Primary splenic lymphoma

Introduction to primary spleen lymphoma Primary spleen lymphoma (PSL) is a rare malignant lymphoma. It refers to the lesion first in the spleen, but no spleen and lymphoid tissue is invaded. The spleen itself is a large lymphoid hematopoietic tissue, often malignant. The site of lymphoma invasion, especially in the late stage of HD, is very easy to invade the spleen, but it is rare in the spleen. basic knowledge The proportion of illness: 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: spleen rupture abdominal pain ascites shock

Cause of primary spleen lymphoma

Cause:

Hepatitis C virus plays an important role in the development of primary spleen malignant lymphoma due to the lymphotropic nature of hepatitis C virus. In recent years, hepatitis C has been associated with primary spleen malignant lymphoma. It has been reported that primary spleen malignant lymphoma is referred to as extrahepatic lesions of hepatitis C virus infection.

Primary spleen lymphoma prevention

The clear cause of lymphoma has not yet been fully discovered, and it is generally accepted that certain infectious factors may be associated with the onset of certain types of lymphoma. Reducing environmental pollution, maintaining good living habits, timely treatment of certain chronic inflammatory diseases of the body, and improving the immune function of the body may not only reduce the incidence of lymphoma, but also reduce the incidence of other malignant tumors.

Primary spleen lymphoma complications Complications, spleen rupture, abdominal pain, ascites shock

Patients with left pleural effusion can be heard and the left lung breath sounds are reduced. Patients with acute abdomen are often caused by rupture of the spleen, which is characterized by severe abdominal pain, bloody ascites, and even shock.

Symptoms of primary spleen lymphoma Common symptoms Nausea abdominal discomfort Low heat fatigue Difficulty abdominal mass Nodules Pleural effusion

Pain and mass in the upper left abdomen are the most common symptoms. Some patients have low fever, loss of appetite, nausea, vomiting, anemia, weight loss or fatigue. A few patients may present with pleural effusion, difficulty breathing, acute abdomen, etc. It can be seen that the spleen is obviously enlarged, while the superficial lymph nodes are mostly abnormal. The swollen spleen loses its original shape, often has an irregular shape, the edges are blunt, the spleen incision is unclear, and sometimes the surface of the spleen can touch the hard nodules. Tenderness, the characteristics of this splenomegaly are conducive to the identification of the congestive spleen of portal hypertension, and it is also a significant difference from the general splenomegaly.

Examination of primary spleen lymphoma

1. Peripheral blood: platelets, hemoglobin and leukopenia.

2. ESR increases: Immunoglobulins increase.

3. Bone marrow: visible lymphoma cell infiltration, the positive rate of up to 40%.

4. Tissue biopsy: The surgeon can organize a biopsy and confirm that it is a B-cell lymphoma.

5. CT scan or MRI: showed that the spleen increased significantly, CT showed a low density change, MRI showed a medium-low signal in the T1 weighted phase, and the T2 weighted phase showed a high signal.

6. B-ultrasound: single or multiple nodular density shadows with low or no echo, but can also show increased spleen homogeneity, spleen tumors can still invade adjacent organs, such as the left kidney capsule, pancreas , liver, stomach curvature and left diaphragm.

Diagnosis and diagnosis of primary spleen lymphoma

diagnosis

Diagnosis of PSL should first rule out secondary spleen invasion of lymphoma.

Gupta has proposed four criteria for the diagnosis of primary spleen lymphoma: the main clinical symptoms are splenomegaly and abdominal discomfort, compression symptoms; clinical biochemistry, hematology and radiology can exclude the presence of other lesions; liver biopsy Negative, and no lymphoma in the mesenteric or para-aortic lymph nodes; lymphoma in other parts of the spleen lymphoma after diagnosis of at least 6 months.

In 1996, Ahmann divided PSL into three phases: stage I tumors were confined to the spleen; stage II had spleen lymph nodes in addition to the spleen; stage III had affected lymph nodes other than liver or spleen.

Differential diagnosis

1. Chronic myeloid leukemia: a malignant proliferative disease of the bone marrow with chromosomal abnormalities.

(1) Clinical symptoms: not typical in the non-catalyzed period, may have fatigue, sweating, and weight loss.

(2) Spleen: The swelling accounted for 92%, of which the giant spleen accounted for 86%.

(3) Peripheral blood: white blood cells are more than 30×109/L, and the smear classification is a hundred flowers (ie, there are various and various stages of blood cells in the blood, such as early-young, young, young, young and middle-aged Red and late red and other cells).

(4) Bone marrow: hyperplasia is extremely active, mainly in the middle and late myelocytes.

(5) Neutrophil alkaline phosphatase decreased.

(6) Chromosomal abnormalities.

2. Hairy cell leukemia: It is a special type of leukemia, which is characterized by a hairy cell membrane, or hairpin, skirt, serrated, and thus called hairy cell leukemia.

(1) Clinical features: more anemia, fever, hepatosplenomegaly, slow progression.

(2) Laboratory examination: Dermal leukemia cells can be seen in the peripheral and bone marrow.

(3) Histochemical staining: positive for acid phosphatase and not inhibited by tartrate.

(4) Spleen: Almost all patients have splenomegaly, often more than 10 cm below the costal margin.

3. Young lymphocytic leukemia: It is a type of chronic lymphocytic leukemia. The clinical symptoms are more obvious than chronic lymphocytic leukemia, and the course of disease progresses rapidly. It often has splenomegaly and lymph node enlargement is not significant.

(1) Clinical features: short symptoms, fatigue, sweating, and weight loss.

(2) spleen: swollen and obvious, more than 10cm below the costal margin, lymph nodes are less swollen.

(3) Laboratory examination: Blood smears and bone marrow see a large number of young lymphocytes, which are characterized by the presence of nucleoli in almost all lymphocytes.

4. Chronic lymphocytic leukemia: It is a kind of lymphocyte hyperplasia and accumulation disease. The clinical onset is more common in the elderly, and its natural course is longer.

(1) Clinical symptoms: early atypical, may have systemic lymphadenopathy, fatigue, fever, sweating, itchy skin.

(2) Spleen: The swelling under the costal margin is more than 90% >10cm.

(3) Laboratory examination: the mature lymphocytes of peripheral blood smear are more than 60%, and the absolute value is 6×109/L for 3 months.

(4) Bone marrow: hyperplasia, mature lymphocytes 40%.

(5) Tissue biopsy: mature lymphocyte infiltration performance.

(6) Excluding lymphocytosis caused by other diseases.

5. Myelofibrosis: It is a chronic myeloproliferative disease. Due to the hematopoietic disorder caused by the replacement of bone marrow with fibrous tissue, bone marrow examination is a dry-sucking phenomenon, often with extramedullary hematopoiesis.

(1) The clinical incidence is more than 40 years old, fatigue, low fever, splenomegaly.

(2) anemia (peripheral blood test): for the young-young erythrocyte, white blood cells and platelets normal or reduced, visible teardrop red blood cells.

(3) Bone marrow: multiple dry pumping, low proliferation.

(4) Bone marrow biopsy: pathological changes.

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