Primary splenic lymphoma

　　Pathogenesis

　　Due to the lymphotropic nature of the hepatitis C virus, the hepatitis C virus plays an important role in the occurrence of primary splenic malignant lymphoma. In recent years, there have been continuous reports of primary splenic malignant lymphoma associated with hepatitis C. Some people call primary splenic malignant lymphoma an extrahepatic lesion of hepatitis C virus infection.

　　This disease can lead to the metastasis of surrounding lymphoid tissue, causing dyspnea; in the late stage, it may metastasize to other parts, causing corresponding complications, such as metastasis to the gastrointestinal tract, which can cause abdominal pain, gastrointestinal ulcers, bleeding, obstruction, etc. Invasive brain tissue can cause headache, blurred vision, language disorders, etc. Invasive bone tissue can cause fractures. Patients with left pleural effusion may have reduced respiratory sounds in the left lung. Acute abdomen patients are often caused by splenic rupture, presenting with severe abdominal pain, hemoperitoneum, and even shock.

　　Pain and mass in the upper left abdomen are the most common symptoms, with some patients accompanied by low fever, decreased appetite, nausea, vomiting, anemia, weight loss or fatigue. A few patients may present with pleural effusion, dyspnea, acute abdomen, etc. Physical examination shows that the spleen is significantly enlarged, while superficial lymph nodes are mostly normal. The enlarged spleen often loses its original shape, often irregular, with blunt edges, and the splenic hilum is often not palpable. Sometimes, hard nodules can be felt on the surface of the spleen, with tenderness. The characteristics of this splenic enlargement are conducive to distinguishing it from portal hypertension-induced splenic enlargement and are also a significant difference from general splenic enlargement diseases.

　　Prevention

　　Since the etiology of lymphoma patients is not very clear, the methods of prevention are mainly:

　　1. Try to minimize infections, avoid contact with radiation and other harmful substances, especially drugs that suppress the immune function;

　　2. Engage in moderate exercise to enhance physical fitness and improve the body's ability to resist diseases.

　　The prevention is mainly aimed at various factors that may lead to malignant lymphoma. It is currently believed that the loss of normal immune surveillance function, the tumor-promoting effect of immunosuppressants, the activity of latent viruses, and the long-term use of certain physical (such as radiation) and chemical substances (such as antiepileptic drugs, adrenal cortical hormones) can all lead to the proliferation of lymphoreticular tissue, eventually resulting in malignant lymphoma. Therefore, attention should be paid to personal and environmental hygiene, drug abuse should be avoided, and personal protection should be noted when working in harmful environments.

　　1. Peripheral blood:Decreased platelets, hemoglobin, and white blood cells.

　　2. Erythrocyte sedimentation rate increases:Increased immunoglobulin.

　　3. Bone marrow examination:Lymphoma cells can be seen to infiltrate, with a positive rate of up to 40%.

　　4. Tissue biopsy:For surgical patients, tissue biopsy can be performed to confirm that it is B-cell lymphoma.

　　5. CT scan or MRI:The spleen is significantly enlarged, CT shows low-density changes, and MRI shows medium to low signal in the T1-weighted phase and high signal in the T2-weighted phase.

　　6. Ultrasound examination:Single or multiple nodular hyperechoic shadows, but can also be manifested as homogeneous enlargement of the spleen. The spleen tumor can also invade adjacent organs, such as the pleura of the left kidney, pancreas, liver, great curvature of the stomach, and left diaphragm, etc.

　　Lymphoma Dietary Therapy

　　1. Goat Bone Porridge

　　Ingredients: 1000 grams of goat bone, 100 grams of sticky rice, a little fine salt, 2 scallions, and 3 slices of ginger.

　　Preparation: Clean and crack fresh goat bones, decoct the soup, use the soup as water, cook rice with the soup, add fine salt, ginger, and scallion when the rice is almost cooked, and boil a few times.

　　Indications: Yin deficiency in the liver and kidneys after radiotherapy for malignant lymphoma. Administration: Eat 1-2 times a day.

　　2. Goji and Pine Nut Minced Meat

　　Ingredients: 100-150 grams of minced meat, 100 grams of Goji berries and pine nuts each.

