primary lymphoma of bone
Introduction
Introduction to primary lymphoma of the bone The primary lymphoma of the bone is a primary lymphoma that originates in the bone. If left untreated, the lesion may be confined or appear to be confined to one or more bones for several years; if treated, the likelihood of healing Large, primary lymphoma of the bone is a round cell sarcoma of lymphocytes originating from the bone marrow. Its histological features, clinical features, disease course and prognosis are significantly different from Ewing's sarcoma, but the boundaries between the two are not always Obviously, the difference between the primary lymphoma of the bone and the systemic lymphoma is less obvious. The primary lymphoma of the bone does not have a morphological and immunological classification like systemic lymphoma. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: anemia
Cause
Primary lymphoma cause of bone
1. The tumor tissue seen by the naked eye is grayish white, soft in texture, rich in liquid, and is myeloid. It is difficult to distinguish it from malignant lymphoma, Ewing's sarcoma and any cell-rich sarcoma.
Similar to Ewing's sarcoma, the primary lymphoma of the bone invades or spreads within the cortex, and multiple tumor nodules and/or extensive infiltration of the tumor can be found in bones that are quite distant from the primary lesion.
Like Ewing's sarcoma, the primary lymphoma of the bone often has hemorrhage, necrosis and liquefaction in the tumor tissue, and the liquefaction zone can be mistaken for osteomyelitis during surgical exploration.
Sometimes the regional lymph nodes can be swollen, tough and elastic, and occasionally fused into a piece. On the cut surface, the medulla of the lymph nodes can be partially or completely replaced by white swollen myeloid tumor tissue.
2. Under the microscope, the tumor tissue is rich in cells, and the cytoplasm is light and light. Some of the cells have abundant cytoplasm and clear boundaries. The cytoplasmic processes can be combined with each other to form a fine intercellular network.
The nucleus is usually larger than the Ewing's sarcoma, the size is different, the polymorphism is obvious, the shape can be round or oval, and it can be pear-shaped or have a notch or lobulated shape, and some cells can have a larger nucleus. Or dual-nuclear, but no megakaryocytes, chromatin can be fine particles, can also be larger agglomerate, the nucleus often has a cavity, there may be one or more nucleoli volume can be large, the split phase is more common, in Lymphocytes and lymphocytes are often found in the middle of these reticulocytes.
Collagen bands of varying thickness can be seen in the tumor tissue, and the tumor tissue is divided into irregular leaflets. Silver staining often but not always shows a thick reticular fibrous tissue, which surrounds the small cell population. The base was wrapped around a single cell, PAS staining was negative, no glycogen was found in the cells, and immunohistochemistry (uncalcified specimens) showed positive lymphocyte markers.
In primary lymphomas with well-differentiated bone, the cells are small in size and appear to be lymphocyte-like. Compared with Ewing's sarcoma, the nucleus is smaller, the color is darker, and the cytoplasm is more clearly defined.
Prevention
Primary lymphoma prevention of bone
Without effective preventive measures, early detection and early diagnosis and early treatment are the key.
Complication
Primary lymphoma complications of the bone Complications anemia
The lesion may be associated with dead bone formation and periosteal reaction.
Symptom
Symptoms of primary lymphoma of the bone Common symptoms Radiation pain Leukocytosis Bone pain Lymph node enlargement ESR increased
Compared with Ewing's sarcoma, the most prominent feature of primary lymphoma of the bone is that the patient's general condition is good, at least for a longer period of time, without fever, anemia, weight loss, ESR, and white blood cells. increase.
The main symptom is pain, which can be intermittent and mild pain for a long time. Other possible symptoms include local swelling and pathological fractures, such as spinal nerve root compression, possibly radiation pain and neurological dysfunction, and Ewing's sarcoma. The incidence of regional lymphadenopathy is lower.
When primary lymphoma is suspected or diagnosed as bone, all bones (bone scans), lymph nodes, liver, spleen, bone marrow smear, and peripheral blood should be examined.
Examine
Examination of primary lymphoma of the bone
The imaging findings of primary lymphoma seen from X-rays are not significantly different from those of Ewing's sarcoma. There is no typical imaging manifestation. The difference from Ewing's sarcoma is that it grows slowly, usually in adulthood, periosteum. Reactive osteogenesis is less.
The imaging of primary lymphoma of the bone is characterized by osteolytic lesions, usually point-soluble bones, blurred borders, and bone destruction often manifests as worm-like. In rare cases, osteolytic bone can be fused into a uniform solution. Bone image.
Beside the osteolytic bone, there may be an area of increased bone density, which is reactive osteogenesis, which is diffusely infiltrated by the tumor tissue and is not reabsorbed. The image of a few cases may mainly be characterized by high density of bone sclerosis.
Cortical bone is generally interrupted, but sometimes it can remain relatively intact. In the advanced stage, the tumor can spread into soft tissues. The formed mass is X-ray transparent, the boundary is blurred, and there may be some reactive ossified streaks. The outer periosteum is not or very Less reactive osteogenesis, such as patients with adolescents, and the tumor is located in the backbone, the ossification of the outer periosteum may be active, but rarely produce onion-like images, pathological fractures are common.
The primary anatomical lesion of the primary lymphoma of the bone is usually much larger than the extent of the lesion seen on the image, similar to Ewing's sarcoma. In this sense, bone scan and MRI are more accurate due to bone. The course of primary lymphoma is slow and lacks symptoms. In some cases, the lesion has been in existence for a long time at the time of diagnosis, and the extent of the lesion on the image can be large. Sometimes, the tumor can invade the entire bone in the image. Half, even the entire backbone.
Lymphangiography can check whether regional lymph nodes are involved. Bone scan can exclude other bone lesions, as well as isotope scans of liver and spleen.
Diagnosis
Diagnosis and diagnosis of primary lymphoma of bone
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
The clinical and imaging findings of primary lymphoma of certain bones may be similar to certain non-neoplastic diseases such as osteomyelitis and eosinophilic granuloma, but in most cases, the imaging manifestations are neoplastic changes, but specific In one case, it may be confused with fibrosarcoma, malignant fibrous histiocytoma, Ewing's sarcoma or osteosarcoma.
In the operation, a small number of cases of tumor tissue were clearly liquefied and wrapped, which may be misdiagnosed as osteomyelitis.
Diagnosis depends on pathological diagnosis, but sometimes pathology is difficult to determine the diagnosis. If the tumor tissue with the above histological features is taken from the lymph nodes, the diagnosis can be confirmed, which can be confused with Hodgkin's sarcoma, but when the tissue is derived from bone. It is difficult to distinguish from Ewing's sarcoma.
Finally, in a few cases, the primary lymphoma of the bone needs to be differentiated from the bone metastasis of undifferentiated epithelial carcinoma, the bone lesion of histiocytosis X, which is due to the edge of the primary lymphoma lesion of the bone. The inflammatory response is obvious.
