primary breast malignant lymphoma
Introduction
Introduction to primary breast malignant lymphoma Primary malignant lymphoma of the breast (PMLB) is a malignant tumor that occurs in the lymphoid tissue of the breast. Primary breast malignant lymphoma is rare and is often part of systemic lymphosarcoma and may be associated with less lymphoid tissue in breast tissue. Regarding the source of breast malignant lymphoma, most scholars believe that the mammary gland is a potential site of mucosa-associated lymphoid tissue. The primary malignant lymphoma of the breast is a mucosa-associated lymphoid tissue tumor (MALT), with mammary ducts and intralobular lymph nodes. Tissue malignant transformation is associated with tumor-like hyperplasia, and some people believe that it is derived from the immature undifferentiated mesenchymal cells of the vascular epithelium. Most of the malignant lymphoma of the breast are non-Hodgkin's malignant lymphoma. Microscopically, the malignant lymphoma of the breast has the common point of malignant lymphoma in other parts. The malignant lymphoma of the breast is characterized by diffuse distribution of tumor cells and single cell components. Mostly diffuse large granulocyte type, diffuse large agranulocytic type and diffuse small granulocyte type, other types are rare, no tendency to aggregate into nests, abundant neovascular parenchyma can be seen, tumor cells diffuse infiltration between leaflets and ducts The catheter is not destroyed, and there are no tumor cells and inflammatory exudates in the cavity. basic knowledge The proportion of illness: 0.002% Susceptible people: women Mode of infection: non-infectious Complications: breast cancer
Cause
Primary malignant lymphoma of the breast
Virology (30%):
A special herpes simplex virus (EBV) has been isolated from lymphoma in children in Africa. About 8% of lymphoma patients can be found to have high titers of Epstein-Barr virus antibodies. Therefore, it is envisaged that the production of malignant lymphoma may be The Epstein-Barr virus has a direct relationship.
Ionizing radiation damage (15%):
Long-term exposure to radioactive materials and radiation, such as radiation therapy and radiation workers, has a higher incidence of lymphoma than normal people, so it is believed that ionizing radiation damage may be related to the disease.
Immunosuppression and defects (10%):
In clinical work, it is common to receive large doses of hormone therapy and drugs such as cyclophosphamide, which may lead to the development of malignant lymphoma. This may result in abnormal hyperplasia of T or B lymphocytes due to impaired immune regulation. .
Genetic factors (15%):
In the chromosome examination of lymphoma patients, abnormalities of chromosomes 14, 17, 18 and X are often seen. It is hypothesized that chromosomal abnormalities may be due to congenital chromosomal aberrations or due to DNA damage resulting in abnormal repair function. Reports of diseases.
At present, there is a consensus on the origin of the disease: Janea Lamovec MD et al reported 8 cases of this disease, of which 6 cases of lymphatic invasion of ductal epithelium or lobular epithelium, this epithelial lymphatic invasion showed gastrointestinal and respiratory tract An important feature similar to various mucosa-associated lymphoid tissues, Pattil Cohen (1991) believes that most of the disease originates from B cells, which is considered to be a lymphoid tissue-associated lymphoid tumor with mucosa-associated lymphoid tissue. Occurs, and the vast majority of tissue cytological origin is the origin of B cells.
Pathogenesis
Regarding the source of breast malignant lymphoma, most scholars believe that the mammary gland is a potential site of mucosa-associated lymphoid tissue. The primary malignant lymphoma of the breast is a mucosa-associated lymphoid tissue tumor (MALT), with mammary ducts and intralobular lymph nodes. Tissue malignant transformation is associated with tumor-like hyperplasia, and some people believe that it is derived from the immature undifferentiated mesenchymal cells of the vascular epithelium.
1. The site and course of disease Membo reported that the onset time of this disease is as short as 6 weeks, up to 12 months, more than 2 to 4 months, the tumor is mostly located in the outer upper quadrant of the breast, more common on one side, occasionally double There was a similar chance of breast in the lateral, left and right sides, and there was no significant difference.
2. Pathological morphology Compared with other malignant tumors of the breast, the pathological changes of primary malignant lymphoma of the breast have the following characteristics.
(1) General form: The tumor is mostly nodular, the texture is slightly hard, no capsule or pseudo-envelope, the cut surface is grayish white, the solid tissue is fine and fishy, and there is bleeding and necrosis.
(2) Histomorphology: Most of the malignant lymphoma of the breast is non-Hodgkin's malignant lymphoma. Microscopically, the malignant lymphoma of the breast has the common point of malignant lymphoma in other parts. The malignant lymphoma of the breast is characterized by diffuse tumor cells. Distribution, single cell components, mostly diffuse large granulocyte type, diffuse large agranulocytic type and diffuse small granulocyte type, other types are rare, no tendency to aggregate into nests, abundant neovascular parenchyma can be seen, tumor cells are There is a diffuse infiltration between the leaflets and the catheter, and the catheter is not destroyed, and there are no tumor cells and inflammatory exudates in the lumen.
