What is Non-Hodgkin's Lymphoma?

Non-Hodgkin's lymphoma (NHL) is a general term for a group of independent diseases with strong heterogeneity. It is also a relatively common tumor in China, and it ranks within the top 10 in the ranking of common malignant tumors. NHL lesions are malignant tumors of the lymphoid hematopoietic system that mainly occur in lymph nodes, lymph nodes, spleen, thymus, and other lymphoid tissues and organs. It is divided into three basic types according to cell source: B cells, T cells, and NK / T cell NHL. Most clinical NHL is B-cell type, accounting for 70% to 85% of the total. NHL is complicated in pathological classification, clinical manifestations, and individualized treatment, but it is a tumor that is highly likely to be cured. At present, the incidence rate is increasing significantly at different ages.

Basic Information

English name: non-Hodgkinlymphoma
English alias: NHL
Visiting department: Oncology, Hematology
Common locations: Lymphatic hematopoietic system of lymph nodes, spleen, thymus, lymphoid tissues and organs outside the lymph nodes

Common symptoms: Fever, night sweats, weight loss, itching of the skin, skin lesions, abdominal fullness, abdominal pain, indigestion, abdominal mass, gastrointestinal bleeding, intestinal obstruction, bowel perforation, lymphadenopathy, nasal congestion, nosebleeds, local mucosal ulcers
Contagious: no

Causes of non-Hodgkin's lymphoma

The cause of the increased incidence of NHL is not clear, but should be the result of a combination of factors.

Abnormal immune function

Whether it is congenital or acquired immune dysfunction are related factors. For example, in patients with acquired autoimmune diseases, Sjogren's syndrome and systemic lupus erythematosus are often accompanied by impaired T lymphocyte function, which affects the body's immune response to viral infection and new malignant cells. The incidence of NHL in these patients has increased. Several times.

2. virus infection

Many viruses are associated with NHL. Including EB virus, human T lymphocyte type I virus, human herpes virus type 8 and so on.

3. Bacterial infection

Bacteria cannot directly stimulate tumor cells, but they can stimulate the malignant proliferation of cells by stimulating cells in specific areas of the tumor, leading to tumorigenesis. It is known that more than 90% of gastric mucosa-associated tissue lymphomas in NHL are related to Helicobacter pylori infection.

4. Genetic factors

People with close relatives in the family who have a history of certain blood / lymphatic malignancies may have a 2- to 4-fold increased risk of NHL.

5. Other factors

Increased use of chemicals, increased exposure to radiation, and poor lifestyles. Such as hair dye may be a risk factor for disease.

Clinical manifestations of non-Hodgkin's lymphoma

Because NHL is a general term for a group of lymphoid hematopoietic malignancies, clinical manifestations have certain common characteristics, and there are also large differences according to different pathological types, invaded sites and areas. Although the lesions occur in the lymph nodes, the NHL is basically a systemic disease based on the distribution of the lymphatic system.

Local performance

(1) Lymph node enlargement is the most common and classic clinical manifestation. It is characterized by painlessness and gradual increase. When the lymph nodes grow rapidly, local compression symptoms appear, accompanied by swelling and pain. Superficial lymphadenopathy is more common in the neck, supraclavicular, and axillary areas. Deep lymphadenopathy is more common in the mediastinum, retroperitoneum, and mesentery. The site of the affected lymph nodes is often skipping, with no regularity.

(2) The organs outside the lymph nodes are mainly the gastrointestinal tract, skin, bone marrow, and central nervous system. In the thyroid, bones, reproductive system, nasal cavity, etc. are also vulnerable organs. Invasion of extra-lymph nodes can coexist with lymph nodes or stand alone. Clinical manifestations are complex and diverse.

(3) Most of the nasal lymphomas are NHL. The pathological types are mainly nasal NK / T-cell lymphoma and diffuse large B-cell lymphoma in NHL. Early lesions are mostly confined to the inferior turbinate on one side, manifesting as nasal congestion, nosebleeds, and local mucosal ulcers. As the disease progresses, it can invade the contralateral nasal cavity or adjacent tissues and organs, manifested as tinnitus, hearing loss, sore throat, hoarseness, and swelling of the cheek. Tumor invasion can destroy bone and cause corresponding symptoms such as nasal septum and hard palate perforation.

2. Whole body performance

Different systemic symptoms can occur before or at the same time as lymphadenopathy.

(1) Fever Most NHL patients have fever, but the duration of fever, the height of the temperature, and the periodic changes in fever can be different. The duration of fever in some patients can be calculated in months. Finally, the pathological basis of the relevant site must be obtained before diagnosis.

(2) Night sweats and weight loss Due to the failure of the body's immune function and the progression of tumor diseases, or with consumable factors such as fever, patients often experience hyperhidrosis, night sweats and progressive weight loss.

