Orbital non-Hodgkin's malignant lymphoma
Introduction
Introduction to non-Hodgkin's malignant lymphoma of the eyelid Non-Hodgkinsmalignant lymphoma is a group of lymphoid tumors of varying degrees of malignancy. There is a lack of lymphoid tissue in the orbit. The malignant lymphoma originating in the orbit is an extra-glandular lymphoma, accounting for extra-glandular malignant lymphoma. 3%. basic knowledge The proportion of illness: 0.025% Susceptible people: no special people Mode of infection: non-infectious Complications: eye movement disorders
Cause
Eyelid non-Hodgkin's malignant lymphoma
Cause:
The etiology of non-Hodgkin's lymphoma involves a variety of factors including viral bacteria, radiation, certain chemicals, and herbicides. Epstein-Barr virus is known to be associated with high-risk Burkitt lymphoma and extranodal T/NK cell lymphoma nasal type. Adult T-cell lymphoma/blood disease is closely associated with human pro-T-cell virus type I (HTLV1) infection. Gastric mucosa-associated lymphoid tissue lymphoma is a malignant change caused by the initiation of a reactive lesion of H. pylori infection. Radiation exposure, such as survivors of nuclear explosions and nuclear reactor accidents, and cancer patients receiving radiation and chemotherapy, are at increased risk of non-Hodgkin's lymphoma. AIDS Certain hereditary acquired immunodeficiency diseases or autoimmune diseases such as ataxia-telangiectasia combined with immunodeficiency syndrome rheumatoid arthritis, systemic lupus erythematosus Sjögren's syndrome, low Hypergamma globulinemia and long-term immunosuppressive drug therapy (such as organ transplants) caused by immune dysfunction are high risk factors for non-Hodgkin's lymphoma.
Prevention
Eyelid non-Hodgkin's malignant lymphoma prevention
Because the cause of lymphoma patients is not yet clear, there are no targeted preventive measures. The general prevention methods include:
(1) Minimize infection and avoid exposure to radiation and other toxic substances, especially drugs that have an inhibitory effect on immune function;
(2) Appropriate exercise, enhance physical fitness, and improve their disease resistance.
(3) Pay attention to the law of eating, avoid frying and roasting foods, avoid smoking and drinking, and so on, so as not to affect the body's resistance, resulting in genetic mutation.
Complication
Eyelid non-Hodgkin's malignant lymphoma complications Complications, eye movement disorders
1. Local compression combined with eyeball protrusion, limited eye movement, eyeball displacement; compression of nerves and extraocular muscles, causing vision loss.
2. Nasopharyngeal infiltration, causing sore throat, nasal congestion, tonsil enlargement and other complications.
3. Lymphoma also often invades the liver and spleen, manifested as hepatosplenomegaly and jaundice.
4. Skeletal, central nervous system, thyroid, lung, breast, kidney, etc. can be affected, resulting in corresponding symptoms.
Symptom
Eyelid non-Hodgkin's malignant lymphoma symptoms Common symptoms Eyeball can not be free of eye movements, edema, eyeballs, prominent eyelids, drooping lymph nodes
Although the classification of non-Hodgkin's malignant lymphoid tumors is complicated, the clinical manifestations are more consistent and more common in the lacrimal gland. This is due to the presence of lymphoid tissue in the normal lacrimal gland. One or both of the eyelids are swollen, drooping, and Painless hard mass, prominent eyeball, and shift to one side, conjunctival edema, due to invasive hyperplasia of the lesion, affecting the optic nerve and extraocular muscles, vision loss often occurs, eye movement is limited, and even the eyeball is fixed, conjunctiva Invasive, pink fish-like mass can be seen through the conjunctiva. The tumor with higher malignancy develops faster, the eyelids infiltrate and harden, cover the eyeball, and connect with the tumor in the sac, the age and clinical manifestation of the tumor. It is quite similar to lymphatic infiltration inflammatory pseudotumor, especially in the differential diagnosis of lacrimal gland type pseudotumor. Intraorbital malignant lymphoma is sometimes accompanied by lymphadenopathy in other parts, requiring detailed examination.
Examine
Examination of non-Hodgkin's malignant lymphoma of the eyelid
1. Peripheral blood: early bloody images of patients with normal, secondary autoimmune hemolysis or tumor involving bone marrow can cause anemia, thrombocytopenia and hemorrhage, 9% to 16% of patients may have leukemia conversion, common in diffuse small lymphocytic Lymphoma, follicular lymphoma, lymphoblastic lymphoma and diffuse large cell lymphoma.
2. Biochemical examination: there may be erythrocyte sedimentation rate, serum lactate dehydrogenase, 2-microglobulin and alkaline phosphatase increased, monoclonal or polyclonal immunoglobulin increased, the above changes can often be used as tumor burden and disease detection indicators .
3. ESR: ESR increases in the active phase, and the remission period is normal. It is a simple method for determining the remission period and the activity period.
4. Immunophenotypic detection: monoclonal antibody immunophenotyping can identify the cell lineage and differentiation level of lymphoma cells, and commonly used monoclonal antibody markers including diagnosis and typing include CD45 (white blood cell common antigen) for identification. Its leukocyte origin; CDl9, CD20, CD22, CD45RA, CD5, CD10, CD23, immunoglobulin light chain and are used to identify B lymphocyte phenotype; CD2, CD3, CD5, CD7, CD45RO, CD4, CD8, etc. T lymphocyte phenotype was identified; CD30 and CD56 were used to identify anaplastic large cell lymphoma and NK cell lymphoma, respectively, and CD34 and TdT were common in lymphoblastic lymphoma phenotype.