3. Rye Conference Classification The Rye Conference in 1996 divided breast malignant lymphoma into 4 types: 1 lymphocyte-based. 2 nodular hardening type. 3 mixed cell types. 4 lymphocyte depletion type.
4. Metastatic route Most of the malignant lymphoma of the breast can be seen in both the blood line and the adjacent lymph node invasion.
Prevention
Primary breast malignant lymphoma prevention
(1) Once you find yourself suffering from fibrocystic breast disease, you should treat it immediately, without delaying the timing of treatment.
(2) For women in lactation, milk should be discharged as much as possible during each breastfeeding process, which can increase the secretion of milk on the one hand and reduce the retention time of the last secreted milk in the breast on the other hand.
(3) Women with a family history of breast cancer should go to the hospital for a more comprehensive examination in addition to self-examination.
Complication
Primary breast malignant lymphoma complications Complications
The disease has a high rate of axillary lymph node metastasis, and a few have enlarged neck and mediastinal lymph nodes.
Symptom
Primary breast malignant lymphoma symptoms Common symptoms Repeated bleeding nipple discharge nodules
The clinical features of this disease are similar to those of breast cancer, which are characterized by rapid growth of breast mass, often accompanied by different degrees of fever. The masses are mostly unilateral, rarely bilateral, mostly located in the outer upper quadrant, and the mass is nodular. Or lobulated, hard and tough texture, clear early boundary, movable, no adhesion to skin and chest wall, no nipple depression and discharge, can occupy the entire breast when the mass is huge, the surface is thin, blood vessels are dilated, and even ulceration, most The lesion is confined to the mammary gland, and later spread to the whole body, causing death.
If there are multiple scattered nodules in the patient's breast, the disease should be considered when considering cancer. Detailed examination of the surface lymph nodes, liver and spleen, etc. to exclude systemic lymphoma and leukemia infiltration, it is pointed out that: the primary Sexual breast malignant lymphoma must meet the following conditions: 1 requires pathological materials to meet strict technical requirements. 2 The lymphoma in the breast must be closely linked to the breast tissue. 3 There is no other part of the malignant lymphoma before the appearance of the breast mass. 4 Breast lymphoma is the first or only primary lesion in the clinic, and pathological diagnosis is needed for other difficult to diagnose lesions.
Examine
Examination of primary breast malignant lymphoma
Histopathological examination is the basis for the diagnosis of this disease. It can be seen that the tumor cells are diffusely infiltrated between the mammary gland and the duct, the mammary duct is not damaged, and there are no tumor cells and inflammatory exudate in the lumen. Most of the tumors are non-Hodgkin. Malignant lymphocytes, which have a single cell component, are diffusely distributed, have no tendency to accumulate into nests, and are rich in new thin-walled blood vessels.
1. X-ray examination of molybdenum target, see the nodular type and diffuse type of the mass; the former is a nodule with clear inner edge of the mammary gland, no burr, the common density of the breast is increased, the skin is thickened, the whole breast is invaded, and the subcutaneous fat layer Because of the coarse network of lymphatic vessels, noisy or diffuse X-ray findings are non-specific, similar to mastitis or inflammatory breast cancer.
2. B-ultrasound examination showed a low echo, clear boundary, and there were discontinuous sound and shadow enhancement after the lesion.
Diagnosis
Diagnosis and diagnosis of primary malignant lymphoma of the breast
The disease needs to be differentiated from medullary carcinoma and breast pseudolymphoma, both of which are similar to malignant lymphoma in clinical manifestations and histology.
1. The clinical manifestations and histological findings of medullary carcinoma are very similar, especially when there is a large amount of lymphocyte infiltration in the medullary carcinoma interstitium, which can cover up the cancer, making the two more similar. Special staining distinguishes, the medullary carcinoma has multiple boundaries, the tumor cells do not interweave with the surrounding tissues, and the cancer cells have a tendency to aggregate. The silver staining shows that the reticular fibers surround the periphery of the cell mass, and the cancer structure is revealed. There is no net in the cancer. Fibrous fibers, infiltrating lymphocytes differentiated and matured mostly on the edge of cancer, in addition, cancer cells were abnormally shaped.
In recent years, the application of immunoenzymatic labeling technology has made a major breakthrough in the identification of this disease and breast cancer. Wang Shulun reported that among the 8 cases, 7 cases were identified as B lymphocyte type by enzyme-labeling technique, and only 1 case was undifferentiated.
2. Pseudo-lymphoma of the breast is more common in young women. It has a history of traumatic injury. The path of dull pain in the breast is unclear and nodules. The volume is small, and its diameter is no more than 3cm. It does not involve the ipsilateral axillary lymph nodes. Histology. It can be seen that the mature lymphoma cells infiltrated by the lobules, the lymphoid follicles are formed, and other inflammatory cells such as plasma cells can be seen, and thick-walled blood vessels can be seen in the interstitium.
3. When the histological differentiation of solid ductal carcinoma is difficult, immunohistochemical staining can be performed by means of leukocyte common antigen (Fig. 3).
