Primary esophageal malignant lymphoma

Introduction to primary esophageal malignant lymphoma Primary gastrointestinal lymphoma (primary malignally mphomaofesophagus) is a lymph node extranodal lymphoma, rare, with a prevalence of less than 4% in all gastrointestinal malignancies, and 24% in extranodal lymphoma in malignant lymphoma. ~25%, of which 15% are found in tonsils or in the pharyngeal lymphatic ring (Waldeyer ring surrounded by pharyngeal tonsils, eustachian tube tonsils, lingual tonsils and sputum tonsils). basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: esophageal perforation

Causes of primary esophageal malignant lymphoma

Primary factor (55%):

The general pathological morphology (shape) of esophageal primary malignant lymphoma is inconsistent. Some lesions have a polypoid mass, which protrudes from the esophageal mucosa to the esophageal lumen. The surface mucosa is often normal and relatively complete. The lesion is nodular or hemispherical to the esophageal lumen, and the surface of the esophageal mucosa is also normal. This lesion needs to be differentially diagnosed with esophageal leiomyoma to avoid misdiagnosis, because of the pathological nature of the two, treatment options And the prognosis is completely different.

Some esophageal primary malignant lymphomas can infiltrate under the esophageal mucosa and spread under the mucosa along the longitudinal axis of the esophagus. Sometimes it is difficult to determine the upper and lower limits of the tumor during surgery. Difficulties, the tumor's profile is gray or light yellow, the texture is firm and not hard; tumor hemorrhage and necrosis are rare; the surface of the tumor may have superficial ulcer formation.

Secondary factors (45%):

There are few cases of malignant tumors in other parts of the body that are transmitted to the esophagus through blood circulation or lymphatic vessels. However, secondary lymphoma of the esophagus is more common. According to reports in the literature, 7% of autopsy data of lymphoma patients are involved. Esophagus, mostly caused by mediastinal lymph node involvement, there are few cases of esophageal mucosal invasion. Endoscopy in these cases to determine primary or secondary malignant lymphoma is very difficult.

Type

Like the primary malignant lymphoma in other parts of the gastrointestinal tract, the gross pathology of primary malignant lymphoma of the esophagus is classified into the following four basic types according to its morphological characteristics.

1. Uplift type: The tumor is located in the esophageal wall, which is nodular or polypoid to the esophageal lumen, and some are flat masses. The surface esophageal mucosa is mostly normal. When the tumor is large, the surface mucosa may have erosion. Or superficial ulcer formation.

2. Ulcer type: The central part of the uplifted lesion and the infiltrating type lesion is called ulcer type if there is a single large ulcer. Some of them are multiple, relatively superficial ulcers. The bottom of the large ulcer is flat and the edge is flat. Sharp, surface esophageal mucosal folds are interrupted, surrounded by dike-like bulges, ulcers can be accompanied by blood and even esophageal perforation, resulting in mediastinal infection and even the formation of mediastinal abscess.

3. Infiltration: The esophageal mucosa of the lesion has localized or diffuse invasive changes:

1 localized infiltration: manifested as local esophageal mucosal bulge, thickened or pleated;

2 diffuse infiltration: tumor cells infiltrate extensively under the esophageal mucosa, thickening the esophageal wall, stiffness and loss of elasticity, can cause esophageal stenosis, patients may have symptoms of dysphagia, up to 89%.

4. Nodular type: There are multiple or diffuse nodular bulges and nodules on the surface of the esophageal mucosa, which may have superficial mucosal erosion.

The gross pathological type of single esophageal primary malignant lymphoma is often rare, and the infiltration of tumor cells under the esophageal mucosa can be seen in almost every patient. In addition, the degree of tumor differentiation also affects the gross pathological morphology.

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Primary esophageal malignant lymphoma complications Complications perforation of the esophagus

Esophageal primary malignant lymphoma causes more cases of esophageal perforation than esophageal squamous cell carcinoma. Two of the 3 cases reported by Orvidas et al (1994) have esophageal perforation, esophageal mediastinal fistula, which may be associated with esophageal lymphoma patients. The pathological response to fibrosis of the wall and its surrounding tissues is relatively light.

Symptoms of primary esophageal malignant lymphoma Common symptoms Dysphagia, upper abdominal pain, hoarseness, loss of appetite, loss of weight

According to Korst (2002), primary non-Hodgkin's lymphoma of the esophagus (NHL) is more common in men with an average age of onset of 61 years.

Patients with primary malignant lymphoma of the esophagus are generally asymptomatic, but dysphagia is also reported to be one of the common clinical symptoms of patients with primary non-Hodgkin's lymphoma (NHL) in esophagus, which is caused by obstruction of the esophageal cavity by the esophageal submucosal mass. Other symptoms include loss of appetite, weight loss, pain in the upper abdomen, hoarseness, cough and fever.

