Malt-lymphoma stomach - symptoms, causes and methods of treatment. Stomach Lymphoma - Malt and its other types How often do recurrences at Malt Lymphoma

Session 561.
Dedicated to the memory of Academician N.A. Kraevsky,
Joint with the Russian society of pathologists
will be held on Tuesday October 13, 2009 in 17:00
In the conference hall of the clinic of the Russian oncological scientific center. N.N. Blochina

Presidium: prof. A.I.pache, Academician RAMN, prof. Yu.N.Solovyev, ChL-Corr.rane, Prof.I.V. Poddubnaya, prof. A.I. Karseldze

Agenda:

Clinic and Morphology MALT Lymph

Zakharova E.S., Karsheladze A.I.

Clinical aspects of MALT lymphom

Poddubnaya I.V.¹, Osmanov E.A.², Moskalenko O.A.¹, Malikhova O.A.², Sotnikova O.P.¹, SUANova Z.A., Sorutoreva, I.N.¹

² Russian oncological scientific center. N.N. Blokhin)

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Proceedings of the Moscow Oncology Society

Essays Messages:

Proceedings of the Moscow Cancer Society No. 561
(October 13, 2009)
The Proceedings IS Held Jointly With The Society Of Pathologists
To Honor The Memory Of Prof. N.A.KRAEVSKY (1905-1985)

Clinical Features and Pathology of Malt-Lymphomas

REPORT:
Pathology of Malt-Lymphomas. By Dr. N.Kokosadze, Prof. N.Probatova, Dr. E.ZAHAROVA, PROF. A.KARSELADZE (The N.N.Blokhin Cancer Research Center).

REPORT:
Clinical Features and Curability in Patients with Malt-Lymphomas. By Prof. I.PodDubnaya, Prof. E.osmanov, Dr. O.MOSKALENKO ET AL. (Russian Medical Academy of Postgraduate Education).

Morphological Diagnostics of the Malt Lymphoma Stomach

Kokosadze N.V., Tryatova N.A., Kovrigina A.M.,
Zakharova E.S., Karsheladze A.I.
(Russian oncological scientific center named after N.N. Blokhin)

« Malt Lymphoma"First described ISAACSON p.d. (1980). Despite the extensive experience in learning this nosological form, its diagnosis and treatment remain imperfect. The reason for this provision is a common opinion on a relatively favorable forecast of the neoplasm, which gives reason to conduct dynamic observation without an adequate assessment of the severity of the condition and stage of the disease. On the contrary, associated with MALT lymphomas chronic inflammatory processesIn particular, autoimmune, determine the appointment of unreasonable expensive diagnostic procedures and therapeutic measures. Obviously, the state of diagnosis and treatment of MALT-lymphoma, among other things, is a consequence of insufficient coverage of these problems in the methodological scientific literature.

Clinico-morphological data

Malt lymphoma is about 7-8% of all B-cell lymphomas and more than 50% of the primary stomach lymph. Most cases are observed in adults (median age - 61 years), the ratio of men and women 1.0: 1.2. Most cases of MALT-lymph are associated with long-term inflammation, as a result of which the extremeal lymphoid tissue is accumulated. Chronic inflammation may be caused by infection, autoimmune or other, unknown cause. Infectious agents causing the accumulation of extrodal lymphoid tissue preceding MALT lymphoma are Helicobacter Pylori for the stomach Malt lymphoma (Fig. 1), Chlamydia Psittaci - for Malt Limphoma Orbits, Borrelia Burgdoferi - for Malt-lymphoma skin, Campylobacter jejuni - for A special subtype of MALT-lymphoma, previously known as the "disease of the α-heavy chain", and now - as "an immunoproliferative disease of the small intestine (IPSID)". An autoimmune chronic inflammation with thyroid Hashimoto and SHEGREEN syndrome, as you know, repeatedly increases the risk of Malt lymphoma of the thyroid and salivary glands. The gastrointestinal tract most often (more than 50% of all cases) is affected by the Malt lymphoma, while 85% of gastrointestinal lymphomes are localized in the stomach. Further, in the frequency of damage, the MALT-lymphoma follows: bone marrow (up to 20% of cases), head and neck organs (first of all - salivary glands, orbits) and light (14%), leather (11%), thyroid and mammary glands ( four%).