5. Genetics: 90% of non-Hodgkin's lymphomas have non-random karyotype abnormalities, usually chromosomal translocations, partial deletions and amplifications, etc. Different types of non-Hodgkin's lymphomas have According to their respective cytogenetic features, non-Hodgkin's lymphoma is a monoclonal malignant proliferation that occurs in a single parental cell. The gene rearrangement of tumor cells is highly consistent. IgH gene rearrangement is often used as a gene marker for B cell lymphoma, TCR . Or gene rearrangement is often used as a genetic marker for T-cell lymphoma, and the positive rate can reach 70%-80%. Cytogenetics and gene markers can be used for the diagnosis, classification and microscopic lesions of non-Hodgkin's lymphoma. Detection.
6. Bone marrow: early normal, bone marrow can change when the bone marrow is infiltrated in the late stage. If lymphoma cells are found, it can be called lymphoma leukemia.
7. Pathological examination: Visual inspection of lymphoid tumors is a homogeneous yellow or pink mass. Although the internal lobular shape is obvious, the boundary contours are often distinct. Under the microscope, it may be difficult to distinguish these tumors into benign and malignant types. Because they represent a continuum of changes in cell morphology, although some tumors can be clearly diagnosed as benign reactive lymphocytosis, others are diagnosed as malignant lymphoma, but some are in transitional cell morphology called atypical lymphocyte proliferation. In order to solve the diagnosis problem, diagnostic criteria for benign reactivity, atypical lymphoid hyperplasia and malignant lymphoma have been proposed.
Reactive lymphocytosis: the lesion consists of diffusely proliferating lymphocytes. Compared with inflammatory pseudotumor, lymphoid hyperplasia is more pronounced. Lymphoid follicles are more common. The lesions are mainly small and round mature lymphocytes with pulp. The pleomorphic arrangement of cells is characterized by an active mitotic germinal center, a primordial fibrous matrix with several eosinophils and endothelial cell proliferation.
Atypical lymphocytosis: represents an intermediate transitional disease between reactive lymphocytosis and malignant lymphoma. It is characterized by lymphocyte composition. Lymphocytes are diffusely hyperplasia, lymphoid follicles are less, and lesions are mainly mature. The composition of cells, which differs from reactive lymphoid hyperplasia, is that the number of immature lymphocytes is large, and there is a nuclear fission image outside the germinal center.
Malignant lymphoma: consists of morphologically simple, immature lymphocytes or distinctly shaped lymphocytes, with more, larger mitotic figures of degenerative developmental cells, more polymorphonuclear and often coexisting nucleus Ren characteristics, lymphoid follicles are absent or inconspicuous, and endothelial cell proliferation is not obvious.
Histopathologically benign reactive lymphoid hyperplasia shows lymphoid follicles with reactive germinal centers and a variety of cellular components including lymphocytes, histiocytes and plasma cells; malignant lymphomas with lymphoid invasive lesions Cytologically, it is characterized by atypical, atypical cell composition. According to pathological features, it is divided into inflammatory pseudotumor, reactive lymphoid hyperplasia, atypical lymphocyte hyperplasia and malignant lymphoma. Through the organic combination of histopathological classification and immunological classification, it can provide a more reliable basis for clinical diagnosis and treatment. Pathological examination is the main basis for diagnosis of MHL and pathological types.
1. Ultrasound exploration: Because lymphoma is composed of a large number of lymphocytes, the fibrous tissue is sparsely spaced, A-superior shows low reflection within the lesion, the sound attenuation is not obvious, the boundary is clear, and the B-ultrasound shows that the lesion is irregular, flat or Oval shape, clear boundary, less internal echo, light attenuation, generally CDI often found rich blood flow in the lesion.
2. CT scan: Most tumors are located in the front of the eyelid and involve the eyeball, extraocular muscle or optic nerve. The boundary is unclear, the shape is irregular, the enhancement is obvious, and bone destruction is rare, but it can be filled with eyelids.
3. MRI: Lymphoma is mostly located in the lacrimal gland, or in the eyelids. It can also diffuse into the soft tissue of the sputum. On the MRI, TlWI is mostly the middle signal, T2WI is the high signal, or the medium and high heterogeneous signal, the enhancement is obvious, because the lesion is invasive hyperplasia. It can show the normal structure of the eyelids, even full of eyelids.
Diagnosis
Diagnosis and differentiation of non-Hodgkin's malignant lymphoma of the eyelid
According to the history and clinical manifestations, combined with imaging examination, the diagnosis is not difficult, and the final diagnosis depends on the biopsy.
Mainly differentiated from lacrimal gland epithelial tumors, the latter is multi-echo or moderate-high reflex, but it is difficult to distinguish from lacrimal gland pseudotumor. If necessary, biopsy confirms the diagnosis. The most easily confused with lymphocytic inflammatory pseudotumor, two The clinical and imaging findings are similar, only the age of the lymphoma is too large, and the final identification requires pathological confirmation.
