primary duodenal malignant lymphoma
Introduction
Introduction to primary duodenal lymphoma Primary malignant lymphoma of the duodenum refers to a malignant tumor that originates in the lymphoid tissue of the duodenum, which is different from the secondary lesion of the systemic malignant lymphoma that invades the intestine. Dawson Five diagnostic criteria for primary malignant lymphoma of the small intestine were proposed: 1 no surface lymphadenopathy was found; 2 white blood cell count and classification were normal; 3X line chest radiograph had no mediastinal lymphadenopathy; 4 no small intestinal and mesenteric lymph nodes were found during operation Other lesions; 5 liver, spleen non-invasive. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: acute diffuse peritonitis abscess intestinal fistula
Cause
Primary duodenal malignant lymphoma
Primary duodenal malignant lymphoma originates from the submucosal submucosal lymphoid tissue and can be invaded to the mucosa and muscular layers, manifesting as a polypoid, submucosal mass or diffuse infiltration under the longitudinal axis of the small intestine. Often accompanied by ulcers, tumors are often single, rarely multiple.
1 According to histological morphology can be divided into: lymphocyte type, lymphoblastic type, reticulocyte type, giant follicular type and Hodgkin disease.
2 according to the general pathological morphology can be divided into: mass type or polyp type; ulcer type; infiltration type; nodular type.
3 According to the type of histology can be divided into: Hodgkin's disease and non-Hodgkin's lymphoma 2 categories, the latter is most common, the metastatic route can be through the lymphatic, blood and direct spread, lymph node metastasis is earlier than adenocarcinoma.
Prevention
Primary duodenal malignant lymphoma prevention 1. Adjust daily life and workload, and regularly carry out activities and exercise to avoid fatigue. 2. Maintain emotional stability and avoid emotional excitement and tension. 3. Keep the stool smooth, avoid using stools, eat more fruits and high-fiber foods. 4. Avoid cold irritation and keep warm.
Complication
Primary duodenal malignant lymphoma complications Complications, acute diffuse peritonitis, abscess, intestinal fistula
Intestinal perforation is the main complication of this disease. Intestinal perforation occurs in 15% to 20% of patients with duodenal malignant lymphoma, which is higher than other malignant tumors. This is the tumor invasion of the intestinal wall and intestinal necrosis. Or secondary infection of the tumor, acute perforation can cause diffuse peritonitis, chronic perforation can cause inflammatory mass, abscess, intestinal fistula and other manifestations.
Symptom
Primary duodenal lymphoma symptoms Common symptoms Abdominal mass Abdominal pain, dull, nausea
1. Symptoms and signs: The clinical manifestations of the disease are non-specific and may vary depending on the type and location of the tumor.
(1) Abdominal pain: Abdominal pain is the most common symptom of the disease. About 65% of patients show abdominal pain. Most of abdominal pain is due to intestinal obstruction, tumor swelling and stretching, intestinal peristalsis, infection secondary to tumor necrosis, intestinal wall ulcer And perforation and other factors, abdominal pain generally appears earlier, different severity, hidden and irregular, a chronic process, initial pain or dull pain, with the development of the disease gradually turned into paroxysmal spastic colic, late pain Sustained, the drug can not be relieved, most of the abdominal pain is located in the mid-abdomen, the umbilical cord and the lower abdomen, and sometimes can appear in the left upper abdomen or under the xiphoid. Once the perforation of the tumor causes acute peritonitis, severe abdominal pain may occur.
(2) intestinal obstruction: tumor obstruction of the intestine or intestinal wall infiltration and stenosis can cause intestinal obstruction, intestinal obstruction caused by malignant lymphoma occurs earlier, mainly as chronic, partial intestinal obstruction symptoms, patients have repeated episodes Nausea, vomiting, aggravation after eating, abdominal distension is not obvious, obstruction occurs in the lower part of the nipple, vomit can contain a lot of bile.
(3) Abdominal mass: According to the domestic data, about 25.5% of the patients can have abdomen and mass in the abdomen. Some patients are the main reason for the treatment. 60%~70% of the tumors have a diameter of more than 5cm, and the larger ones have more than 10cm.
(4) Astragalus: Obstructive jaundice caused by malignant tumor invasion or obstruction of the common bile duct opening or compression of the common bile duct by metastatic lymph nodes. The incidence of jaundice is much lower than that of adenocarcinoma, which is about 2%.
(5) Others: Duodenal malignant lymphoma may have some non-specific clinical manifestations such as upper gastrointestinal bleeding, weight loss, anemia, diarrhea, fatigue, loss of appetite, fever.
2. Clinical staging: Noqvi (1969) proposed clinical criteria: stage I, lesion limitation, non-invasive lymph nodes; stage II, lesion limitation, invaded lymph nodes; stage III, adjacent organ tissue involvement; stage IV, distant metastasis .
Examine
Examination of primary duodenal malignant lymphoma
1. Histological examination: cytology can be obtained by pathological examination by brushing the exfoliated cells under the duodenal endoscopy or clamping the intestinal wall tissue.
2. Blood routine: There may be a red blood cell count and a decrease in the amount of hemoglobin.
3. Fecal occult blood test was positive.
The latter two lack the specificity of diagnosis.
4. X-ray examination: X-ray film may show X-ray findings of duodenal obstruction, or soft tissue block shadow, gastrointestinal barium meal double contrast angiography for duodenal tumor diagnosis accuracy of 42% to 75% , its image performance is:
1 duodenal mucosal folds deformed, destroyed, disappeared, and the intestinal wall was stiff;
2 intestinal wall filling defect, shadow or ring narrow;
3 The intestine can have a cystic dilatation and an aneurysm-like change;
4 thickening of the intestinal wall, intestinal tube becomes smaller, with multiple nodular stenosis, duodenal hypotonography, is more conducive to the observation of subtle changes in mucosal folds, so that its diagnostic accuracy increased to about 93%.
5. Endoscopy: This disease can directly observe the size, location, extent and shape of the lesion through duodenoscopy. At the same time, it can be used for camera, photography, brushing of exfoliated cells and biopsy for pathological diagnosis.
6. Others: B-mode ultrasound, CT and angiography (DSA) have a role in the diagnosis of the disease.
Diagnosis
Diagnosis and diagnosis of primary duodenal malignant lymphoma
diagnosis
The early diagnosis of the disease is very difficult, and the rate of misdiagnosis can be as high as 70% to 90%. The reasons are as follows:
1 The disease lacks specific clinical manifestations;
2 doctors have insufficient understanding of the disease, and even lack of knowledge in this area, so the vigilance is not high;
3 The disease is often treated as an emergency, often obscured by the clinical manifestations of acute abdomen;
4 The diagnosis of the disease, especially in the primary hospitals often do not have effective diagnostic methods, the failure to identify the cause of fever, nausea, vomiting, loss of appetite, weight loss, anemia, intestinal bleeding, upper abdominal pain, chronic intestinal obstruction, etc. In clinical manifestations, you should be alert to the possibility of the disease and carry out various tests.
Differential diagnosis
The disease is often misdiagnosed as gastroduodenal inflammation, peptic ulcer, chronic pancreatitis, biliary tract disease, etc., clinical should pay attention to identification.