Malt lymphoma is characterized by a long clinical (indolent) current, in connection with which most cases are detected in the I-II stages. With primary MALT-lymphomes of the stomach of the lesion of extranodal localizations, up to 25% of cases are diagnosed to 25% of cases, while with primary Malt lymphomes of other organs the frequency of damage to extractal localizations increases to 46%. Incorrectly stating MALT lymph in the same way as determining the stages of lymphoma striking the lymph nodesSince with multiple extroduction tumor foci, systemic lesions (gastrointestinal tract, skin, etc.) The determination of the stage does not reflect the true prevalence of the process.

On the biopsy and operating material of 115 patients with primary lymphomas of the stomach observed in Rondz since 1995, morphological criteria for the diagnosis of MALT-lymphoma were developed, its differential-diagnostic signs are compared with reactive (neuhroquim) lymphoid-bottle infiltrates and other peripheral fine-cell in cell lymphomas.

The morphological picture of the MALT lymphoma polymorphs due to the heterogeneous composition of the tumor infiltrate, in which they are determined in various combinations, the cells of the marginal zone, small lymphocytes, scattered immuno and centroblasts, monocytoid cells (Fig.2-3).

Morphological features were evaluated in the following indicators: cellular composition, atypics of neoplastic elements, the presence of plasma-milk differentiation of lymphoid cells, the severity of plasmocyte infiltration, the presence and severity of lymphoepithelial lesions, reactive lymphoid follicles with colonization phenomena, the presence of large (blass) cells.

Limphoepithelial lesions (LELS) - aggregates of 3 or more marginal zone cells that destroy the epithelium glands are found in each second case. The destruction of the glands was expressed in the distortion of their outlines, erasing the boundaries. At 17.1% of cases, large "blast" lles were determined (Fig. 4).

Fig. one. Helicobacter pylori in mucus on the surface and in the lumen of the glands (gem-eosis color. X1000).
Fig. 2. Malt-lymphoma: "dense" lymphoid cell infiltrate in its own plate of the stomach mucosa among the glands (gem-eosis color. X200).
Fig. 3. Malt-lymphoma: lymphoid-cell infiltrate from a mixture of small and medium in size of cells with rounded-oval, centrocyt-like and irregular shape of the kernels (gem-eosis color. X400).
Fig. four. Lymphoepithelial lesion: infiltration of the epithelium gland with small lymphoid cells (gem-eosis color. X1000).

In the material of the gastrobills of follicles and follicle-like structures were determined in 30%, reactive follicles with light reproduction centers from the centrocytes and centroblasts in 14% of cases. In almost every second case, if there are lymphoid follicles, their colonization was observed. In the neoplastic infiltrate, large cellular forms were usually similar to centroblasts or immunoblasts - blast cells with nuclei or rounded-oval, or a slightly irregular shape and 1-3 nuclei; Either - with bubble-shaped cores of the rounded shape and a compact, centrally located nuclear one. Since the Malt lymphoma is determined mainly from small cells, if there are large transformed poly-broken cells in the tumor infiltration, the tumor should be qualified as a diffuse large-cellular B-cell lymphoma and notify the presence of a concomitant MALT lymphoma.

The term "MALT-lymphoma is a high degree of malignancy" is not recommended. In addition, the term "Malt-lymphoma" should not be used in relation to B-large cell lymphoma, even if it occurs in organs with Malt and is associated with lymphoepithelial lesions.

