Vulvar malignant lymphoma
Introduction
Introduction to vulvar lymphoma Malignant lymphoma involving the reproductive tract is usually part of a systemic disease, but primary vulvar lymphoma has also been reported. Malignant lymphoma is divided into two major categories according to clinical and pathological: Hodgkin's lymphoma (HD) and non-Hodgkin's disease lymphoma (NHL). basic knowledge The proportion of illness: 0.00035% Susceptible people: women Mode of infection: non-infectious complication:
Cause
The cause of vulvar lymphoma
(1) Causes of the disease
The occurrence of vulvar lymphoma may be related to local infection. Epstein-Barr virus can be found in patients with vulvar lymphoma. The incidence of non-Hodgkin's disease lymphoma (NHL) is higher in HIV infection. Immunosuppression is closely related. Some congenital immune defects are often complicated by malignant lymphoma. Some bacterial infections such as Helicobacter pylori (HP) and environmental factors such as insecticides, pesticides can cause the disease.
(two) pathogenesis
The tumor cells of malignant lymphoma, including lymphocytes, lymphoblasts, and reticulocytes, have varying degrees of variability. The tumor cells are scattered or densely distributed, and there are mitotic figures, and the tumors and surrounding tissues are unclear.
1. Histological classification
According to the histocytic morphology, it is divided into non-Hodgkin's lymphoma and Hodgkin's disease. The histological classification of non-Hodgkin's lymphoma mainly includes Rappaport classification (1966), Lukes and Collins classification (1975), and international NHL work classification (1981). National Clinical Cancer Institute (NCI) clinical classification (1989), but these classifications do not include important prognostic features such as immunophenotype, and do not include mantle cell lymphoma and anaplastic large cell lymphoma. The new type, so in 1995 the International Lymphoma Cooperative Group proposed a new classification system - "Revised European-American Lymphoma REAL" (Revised European-American Lymphoma REAL).
2. Immunohistochemistry
The leukocyte common antigen CD45 is positive, the B cell type also shows CD20, CD45RA, CD45RB, CD74 and CD79a positive, the T cell type is mostly CD3, CD4, CD45RO positive, CD30 is Hodgkin's disease and anaplastic large cell lymphoma. Diagnostic sign.
3. Types of vulvar lymphoma
Of the 16 patients summarized by Kaplan et al, 5 were reticulum sarcoma and 1 was lymphosarcoma. For example, according to the NHL work classification criteria, 8 of them were diffuse large cell type, and 14 cases of primary vulva reported by Macleod et al. Among the malignant lymphomas, 13 were NHL, 10 (77%) were diffuse large cell type, 1 case was small cell type, 2 cases were diffuse cell type, and 6 cases were immunophenotypic, 4 cases. For the B cell type, Vang et al. reclassified patients according to the revised classification of the European and American lymphomas. It was found that 7 of the 10 cases of primary vulvar NHL were diffuse large cell type, and diffuse mixed type, peripheral T There were 1 case of cell lymphoma and 1 large follicular cell type, 8 of which were immunotyped, 6 cases of B cell type; 4 cases (50%) of 8 cases of secondary vulvar NHL were diffuse large cell type. Peripheral T-cell lymphoma, follicular-type small-splitting cells, small lymphocyte type and sputum-like candidiasis, 1 case, 5 of 9 patients with no-stage data were diffuse large cell type, and Boji Special lymphoma, vascular central cell lymphoma, lymphoplasmacytoid lymphoma, etc.
Prevention
Vulvar lymphoma prevention
Do a good job according to the tertiary prevention of the tumor.
Complication
Vulvar lymphoma complications Complication
Tumor rupture infection.
Symptom
Vulvar lymphoma symptoms common symptoms lymphatic rupture skin itching inguinal lymphadenopathy lower extremity edema sexual intercourse difficult edema caper vaginal bleeding nodular vulvar skin swelling
History
The incidence of non-Hodgkin's lymphoma in HIV-infected patients is 20 times higher than that in non-infected patients. Therefore, patients with vulvar non-Hodgkin's lymphoma need to be routinely examined for HIV, and 2 patients have a history of immunosuppression, 1 case Azathioprine was taken for dermatomyositis, and azathioprine and prednisone were continued after renal transplantation. In 8 cases of secondary vulvar NHL, 4 cases had a history of NHL and 1 case had a history of chronic lymphocytic leukemia. Vang 2000).
2. Symptoms and signs
The course of disease varies from 1 to 39 months. Common vulvar skin swelling or subcutaneous nodular mass, accompanied by pain, difficulty in sexual intercourse, skin itching, vaginal bleeding, drainage, mass size 3 ~ 14cm, average 5.5cm, tenderness Obviously, the surface of the skin erythema or edema, ulceration, there are only manifested as lower extremity edema, occasionally accompanied by fever and weight loss, some patients with anemia, often accompanied by bilateral inguinal lymphadenopathy, patients often due to lump, bleeding and pain In some cases, the lumps can be unchanged for several years.
Examine
Examination of vulvar lymphoma
Immunohistochemical detection.
Histopathological examination.
Diagnosis
Diagnosis and differentiation of vulvar lymphoma
diagnosis
Fox et al have thought that the diagnosis of primary vulvar lymphoma must meet the following criteria:
1. Clinically, the lesion is confined to the vulva. After systemic examination, it is not possible to find lymphoma in other parts of the body. Only the vulva should be considered, but the malignant lymphoma adjacent to the lymph nodes or organs should be excluded from spreading or infiltrating into the vulva.
2. There should be no abnormal cells in the peripheral blood and bone marrow.
3. If a secondary lymphoma appears in a distant location, it must be separated from the primary lymphoma for several months.
4. There was no history of lymphoma in the past, and Boston et al. (1974) suggested that the number of months should be clearly 6 months.
Macleod et al suggest that it is best to use a vulvar mass incision or excision biopsy, because acupuncture or needle biopsy may be due to the organization of the tissue, too few cells can not be qualitative, and can not be classified, in addition, a whole body examination including blood Learning such as erythrocyte sedimentation rate, serum lactate dehydrogenase, chest X-ray, abdominal and pelvic CT or MRI, bone scan, bone marrow biopsy, etc., to clear the primary or secondary, and conducive to accurate staging, NHL staging standards are mainly used Ann Arbor staging (1971), the stage of vulvar NHL can also refer to the FIGO staging method, but the Ann Arbor staging is more telling the problem and can guide the clinical treatment.
Ann Arbor staging of the female reproductive tract NHL:
IE: The tumor is confined to the vulva, vagina, cervix, and uterus.
IIE: Tumor and involving the ipsilateral pelvic or abdominal lymph nodes.
IIIE: Tumors and involve bilateral pelvic or abdominal lymph nodes.
IV: Tumor and involving the ovaries, bone marrow.
Each stage was divided into A, B, A: asymptomatic according to the presence or absence of systemic symptoms, B: no cause of fever > 38 ° C for more than 3 consecutive days, night sweats and no loss of weight within 6 months > 10%.
Differential diagnosis
Need to pay attention to the identification of the following diseases of the vulva:
1. Inflammation is a mixed type of lymphocyte infiltration, and other inflammatory cells are also visible.
2. Lymphoid epithelial carcinoma has epithelial components and is high in molecular weight keratin.
3. The poorly differentiated cancer large cell lymphoma (including anaplastic large cell lymphoma) and the poorly differentiated pasteurized adenocarcinoma, the difference of undifferentiated squamous cell carcinoma is sometimes difficult, mainly by immunohistochemical staining.
4. Other tumors include melanoma, Merkel cell carcinoma, rhabdomyosarcoma and the like.
