.
5. According to clinical manifestations, symptoms, signs can choose to do ECG, B-ultrasound, hematuria, routine, biochemical and erythrocyte sedimentation.
Diagnosis
Diagnosis and diagnosis of primary bone lymphoma
Diagnostic criteria
The clinical manifestations of this disease are non-specific. For patients with localized bone pain surrounding soft tissue swelling, or local contact with mass, prone to pathological fractures, the disease may be suspected. Skeletal scan-positive MRI showed space-occupying lesions, and the possibility of primary bone lymphoma should be considered before performing a bone biopsy in order to take sufficient material for pathological examination to confirm the need for pathological biopsy. However, surgical biopsy increases the likelihood of pathological fractures. Most primary bone lymphomas showed IE (60%) stage IV (40%).
Differential diagnosis
1. Other skeletal system primary tumors such as osteosarcoma, Ewing sarcoma, osteoid osteoma, etc., generally have characteristic X-ray findings, such as onion skin-like changes, but a clear diagnosis requires pathological biopsy.
2. Metastatic bone tumors generally have primary diseases, and the lesions are mostly multiple lesions. The primary lesions are mostly breast cancer, prostate cancer, lung cancer, etc., and the identification is easier.