Differential diagnosis

For the development of reliable differential-diagnostic criteria, reactive lymphoid cells were studied in histological drugs of gastrobills of patients with chronic gastritis associated with HP infection. It should be noted that some polymorphism, the phenomena of atiphy, follicles and lymphoepithelial lesions, which can coexist with the most common crypt-abscesses, are also observed in reactive infiltrates.

Among the morphological signs of reactive lymphoid cells, cells with a centrocytoid nuclear morphology prevailed, without signs of cytological atiphy, or with poorly pronounced cytological atiy. Monocytoid in lymphocytes were not detected. Plasma cells were found in large quantities in the form of layers under surface sealing and packer epithelium. In no case was not revealed by plasmocytoid differentiation of lymphoid cells of infiltrates. Follicles were found in 34.7% of cases without signs of colonization. Single large (blast) cells were determined in 8.7% of cases and were scattered among small-cell infiltrate.

Stomach lymphoma selected for differential diagnosis With Malt-lymphoma, were represented by peripheral fine-cell in cell lymphomas. This group analyzed follicular lymphoma, lymphomas from the cells of the mantle zone, cases of Berkitt lymphoma, since this nosology may have the average dimensions of neoplastic cells. Follicular lymphoma was characterized by a nodular or diffuse-inactive nature of growth mixed by infiltrate cellular composition. Fl differed over the cellular composition into several types. The lymphoma from the cells of the mantle zone was characterized by the focal-diffuse or diffuse growth of infiltrate from monomorphic or small (medium) in size of the cells against the background of inflammatory changes. In the Lymphoma of Berkitta, the tumor infiltrate was spread to the sealing and paranage epithelium, displacing the cells of the inflammatory series, forming single LELS; At the same time, closely underlying cells are preferably medium-sized with multiple macrophages formed a picture that resembles the "Starry sky" (similar to the picture observed during the lesion of lymph nodes).

Immunohistochemical and Genetic Studies

The classification of lymphoid tumors is based on the processing of all available information to determine the nature of the disease. The morphological picture and immunophenotype are quite sufficient to diagnose most lymphomas. However, no antigenic marker lymph is specific. Only a combination of morphological features and a certain panel of antigenic markers can help establish a correct diagnosis. Most in cell lymphs have a characteristic combination of immunophenotypic features. Pathognomonic immunohist-chemical features for MALT lymphoma have not yet been found to date. In differential diagnosis, the method of excluding other small-cell in cell lymph is still used. It is advisable to evaluate the immunohistochemical picture in the following parameters: impaired immunoarchitectonics, aberrant immunophenotype, monoclonality. In an immunohistochemical study, differential-diagnostic value is a comparison of the expression of CD20 and CD3 antibodies: the predominance of CD20-positive B-lymphocytes over CD3-positive T-lymphocytes indicates a violation of immunoarchitectonics observed during lymphomas. With reactive (neuhrochol) processes of T-lymphocytes in lymphoid cell infiltrate prevail over in lymphocytes or are equal to the ratio. An important feature is the coexpression of BCL-2 BCl-2 and T-cellular marker CD43. To identify the aberrant immunophenotype, it is necessary to compare the expression of BCL-2 and CD43 with the expression of other T- and B cell markers.

Genetic signs play an ever-increasing role in the classification of lymphoid tumors. For most small-cell in-cell lymphomas and leukemia, genetic damage is identified. However, the molecular pathogenesis of most T-cell and Nk cell lymphomes remains unclear. PCR study of the rearrangement of IGH genes and T-cell receptor gene (TCR), fluorescent in situ. Hybridization (Fish) are valuable diagnostic studies, both to determine clonality in V- and T-cell proliferates (in terms of differential diagnosis with reactive hyperplasia) and to establish translocations associated with some tumors. In the overwhelming majority of cases, a molecular study for the presence of a clonalness of the rearrangement of hem-chain genes Ig allows you to confirm or disprove the diagnosis of MALT lymphoma. Some mature B-cell neoplasias have characteristic genetic anomalies, according to which it is possible to determine their biological properties and, consequently, the possibilities of differential diagnosis (and treatment). The detection of a chromosomal translocation T (11; 18) in patients with MALT-lymphoma is necessary for the purpose of rational treatment, since cases of MALT lymphoma with T (11; 18) are resistant to antihelicobacter therapy.

