gastric remnant lymphoma
Introduction
Introduction to residual gastric lymphoma Benign gastroduodenal ulcer, a malignant tumor that occurs 5 to 10 years after the initial partial gastric resection, is called residual gastric cancer. Malignant lymphoma originates from the residual stomach. It is also a type of residual gastric cancer, but it is clinically disabling. Gastric lymphoma is extremely rare. basic knowledge The proportion of the disease: the majority of patients with gastric resection, the incidence of this disease is about 0.08%-0.09% Susceptible people: no specific people Mode of infection: non-infectious Complications: diarrhea, blood in the stool
Cause
Causes of residual gastric lymphoma
(1) Causes of the disease
The etiology is unknown, and it is speculated that it may be similar to malignant lymphoma of the stomach. The connective tissue near the gastric ulcer lesion is stimulated for a long time, the lymphoid tissue proliferates, the malignant transformation forms a malignant tumor, and the postoperative residual stomach is chemically stimulated by reflux bile and contacts other chemicals. Substances, etc., cause the body's cellular immunity to decline, and induce malignant transformation of residual gastric lymphoid tissue.
(two) pathogenesis
It is generally believed that endoscopic examination revealed that the biopsy tissue obtained from the residual stomach tumor, or the resected mass, was examined by histopathology to confirm that the primary malignant lymphoma occurred in the residual stomach, and the tumor originated from the submucosal lymphoid tissue. Single or multiple, lymphoma is roughly divided into single nodular type, multiple polyposis type, ulcer type and infiltration type.
Prevention
Residual gastric lymphoma prevention
Connective tissue near the gastric ulcer lesions is stimulated for a long time, lymphoid tissue proliferate, malignant transformation forms malignant tumors, postoperative residual stomach is affected by chemical stimulation of reflux bile and exposure to other chemicals, resulting in decreased cellular immunity and induced residual gastric lymphoid tissue. Malignant changes occur. It is not only the disease itself, but also the lesions in other parts of the body. These conditions can add a lot of pain to patients, so active treatment can effectively alleviate the patient's pain and actively prevent it.
Complication
Residual gastric lymphoma complications Complications, diarrhea, blood in the stool
Late in the patient may have loss of appetite, repeated diarrhea, blood in the stool and weight loss.
Symptom
Symptoms of residual gastric lymphoma Common symptoms Loss of blood in the stool, diarrhea, loss of appetite, suffocation, upper abdominal discomfort, abdominal distension, abdominal pain
Because of the occurrence of residual gastric cancer, at least 5 to 10 years after partial gastric resection, in the case report of limited residual gastric lymphoma, the shortest time is 9 years after partial gastrectomy, and most of them are in 20 years. After a year or more, the stump malignant lymphoma appears. Therefore, the residual gastric lymphoma in the middle-aged or more benign partial gastric resection is more likely to occur. The main clinical manifestations are abdominal distension, upper abdominal discomfort, and anti- Acid, hernia, eating sensation of obstruction, progressive increase of abdominal pain, etc., but non-specific, late loss of appetite, repeated diarrhea, blood in the stool, weight loss, sometimes abdomen and mass in the abdomen, barium meal angiography due to surgery, normal morphological changes of the stomach and Secondary mucosal lesions mask early lesions. In typical cases, tumor soft tissue lumps are visible, which are rounded filling defects. However, because the pylorus has been removed, the expectorant rapidly enters the intestinal lumen from the residual stomach, and the residual stomach is located after gastric resection. Under the rib arch, the application of compression technique is limited, and it is often missed or misdiagnosed. X-ray double contrast angiography can be used to detect the lesion, and the early mucosal surface is not affected by lymphoma cells. At the time, endoscopic biopsy or cytology is often negative, and this disease should not be excluded. When the tumor is seen in the residual stomach with multiple nodular tumors, the course of disease has reached the advanced stage.
Examine
Examination of residual gastric lymphoma
Cytological examination of endoscopic biopsy is often negative, but it cannot be excluded.
X-ray showed the characteristics of typical submucosal tumors. Under the barium meal angiography, there were multiple rounded filling defects of the fingertips, the boundary was smooth, the stomach wall was soft, the expansion was good, and the surrounding mucosa was not damaged.
Diagnosis
Diagnosis and differentiation of residual gastric lymphoma
It is extremely rare to have primary malignant lymphoma at the end of the stomach. To consider the primary malignant lymphoma of the residual stomach, there must be a history of 5 to 10 years after partial gastrectomy due to benign disease (pathologically confirmed). It has: no superficial lymph nodes and mediastinal lymphadenopathy; white blood cell count and classification are normal; no other parts of the lesion except for local lymph node enlargement during operation; no signs of liver and spleen, X-ray image is the main examination method, because of lymphatic The lymphoid follicles of the tumors originating in the gastric mucosa can be single or multiple. The X-ray shows the characteristics of typical submucosal tumors. Under the barium meal, there are multiple rounded filling defects of the fingertips, the boundary is smooth, and the stomach wall is soft. The expansion is good, and the surrounding mucosal folds are not damaged. However, the early diagnosis rate of X-ray is not high. The early detection of residual gastric lymphoma depends mainly on endoscopy and biopsy.
The disease has a history of partial gastric resection for 5 to 10 years. The pathology confirmed that the lesion of residual gastric lymphoma was infiltrated by the submucosal submucosal to the lower end of the esophagus, but there was no stenosis obstruction in the lower esophageal sacral tendon. Absolutely ruled out other cancers, submucosal leiomyomas usually occur in the fundus and cardia area, lesions more than 3cm, multiple, can be fused and lobulated, mucosa forming "bridge" folds, tumor surface Necrosis can be seen with ecchymosis, which can be distinguished from residual gastric lymphoma, gastric varices and gastric mucosal giant hypertrophy (M-éntrier's disease), and the cerebral palpebral filling defect with X-ray findings of irregular sputum is characteristic. The former is associated with lower esophageal varices and portal hypertension; the latter is associated with hypoproteinemia, which is different from residual gastric lymphoma.