　　Preparation: Add minced meat to wine, salt, and seasonings, stir-fry over a low heat until half-cooked, then add Goji berries and pine nuts, and stir-fry together.

　　Indications: Yin deficiency and internal heat after radiotherapy for malignant lymphoma. Administration: Take once a day, as a side dish.

　　3. Pork kidney Guangzi Gu Soup

　　Ingredients: 30 grams of Guangzi Gu, 1 pork kidney and testicle, a little salt, scallion, and ginger.

　　Preparation: Soak Guangzi Gu 2 hours, then decoct the soup, filter the liquid. Clean and remove impurities from the pork kidney and testicles, cut into cubes, add Guangzi Gu filtered soup, and boil together with salt, scallion, and ginger over low heat until cooked.

　　Indications: Deficiency of essence and blood after chemotherapy for malignant lymphoma. Administration: Drink the soup and eat pork kidney and testicles, as a side dish every day, which can be taken regularly.

　　4. Huai杞Sanqi Soup

　　Ingredients: 17G Sanqi, 32G Huai山药, 26G Goji berries, 25G Longan meat. 300G pork ribs. Appropriate amount of salt and ground pepper.

　　Preparation: Wrap the traditional Chinese herbs such as Sanqi and山药 in a cloth bag and place them together with pork ribs, adding 4 bowls of clear water. Boil with high heat first, then low heat, for 2-3 hours. Add salt and ground pepper to taste. It can make 3 small bowls. Eat one small bowl each time, with meat and soup. Eat once every 1-2 days. Benefits: Nourishes blood and promotes digestion.

　　Note: This diet is suitable for malignant lymphoma masses that grow rapidly and have dark purple spots on the tongue.

　　I. Treatment

　　Most scholars believe that splenic lymphoma resection not only improves symptoms but also serves as a diagnostic and treatment method. Generally, it can restore the blood count reduced due to splenic lymphoma to normal after surgery.

　　1. Surgical Treatment:Exploratory laparotomy, during which the extent of tumor extrusion is clarified, the spleen and the surrounding infiltrated tissues and organs are resected. For those who cannot be resected, tissue biopsy should be performed, and routine liver and abdominal lymph node biopsy should be performed to provide evidence for postoperative staging, typing, and radiotherapy and chemotherapy. Postoperatively, auxiliary chemotherapy is recommended to prevent possible dissemination.

　　2. Radiotherapy:In the past, it was believed that for cases with low, moderate malignancy or stage I and II, whole abdominal irradiation after surgery could be given. Currently, it is not recommended to perform whole abdominal irradiation. If necessary, photon knife direct irradiation of the mass or conformal intensity-modulated irradiation of the splenic area can be used.

　　3. Chemotherapy:For patients with highly malignant or stage III, systemic chemotherapy should be the main treatment. The chemotherapy regimen often used is CHOP or BACOP, with a total of 6 cycles. Although the combined use of systemic chemotherapy and photon knife irradiation can cause relatively serious bone marrow suppression and gastrointestinal reactions, appropriate symptomatic supportive treatment can generally complete the treatment plan. If radiotherapy and chemotherapy are used simultaneously, the chemotherapy cycle can be appropriately reduced.

　　II. Prognosis

　　Martins et al. pointed out that the prognosis of primary splenic lymphoma is related to the primary site, stage, and pathological type, especially the latter two. For those with low or moderate malignancy, the 3-year and 5-year survival rates are 75% and 60% respectively; while for those with highly malignant, the 3-year survival rate is only 20%. For those in stage I to II, the 2-year and 5-year survival rates are 71% and 43% respectively; while for those in stage III, they are 21% and 14% respectively. Most scholars believe that the prognosis of PSL patients in stages I to II is similar to that of other stage I NHL patients; while the prognosis of stage III patients is the same as that of other stage IV NHL patients. Ahmann reported 49 cases of splenic malignant lymphoma, indicating that the prognosis of follicular type is better than that of diffuse infiltration. The 5-year survival rate of the whole group is 31%, and the 5-year survival rate of well-differentiated lymphocytic lymphoma is 60%.