Clinical aspects of MALT lymphom

Poddubnaya I.V.¹, Osmanov E.A.², Moskalenko O.A.¹, Malikhova O.A.², Sotnikova O.P.¹, SUANova Z.A., Sorutoreva, I.N.¹
(¹ Russian Medical Academy of Postgraduate Education;
¹-Russian oncological scientific center. N.N. Blokhin)

In the literature of the 2000s. It is emphasized not only the steady increase in the incidence of non-Hodgkinsky lymphomas, but also an increase in detection various shapes and / or morphological variants of lymphoproliferation; First of all, the extrafal lymphoma. The identified features have both scientific and practical importance. The greatest interest is the increase in the incidence of malt-lymphomas, as lesions of various localization and forecast.

For the period from 1983 to 2007, 704 patients with extrafrial lymphomas were observed in Rondz. In this group, stomach lesions (33%), bones (13%), testicles (8%) were most often diagnosed; other organs and tissues (46%).

The MALT-Lymph frequency turned out to be the greatest when localizing tumors in the gastrointestinal tract; First of all - in the stomach. The experience of RONC is characterized by the diagnosis and treatment of 68 cases of primary Malt Lymph of the stomach of the I-II stage. When analyzing the clinical material, the predominance of women (65%) was noted, variants of macroscopic growth forms were clarified. A peculiar, gastritis-like MALT-lymphoma form is characteristic of a small-cell version. Endoscopic signs of treatment efficacy are determined.

Other departments of the gastrointestinal tract are involved in the tumor process during lymphomas much less often - the intestinal lesion is only 4.7%. The morphological structure of these tumors is also represented - the frequency of MALT-lymphoma is significantly inferior to the diffuse B-large cell lymphoma (DKVLC). We have experience in monitoring the course of the disease in 33 patients of the primary non-Hodgkin's intestinal lymphoma - Malt-Omms and DKVLC.

Regardless of the morphoimmunologically, the variant with this pathology often (84.9%) develops threatening life complications of the clinical course of the disease: intestinal obstruction (92.8%), intestinal perforation (3.6%), bleeding (3.6%). This suggests that the intestinal Malt-Ohms have a clinical peculiarity and require a special therapeutic approach. Performance radical operation At the height of complications, 78.3% of 5-year-old overall survival provides, but does not prevent the development of recurrence - the progression of the process is diagnosed in 20.8% of patients.

The primary lesion of the lungs should be attributed to the rare forms of extrafal lymph. Among the 704 patients, primary tumors are detected only in 13 (1.8%) patients. All neoplasms were in cellular origin, among them prevenged (54%) MALT lymphoma, aggressive options were 32%. Malt-Ohms are diagnosed in the initial stages and were highly sensitive to immunochemistry: when conducting R-CHOP, all patients achieved complete remissions. With aggressive variants of lymph with primary lung damage, none of the standard treatment schemes have had a positive effect, which makes it possible to recommend in these clinical situations the intensification of the first line of therapy.

It is known for increasing the risk of lymphoproliferation for various autoimmune processes. In this regard, non-Hodgkinsky lymphomas of the salivary glands are of particular interest. Of the observed 44 cases of lymphoma salivary glands in 8 patients (16%) in history there was SHEGREEN Disease. DKVCC are the most frequent morphoimmunological option for NHL salivary glands arising de novo; The share of the Malt-Ohm was 30%. This ratio is fundamentally changing if the lymphoma arises against the background of SHEGREEN Disease: the main option is Malt lymphoma, which is diagnosed in 78% of cases.

