Overview of colorectal lymphoma
Colorectal lymphoma originates from lymphatic reticular tissue and includes extranodal lymphoma originating in the colorectum and secondary lymphoma, with the former mostly located in the ileum and the latter predominantly in the rectum and sigmoid colon. The incidence of this disease is low, and there are more males than females. The main clinical manifestations are abdominal pain, diarrhea, change of fecal character, bloody stools, mucus stools, etc., but diarrhea occurs more often. Surgical treatment is critical, and patients who can undergo complete radical resection have a better prognosis.
Causes
1. Radiation
People who are often exposed to various kinds of radiation have a high risk of developing lymphoma.
2. Environmental pollution
These factors include excessive exposure to organic solvent dyes, such as hair dyes, living or working in newly renovated houses with a lot of toxic and harmful chemical residues, frequently inhaling automobile exhaust fumes, living and working around electronic waste, and long-term exposure to pesticides and other chemical substances.
3. Infection
Infection with EB virus and hepatitis virus is related to the development of lymphoma.
4.Psychological factors
Because the onset of lymphoma has a great relationship with human immune function. If a person has too much work pressure for a long time, which leads to mental tension, psychological pressure, irregular life and rest, which makes the person very tired and causes the resistance of human body to decline, it will also induce lymphoma.
Symptoms
The clinical symptoms of this disease are similar to other malignant colorectal tumors, mainly manifested as abdominal pain, diarrhea, change of fecal character, bloody stools, mucus stools, etc. However, diarrhea occurs more often, and due to the lack of characteristic manifestations, it may be misdiagnosed as inflammatory bowel disease, ulcerative colitis and other benign diseases.
Examination
1. X-ray examination
In gas-barium double-contrast enema, lymphoma is mainly manifested as localized soft tissue mass, thickening of mucosal folds, submucosal filling defects, irregularity of intestinal wall, stiffness of intestinal wall, etc.
2. CT examination
(1) Focal mass type, which manifests as soft tissue mass inside or outside the localized intestinal lumen of the intestine, and the normal shape of the intestine may disappear.
(2) Segmental ring-shaped infiltration: the length of the invaded intestinal segments varies, and all of them show ring-shaped thickening of the intestinal wall, which is symmetrical or slightly asymmetrical, and locally maintains the shape of the intestinal tract.
(3) Diffuse infiltrating type: segmental multiple lesions, involving all or most of the large intestine. On enhancement scan, B-cell lymphoma has mild to moderate uniform enhancement, and most of the colonic lymphomas belong to this type.
3. Colonoscopy
Colonoscopic biopsy is the main means of histologic diagnosis.
Diagnosis
Accurate diagnosis of colorectal lymphoma depends on pathological biopsy, which can confirm the diagnosis of colorectal tumor as T-cell or B-cell lymphoma.
Differential diagnosis
1. Colorectal cancer
The shape of the mass is irregular, which is an eccentric lobulated mass in the intestinal lumen, with stiff intestinal wall, obvious narrowing of intestinal lumen, interruption of mucous membrane destruction; the edge of colon cancer breaking through the plasma membrane layer may be blurred, and infiltrate and grow to the periphery; colon cancer may be accompanied by enlarged lymph nodes around the lesion, which is mostly larger than 2 cm; the enhancement scan of the lesion is dominated by inhomogeneous enhancement. Sometimes, it is impossible to distinguish colon lymphoma from colon cancer simply according to the image presentation, and colonoscopy biopsy and immunohistochemistry are needed to confirm the diagnosis.
2. Gastrointestinal polyps
X-ray gas-barium double-contrast enema is the preferred method of examination. Polyps usually appear as round filling defects with smooth and sharp boundaries in the colon, and sometimes can be lobulated or villous. Double-contrast polyps present a ring-shaped soft tissue shadow coated with barium, sometimes with a variable length of the tip, and those with a long tip may have a certain degree of mobility. Multi-slice CT simulation endoscopy can detect polyps with a diameter of several millimeters, and show the size and shape of polyps more clearly.
Treatment
1.Surgical treatment
If the lesion is confined to the intestinal wall and regional lymph nodes, radical resection should be performed, and palliative resection can be considered when there are distant metastases.
2.Chemotherapy
Generally, CHOP chemotherapy program (combined use of cyclophosphamide, doxorubicin, vincristine and prednisone) can be used for low to moderate malignant lymphoma, which is a more ideal adjuvant therapy for non-Hodgkin’s lymphoma at present.
3. Other
For pathologic types with high malignancy and poor prognosis, chemotherapy with increased dose intensity or stem cell transplantation is feasible after surgical resection of the lesion.