gastric reactive lymphoid hyperplasia
Introduction
Introduction to gastric reactive lymphoid hyperplasia Gastric reactive lymphoid hyperplasia (gastric reactive lymphoid hyperplasia) is a benign disease of gastric mucosal localization or diffuse lymphocyte hyperplasia, clinically rare, the cause is not clear. This disease is also known as gastric pseudolymphoma, benign lymphoid tissue in the stomach, gastric lymph node hyperplasia, chronic lymphocytic gastritis. basic knowledge The proportion of illness: 0.005%-0.006% Susceptible people: no special people Mode of infection: non-infectious Complications: malignant lymphoma
Cause
Gastric reactive lymphoproliferative etiology
Cause:
The etiology of gastric reactive lymphoproliferation is still unclear. Some people think that it is similar to small intestine lymph node hyperplasia. Most scholars believe that gastric ulcer gradually develops into gastric-responsive lymphoid hyperplasia under the stimulation of environmental and/or antigen. It may be a reactive hyperproliferation of gastric ulcer or gastritis, or a tissue response to an antigenic stimulus. Recent studies have shown that it is associated with Helicobacter pylori (Hp) infection.
Pathogenesis :
Helicobacter pylori and bacterial products act as an antigenic stimulator that activates the human mononuclear-macrophage system, which increases the secretion of cytokines such as peroxide, interleukin-1, and tumor necrosis factor- in the gastric mucosa. An inflammatory reaction occurs, and in the histological study, gastric follicular hyperplasia is found to have lymphoid follicle formation and proliferation of lymphocytes and plasma cells, which can also be seen in Hp-associated gastritis. These changes can be seen after eradication of Hp. Gradually disappeared, indicating that the occurrence of this disease may be related to Hp infection, but there is no report to confirm the role of Hp in the occurrence and development of gastric reactive lymphoid hyperplasia.
The main pathological change of this disease is a large amount of lymphocyte infiltration in the lamina propria of the gastric mucosa, and there is a germinal center, which is often mixed with macrophages, plasma cells, polymorphonuclear granulocytes, etc. These characteristics are different from lymphomas, according to their general The morphology is divided into nodular type, ulcer type, erosive type 3, pathological histology shows that the lesion invades the mucosal muscle layer and the submucosa, and even the serosa layer, the lymphatic tissue infiltration and normal tissue have clear boundaries, and the affected mucosal surface may be erosive. And shallow ulcers, there may be a large number of lymphocytes in the gastric juice, the size and shape are the same, the mature lymphocytes, the systemic lymph nodes are not invaded, the lymphatic infiltration, fibrosis, gastric wall thinning and gastric motility function can occur in the late stage of the lesion. Weakened.
Prevention
Gastric reactive lymphatic prophylaxis
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Gastric reactive lymphoproliferative complications Complications, malignant lymphoma
Recent studies have shown that this disease can be converted into malignant lymphoma.
Symptom
Gastric reactive lymphoproliferative symptoms Common symptoms Indigestion anorexia Lymphatic hyperplasia Abdominal discomfort Black weight loss bloating nausea
Most patients have no specific symptoms, often have chronic dyspepsia for more than 1 year, such as abdominal discomfort, anorexia, bloating, nausea, vomiting and weight loss. There are often symptoms similar to ulcer disease in the history, such as pain, hematemesis And black.
Examine
Gastric reactive lymphoid hyperplasia
Identification of lymphocyte surface markers by monoclonal antibodies can be found to be different from malignant lymphomas. Lymphocytes are polyclonal systems. In addition, immunohistochemistry, immunofluorescence techniques, etc. may contribute to correct diagnosis, and Hp examination should not be ignored. Should be listed as a routine.
Gastrointestinal and X-ray misdiagnosis of this disease are more common in malignant lymphoma and type IIC early gastric cancer. Differential biopsy, deep biopsy and large snare biopsy are recommended for gastric biopsy. Lymphocytic follicles for tissue biopsy are beneficial for benign diagnosis. Immunohistochemical staining can sometimes be distinguished from malignant lymphoma, which is a monoclonal cell. This disease is a polyclonal cell, but not absolute.
Diagnosis
Diagnosis and differential diagnosis of gastric reactive lymphatic hyperplasia
The final diagnosis requires careful histological examination and immunological examination to distinguish it from true lymphoma, especially mucosa-associated lymphoid tissue (MALT) lymphoma. In recent years, some people think that this disease can develop into MALT lymphoma. According to the previous diagnosis, A group of 97 patients with gastric pseudolymphoma were followed up and immunohistochemical studies, 51 of which were MALT lymphoma.