The sensitivity to immunochemotherapy Malt-Ohlny glasses of any origin is equally high: the frequency of complete remissions corresponds to 84-100%.

The presented data demonstrate the justification of the release of MALT-lymphoma, since these tumors constitute a heterogeneous group of neoplasms in cellular origin with a large variety of morphological and clinical characteristics.

The introduction of gastrosonography was undoubtedly a new direction in improving the diagnosis and treatment of primary Malt-lymph. Clarification of the degree of invasion into the wall of the body allows you to appreciate the prevalence of the process, to clarify the diagnosis, as well as with greater accuracy to control the effectiveness of the therapy. Perspectively applying the classification of the French group GELA, in which a multistage morphological assessment of therapy performance is carried out, supported by PCR material of gastroscopy.

In the materials of the RONTS, a favorable forecast of MALT-lymph is confirmed: the total 5-year survival, depending on the morphological variants of these tumors, is 71.4; 85.9; 96.8%. Defined indications of antihelicobacter monotherapy and its effectiveness is established depending on the prevalence of the process. At the stage of the I stage, antihelicobacter therapy together with chemotherapy made it possible to achieve 87.5% of complete regressions.

New therapeutic approaches in relapses and refractory forms of primary MALT-OM stomach are being studied (chlorubutin in combination with rituximab, cladribbin with rituximab).

The sessions of the Company are carried out, as a rule, on the last Thursday of each month (except July and August). Messages to discuss at meetings of the professional community of oncologists, as well as the initiative proposals of the new topics should be sent to the postal and email addresses specified in the weekend of the Society Bulletin.

Stomach lymphoma refers to rare diseases. Its distinctive feature is the defeat of nearby lymph nodes. Of the whole list of cancerous diseases 1-2% come on lymphoma.

The essence of pathology

In the risk group - men older than 50 years. Since lymphoma is striking lymphoid nodes, oncology in the stomach develops on the soil of metastasis. Therefore, primary tumors are less common than secondary. Another name of pathology is Malt stomach lymphoma. Features of pathology:

• slow current;
• similarity symptoms with stomach cancer;
• regarding a favorable forecast.

There are several forms of pathology with various symptoms. In each case, lymphoid fabric is affected with the gastric mucosa. An increase in the incidence of lymphoma is explained by the deterioration of ecology, the use of harmful, chemically polluted food, an increase in the load on immunity. In lymphocytes, antibodies, neutralizing and destroying pathogenic stimuli and pathogenic agents begin to form. This leads to malfunctional immunity, characterized by a decrease in the secretion of antibodies. It encourages them to destroy the cells of their own organism.

Mechanism

Lymphocytes are active cells. immune system. In case of failures, there is an excessive or insufficient development of these cells, which leads to an increase in their aggression on its own body. With histological analysis of the affected gastric tissues of the stomach, the pathological accumulation of lymphoid cells in the mucous membrane and the submembrance of the organ layers is detected. At the same time, the lymphoid follicle infiltrates the gastric glands, which leads to digestion dysfunction. If the lymphoma is initially formed in the stomach, metastases in the bone marrow and peripheral lymph nodes in most cases there are no.

In the bulk, the pathological process initially affects lymph node on the neck or in groin. The stomach is subjected to metastasis with a decrease in local immunity against the background of the development and progression of gastritis in chronic formwhich appeared as a result of Helicobacterial infection.