(3) Skin itching and skin lesions NHL can have a series of non-specific skin manifestations. Tumors can be primary on the skin or secondary skin invasions, and the incidence is 13% to 53%. Some itching can occur before the diagnosis is made. Common skin manifestations are pellagra-like pimples, shingles, systemic herpes-like dermatitis, skin pigmentation changes, and nodular erythema. Skin damage is polymorphic, plaques, blisters, erosions, nodules, etc., and some skin damage can be sustained ulceration and exudation. Due to tumor invasion and reduced immune function, it is easy to be infected with infection and not heal for a long time, which is also one of the causes of fever in NHL patients.

(4) The mesenteric and retroperitoneal lymph nodes are the most common lesions in the abdomen , and the gastrointestinal tract is the most common extranodal lesions. According to the affected area, abdominal fullness, abdominal pain, indigestion, abdominal mass, gastrointestinal bleeding, etc., are often manifested in intestinal obstruction, bowel perforation and other acute abdominal symptoms. Hepatosplenomegaly is not uncommon in NHL patients, and most are caused by liver and spleen invasion.

Non-Hodgkin's lymphoma test

NHL tests can be divided into traumatic and non-traumatic tests. Traumatic examinations are mostly performed by taking histological specimens for diagnosis, and non-traumatic examinations are mostly performed to find the location of the lesion, evaluate the extent of the lesion, and evaluate the therapeutic effect.

Traumatic examination

The method of operation is mainly determined by the size of the lesion, the location of the growth, and the risks that a trauma examination may bring. Directly puncture superficial enlarged lymph nodes; or percutaneously perform needle aspiration to obtain samples from deep lymph nodes and occupying lesions under the guidance of ultrasound and CT localization. The value of this method is controversial. According to the lesion site, tissue cell specimens can be taken with the help of bronchoscopy, mediastinoscopy, gastroscopy, colonoscopy and other endoscopes. Obtain lymph node or lesion cell samples from various surgical methods. bone marrow aspiration and biopsy. Cerebrospinal fluid cytology was performed by lumbar puncture.

2. Non-invasive examination

Laboratory tests include complete blood cell count, erythrocyte sedimentation, lactate dehydrogenase, 2 microglobulin, and liver and kidney function. Imaging examination includes whole-body CT, magnetic resonance, and positron emission tomography (PET / CT).

3. Other

Evaluation of general condition of the whole body.

Non-Hodgkin's lymphoma diagnosis

NHL diagnosis must be confirmed by pathology. At the same time, according to the morphological characteristics of tissues and cells, combined with immunophenotype and cytogenetic characteristics, the pathological type can be clarified, which is helpful for guiding individualized medication and judging prognosis. High incidence and representative NHL:

1.B cell type

Diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, mucosa-associated lymphoid tissue lymphoma.

2.T cell type

Peripheral T cell lymphoma, angioimmunoblastic lymphoma, anaplastic large cell lymphoma.

3.NK / T cells

Extranodal NK / T-cell lymphoma-nasal, invasive NK / T-cell leukemia.

Non-Hodgkin's lymphoma treatment

With the continuous research and understanding of NHL's immunology, cytogenetics and molecular biological characteristics, the development of new drugs, comprehensive clinical staging, analysis of comprehensive factors such as the International Prognostic Index (IPI) of lymphoma, and the treatment of individuals The requirements for chemical treatment are getting higher and higher, and the treatment is becoming more and more complicated. At present, the main treatments include systemic chemotherapy, local radiotherapy, biological immunology, surgical removal of some or all of the lesions, hematopoietic stem cell transplantation, or anti-Helicobacter pylori infection treatment for gastric mucosa-associated tissue lymphoma caused by H. pylori infection.

In the actual work of NHL, it can be divided into highly invasive, invasive and inert NHL according to the tumor cell proliferation rate and clinical characteristics. Highly aggressive NHL tumors proliferate rapidly and are prone to invasion of other organs, such as lymphoblastic lymphoma and Burkitt lymphoma. Although highly malignant, there is potential for cure. High-dose intensity or acute lymphocytic leukemia-like regimens are often used. Inert NHL tumor cells have a slow proliferation rate, but are relatively insensitive to chemotherapy and belong to tumors that cannot be cured by chemotherapy. Treatment can improve quality of life and prolong survival. Such as follicular NHL and fungal mycosis.

Non-Hodgkin's lymphoma prognosis

NHL prognosis is related to many factors such as the type of disease, the degree of invasion, clinical stage, molecular genetics, and immunology.

At present, the international prognosis index (IPI) is often used in clinical work to judge prognosis. It is applicable to various types of lymphoma, and patients are divided into four groups with different degrees of risk based on the score.