Esophageal primary malignant Hodgkin's lymphoma (HD) is rare, and in 354 well-diagnosed primary extranodal lymphomas reported by Wood and Columan (1973), only 0.3% of lesions originate in the esophagus. In 1977, Camovale et al reported a total of 8 cases of esophageal lymphoma diagnosed by histological examination, including 1 case of esophageal Hodgkin's lymphoma, clinical data of these 8 patients (abstract).

Examination of primary esophageal malignant lymphoma

Histopathology is a reliable basis for determining diagnosis.

1. X-ray barium meal examination : 8 cases of esophageal lymphoma reported by Camovale et al. After X-ray barium meal examination of upper digestive tract, the main X-ray findings were as follows:

(1) The lesion involves the distal end of the esophagus and the adjacent fundus. It is characterized by large nodular shadows and non-obstructive stenosis at the distal end of the esophagus. It has similar X-ray findings to the adjacent fundus mucosa, and it is difficult to Gastric cancer involves the identification of the lower esophagus.

(2) The non-obstructive stenosis of the esophageal lumen is irregular in appearance, and the lesion can spread upward to the upper third of the thoracic esophagus, and sometimes it has a wide range.

(3) Tumor tissue infiltrated under the esophageal mucosa and showed a large nodular shadow under the mucosa on the esophageal barium meal. It resembled the X-ray findings of esophageal varices.

(4) The middle part of the esophagus has an irregular stenosis area of about 9 cm in length with ulcer formation, and a large single ulcer lesion surface may appear on the surface of the larger nodular lesion.

(5) In some cases, there are multiple nodules (ie, submucosal lymphoma nodules) in the esophageal mucosa on the esophageal X-ray barium meal.

2. CT scan : can show enlarged lymph nodes in the mediastinum, large esophageal cavity and esophageal mucosa, have a certain significance for the diagnosis of mediastinal lymphoma invasion of the esophagus, lymphoma staging, observation of tumor during chemotherapy or radiotherapy Changes in size and follow-up review after treatment also make sense.

3. Endoscopy : It is an important and effective means for diagnosing primary malignant lymphoma of the esophagus. It can be directly observed by the naked eye and histological examination is performed on the living tissue. It has a qualitative diagnostic value, mainly due to the pathological changes of esophageal malignant lymphoma. On the mucosal surface, the positive rate of biopsy is not as high as that of esophageal cancer. According to Orvidas et al. (1994), the positive rate of biopsy is 81%. Some preoperative diagnosis of primary malignant lymphoma of the esophagus is not clear, but surgically removed. The pathological examination of the surgical specimen after the tumor was confirmed.

Diagnosis and diagnosis of primary esophageal malignant lymphoma

diagnosis

Early diagnosis is very difficult, and it is not easy to identify or identify primary lymphoma or secondary lymphoma. Primary malignant lymphoma in a certain part of the gastrointestinal tract (including esophagus) can achieve early stage. Diagnosis, surgical resection is likely to achieve the goal of cure, while secondary lymphoma can only be palliative.

In addition to medical history, the diagnosis of esophageal malignant lymphoma depends mainly on X-ray barium meal examination of esophagus and stomach, CT scan and endoscopy of esophagus (mediastinum). During the examination, special attention should be paid to the stomach wall of the esophagus-gastric junction. No signs of involvement, histopathological findings are a reliable basis for diagnosis.

1. Diagnostic criteria for primary lymphoma of the gastrointestinal tract: In 1961, Dawson et al. proposed five criteria for the diagnosis of primary lymphoma of the gastrointestinal tract:

(1) The superficial lymph nodes of the patient cannot be touched or small.

(2) Chest X-ray examination is normal, no enlarged lymph nodes.

(3) Blood routine examination showed normal white blood cell count.

(4) If the gastrointestinal lymph nodes are involved, the affected lymph nodes should be the lymph nodes in the drainage area of the tumor intestine.

(5) Liver and/or spleen without metastatic disease.

2. Diagnostic criteria for primary plasmacytoma outside the esophagus

Esophageal primary isolated extramedullary primary plasmacytoma is classified as a miscellaneous in the classification of non-Hodgkin's lymphoma (NHL).

(1) No Bence Jones proteinuria.

(2) The serum electrophoresis value is within the normal range.

(3) The results of bone marrow biopsy were normal.

(4) Liver and bone scans are normal, with no distant metastasis and signs.

(5) Esophageal tumors were confirmed by histological examination to be composed of plasmacytoma.

Differential diagnosis

1. Multiple esophageal leiomyoma: X-ray findings of primary esophageal malignant lymphoma are not specific and should be associated with esophageal multiple leiomyoma or hematogenous metastatic tumors (such as esophageal metastatic malignant melanoma) Identification.

2. Cardiac achalasia: Primary malignant lymphoma of the esophagus invades the Auerbach plexus in the muscular layer of the lower esophagus. The clinical symptoms and esophageal X-ray barium meal angiography are similar to achalasia.

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