Varieties and reasons

Distinguish:

1. Primary, similar to cancer of the stomach symptomatically and visually, but without damage to peripheral lymph nodes with a bone marrow. Appear against chronic gastritis.
2. Secondary, striking most of the stomach multicenter.
3. Lymphognulomatosis (Hodgkin's pathology), developing when metastasizing oncology on gastric walls and adjacent lymph nodes. Isolated stomach damage is rare.
4. Lymphomas of non-Khodgkinsky type, differing in different degrees of malignancy and differentiation. Reference to large cell tumors developed from lymphoid fabric. The reason for the appearance is the damage to helicobacteria.
5. Lymphomatosis (pseudolimphoma) related to benign formations. It is found in 10% of all Onkosludaev. There is infiltration of the mucous and submucosal layers. The tumor does not metastasize in lymph nodes, therefore it does not carry a threat to life. But the risk of light quality is preserved, therefore, lymphomatosis should be treated. Less often pathology can develop against the background of malignant lymphoma.

95% of all the Malt Lymph of the stomach is accompanied by intoxicating HP infection. In this form, lymph node has always been increased. Other predisposing factors:

• features of the work of immunity of a separate person;
• genetic predisposition;
• autoimmune diseases;
• AIDS;
• previously transferred transplantation;
• long-term accommodation in adverse places with an increased radiation background;
• nutrition of food saturated with pesticides and carcinogens;
• long-term treatment with medicines overwhelming the work of immunity.

Symptoms

The clinical picture of lymphoid neoplasms is similar to the external and symptomatic manifestations of cancers and other pathologies of the gastrointestinal tract. The first sign of the stomach lymphoma is an enlarged lymph node on the neck or in groin. Symptoms:

1. Painful feelings in epigastrics that can enhance after the meal. The character of pain is stupid, butting.
2. Fast saturation when using small portions of food.
3. Rapid weight loss up to the development of anorexia.
4. Lack of appetite, which leads to an unconscious reduction in the number of food consumed.
5. The appearance of nausea attacks. It is possible to develop vomiting with a slight overeating.
6. Bleeding if the tumor germinates near the grid of blood vessels.
7. Abundant sweating and fever at night.
8. Disconnection to certain types of products, especially to meat.

Often the lymphomathe infiltration of the stomach is accompanied by serious complications, such as:

• perforation or bodybagging of the gastric wall when a through wound is formed in the tumor region;
• development of strong bleeding;
• the appearance of pathological narrowings, more often in the weekend body.

These complications require emergency operation. The special complexity of diagnosis is characteristic of follicular lymphoma, which proceeds almost without symptoms. However, pathological follicles are treatable even in a launched form.

Views

Malignant lymphomathe tumors of follicles in the stomach have a different cellular structure, the features of growth with distribution. There are 5 types of neoplasms that are localized in different layers of gastric tissues. Parameters are taken for classification:

• Form of the flow:
  • polypoid or exofite tumor, germinating in the gossip of the organ;
  • primary nodular, resulting in a gastric layer mucosa;
  • infiltrative ulcerative - the most aggressive.
• Histological sign:
  • malignant;
  • benign.
• Flow nature:
  • primary;
  • secondary.
• Form of pathology:
  • lymphogranulomatosis;
  • nepodgkin Malt Lymphoma;
  • pseudolimphoma.
• Structure:
  • B-cell;
  • T-cell;
  • diffuse B-large-milking non-Hodgkinsky type;
  • follicular.

Diagnosis of stomach lymphoma

1. Pre-inspection with palpation, evaluation of complaints, patient anamnesis.
2. Analysis of blood serum. In the lymphoma, the erythrocyte sedimentation speed will be high, specific proteins will appear (oncomarkers) and signs of microcolitan anemia.
3. Endoscopy stomach. A visual inspection of the inner part of the body is carried out. The method is not indicative due to the impossibility of externally distinguishing the tumor from gastritis or ulcers.
4. Biopsy. It is carried out with an endoscopic examination. A selected piece of tumor-affected tissue is sent to histological and cytological analysis, as a result of which a malignant malt lymphoma is confirmed or refuted, her appearance and stage. The presence of helicobacteria is determined.
5. Diagnostic laparotomy. The technique is a minimally invasive operation. Refers to the most accurate.
6. X-ray examination. Determines the localization of the increased tumor.
7. CT scan. The method allows you to determine the magnitude of the primary tumor, the distribution stage.
8. Magnetic resonance imaging. Secondary foci are compiled - metastases.

