Primary nasal lymphoma

Introduction to primary nasal lymphoma Primary nasal lymphoma is rare and is a type of non-Hodgkin's lymphoma. The primary nasal NHL is different from the primary Nerve ring in pathology, clinical, treatment, and prognosis, and the prognosis is poor, but Early treatment chooses the right treatment to achieve long-term survival. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious complication:

The cause of primary nasal lymphoma

(1) Causes of the disease

The occurrence of nasal NHL is associated with EB virus infection. EBV can infect B cells extensively. It can be found by in situ hybridization that EBV can also infect peripheral T cells in the nasal cavity, while T cells in other parts are rarely infected. The reason is still unclear.

(two) pathogenesis

The primary NHL originating from the nasal cavity is mainly T/NK cells, T cells and B cells. The source of T/NK cells and T cells is more common in China, and the source of B cells is more common in the West. A report from Hong Kong in 1998 Among 113 patients, T/NK cells accounted for 45.1%, T cells accounted for 21.3%, and B cells accounted for 33.6%. T/NK cells were different from other two types of histology. Early lesions showed atypical cell scattered, uneven Distribution, the tumor is pleomorphic, large cells, often have prominent nuclei, large cell nucleoli are obvious, phagocytic cells are visible, vascular central growth, vascular invasion and destruction, inflammatory background after progression, 75% visible Banded, small piece of necrosis, degenerative cells are common, tumor lymphocytes are difficult to identify, immunohistochemistry, CD, CD7, CD3 and TCR , , , proteins are often lost, often NK cell-associated marker CD56 CD16.

Primary nasal lymphoma prevention

Prevent viral infections. The cause of non-Hodgkin's lymphoma is unknown. Some evidence suggests that it is related to a virus that has not yet been identified. However, the disease did not show contagiousness. A rare, rapidly progressing non-Hodgkin's lymphoma associated with infection with HTLV-I (human T-cell lymphotropic virus I), a retrovirus that is functionally similar to the human immunodeficiency virus that causes AIDS . Non-Hodgkin's lymphoma can be one of the complications of AIDS, which is related to the increase in annual cases.

Primary nasal lymphoma complications Complication

Significant immunodeficiency (such as AIDS), multiple infections, and nodular lesions may affect the effects of chemotherapy and cause chemotherapy failure.

Primary nasal lymphoma symptoms Common symptoms Lymph node enlargement Repeated infections Nasal bleeding Facial edema Nasal purulent secretion Logistics Nasal Wei's ring

Common symptoms are progressive nasal congestion, nosebleeds, salivation, repeated infections, facial swelling, neck lymphadenopathy, purulent secretions after infection, often stench, the primary site often in the inferior turbinate, easy to invade the septum, The contralateral and adjacent structures such as the ethmoid sinus, ipsilateral maxillary sinus and nasopharynx can further invade the mouth, throat, skull base, eyelids and cranial nerves.

There are differences in the clinical features of nasal NHL from 3 different cell sources. The proportion of males with T/NK cells is high, and the nasal cavity is more invaded, easily spread to the skin, chemotherapy is not sensitive, and the prognosis is poor. The median survival is 12.5 months. The clinical characteristics of 113 patients in Hong Kong were compared by cell source (Table 1).

Ann Arbor staging can not accurately reflect the prognosis of nasal NHL. According to Ann Arbor staging, the nasal NHL is mostly IE or IIE, and the same IE stage has different scope of invasion. The prognosis varies greatly. Therefore, many scholars recommend IE. It is divided into limited IE stage and super-cavity IE stage. The limited IE stage refers to lesions confined to the nasal cavity. The primary lesion does not invade adjacent structures and organs. The hypercavitary IE stage refers to tumor invasion of adjacent structures or organs, but no lymph nodes and distant organs. Invasive, the survival rate of the two groups was significantly different, and the prognosis was significantly different. The 5-year OS of the limited stage I and super-cavity I were 90% and 57%, respectively (P<0.001).

The TNM staging of nasal and nasopharyngeal lymphoma proposed by the American Cancer Association (AJCC) can also better reflect the prognosis. 89% of patients with DFS, T1, and T2 in 5 years, and 25% in T3 and T4, with significant differences.

Primary nasal lymphoma examination

1. There is no change in peripheral blood, such as the total number of white blood cells and neutrophils in the infection.

2. The bone marrow image is normal.

3. Pathological biopsy can confirm the diagnosis.

CT, MRI can be seen soft tissue swelling, bone destruction, help to understand the extent of the lesion, help staging.

Diagnosis and diagnosis of primary nasal lymphoma

diagnosis

According to clinical manifestations and pathological examination can be diagnosed.

Differential diagnosis

The disease needs to be differentiated from the secondary lymphoma of the nasal cavity, plasmacytoma, Burkitts lymphoma, and nasopharyngeal carcinoma with reactive lymphoid infiltration.

Local lesions need to be differentiated from midline granuloma. The latter progress slowly, have ulcers, bone and soft tissue destruction, and common systemic symptoms, including fever, night sweats, and weight loss.

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