Based on the data obtained, the treatment technique is selected.

Treatment

Lymphoma is treated under the control of an oncologist who selects the technique in accordance with the type, prevalence and speed of the progression of pathology.

Stage I Stage

Early lymphoma can be cured chemical radiotherapy or surgically. Preferably an integrated approach, as it is characterized by low risks of relapse. For this, the tumor is completely excised with part of the stomach. The organ can be completely removed. During the operation, the nearby lymph nodes of the stomach and organs are carefully examined. After the operation, a course of chemistry and irradiation is carried out in order to remove possible remote metastases.

Stage II

X-ray and chemotherapy is always used with such powerful antitumor drugs such as "prednisolone", "Wincristine", "Doxorubicin". The treatment diagram is assigned in accordance with the specificity of the nature of the pathology. If non-good tumors are increased to large sizes, they are pre-reduced, and then removed.

III and IV stages

Treatment is appointed complex phased:

1. A course of shock chemistry and irradiation is carried out in order to reduce the magnitude of the tumor. Antitumor drugs are used: "prednisone", "doxorubicin", "Winnistine", "Cyclophosphane", which significantly improve the effect of a further operation. Maximum radiation dose abdominal cavity - no more than 3,700 kGR.
2. A stomach resection with careful inspection of nearby lymph nodes, tissues and organs is carried out. If the follicles are detected, they are removed with the surrounding tissues.
3. Course appointment antibacterial therapy When detecting helicibacterial infection.
4. Adjuvant (prophylactic) therapy in order to reduce the risk of relapse.

If the non-Hodgkin's tumor is striking blood vessels Or discovered increased lymphoid follicles, such pathologies belong to non-cultural. In this case, palliative therapy is prescribed. The treatment goals are to receive medicines that reduce pain that improve the condition, which will allow to extend the life of the patient.

Course against Helicobacteria

B-cell or helicobacteric digestive body lymphoma is subject to a special treatment method. This uses special medicines that are binding inflammation, overwhelming livelihoods and destroying helicobacteria.

To date, there is no consequential opinion on the preferred methodology for the treatment of this type of lymmform, therefore an individual approach is applied.

In the absence of the effect of drug treatment, a course of irradiation and chemistry is carried out. Operation is assigned to B. extreme cases. After it is shown a repeated antitumor course.

Rehabilitation

AT postoperative period It is important to establish proper nutrition. The nutritionist makes up the menu and the required amount of food. The complexity of the situation lies in the patient's loss of appetite because of their stomach pain. The patient must comply with all the recommendations of the doctor, to undergo regular examination, take folk recipes as prevention.

Folk remedies

Application of any recipe requires consultation with a doctor. Recipes:

1. Jungan aconite. Tincture you need to lubricate and rub it on the spine. After that, the back is tied with a cliff.
2. Season from sea buckthorn. The remedy is taken inward during water dilution 1: 1.
3. Kidney from birch. Accepted in the form of a decoction. Recipe: 75 g is poured 200 ml of water, boils, focusing and taken 60 ml three times a day before meals.

Forecast

Gastric lymphoma is characterized favorable outlook When detected in the early stages. Healing III and IV degree, however, 5-year survival depends on the severity of infiltration, the size of the tumor and its prevalence. Extent survival rate is 95%, at II - 75%, at III and IV - 25%. Full cure is possible in most cases when choosing the right tactics of treatment. The outcome depends on the speed of the distribution of lymphoma and the possibility of metastasis.

Food and diet

The effectiveness of the treatment of lymphoma depends on the correctness of the nutrition and observance of the diet. The patient should receive a sufficient amount of calories and construction protein to restore the body, tissue regeneration and weight maintenance. Good nutrition will soon return normal well-being. But certain products can cause problems.

Often patients refuse food due to pain, lack of taste during treatment. Therefore, a specific diet with a limited amount of animal protein, fatty products is being developed. The content of vegetable protein, fiber, dairy and milk products in the menu increases.

Products must be well wrapped in water or a couple. Dishes should be prepared in a liquid or semi-liquid form. It is not recommended to eat cold or hot food. Diet:

1. Food fractional meal.
2. Small portions.
3. A large number of snacks - 6 times a day.
4. Ensuring rest after meals.
5. Avoid overeating.

Sample menu

Despite the strict restriction in the products, the nutritionist can be acceptable to the variety and nutrition of the menu during the lymphoma of the stomach.

Table number 1.

1. Two meals for breakfast:
   • first: Meatballs from low-fat meat and rice, fastening green tea;
   • second: shredded to puree an apple.
2. Lunch: Puree with vegetables soup, boiled chicken, fresh fruit juice.
3. Sferdnik: Fresh home yogurt.
4. Dinner: Freshly breeded pasta with cheese.

Table number 22.

1. Two meals for breakfast:
   • the first: a omelet, cooked for a pair (can be replaced by the boiled sick of the egg), tea;
   • second: crushed cottage cheese.
2. Lunch: Puree-shaped soup with vegetables, boiled fish of low-fat variety.
3. Sferdnik: Freshly squeezed vegetable or fruit juice.
4. Dinner: Strongly strained cereal porridge with boiled chicken.
5. A glass of goat milk before bedtime.

Prevention

Ways to prevent lymphoma are not fully protected from the possibility of its development due to the ambiguity of the true causes of the appearance. But reducing risk factors contributes to the implementation of such rules.

Experts allocate many varieties of lymphoma. They are not only distinguished by malignancy, but also localization, further forecast. One of the forms of the disease is Malt-lymphoma, which most often amazes the gastric mucosa.

Overview of the disease

Malt lymphoma refers to the class of malignant diseases in which the pathological process affects the cells lymphatic system. Pathology is also called Maltoma.

Inflammation is most often found in the area of \u200b\u200bthe stomach, but it is capable of localizing in other parts of the body. Based on the results of research, it was established that the disease is established more often in elderly patients, mainly in women. Among all Nevatzhkinsky Lymphoma Maltoma ranks third.

But, despite many studies, specialists failed to obtain complete information about the disease and its molecular genetic features.

The danger of the disease is that the pathological process is able to quickly spread to neighboring and remote authorities. The diagnosis in the initial stages is difficult, since the signs of pathology are practically absent.

Classification

Malt lymphoma is divided depending on the location of the pathological process. The disease is also classified in accordance with the development stage of the disease.

1 Stage

Inflammation strikes only one area or body. Located outside the nodes of the lymphatic system.

Signs of pathology are practically absent, which significantly complicates the diagnosis.

2 Stage

The pathological process amazes only one organ or region, lymph nodes on one side of the diaphragm.

Symptoms of the disease become more intense, which causes patients to contact a specialist.

3 Stage

The pathological process affects the tissues located on both sides of the diaphragm. It is also capable of spreading to remote lymph nodes, a spleen.

4 Stage

He is the most dangerous stage of disease development. Signs of pathology are pronounced, patients complain about painful sensations.

Cereal the disease at 4 stages is difficult. To achieve remission use comprehensive treatment.

Localization

Maltoma most often amazes the tissue of the stomach. This localization of inflammation is observed in more than half of the cases of lymphoma.

But the pathological process may affect thyroid gland, liver, lung fabric, conjunctivation area, respiratory tract and breasts. In accordance with the localization of inflammation, symptoms appear.

The reasons

The exact causes of maltoma is not installed. It is believed that the main reason for the development of the pathological process in the area of \u200b\u200bthe stomach are bacteria type Helicobacterpylori.

Also, experts staged a number of adverse factors that influence the occurrence of the disease. These include the effects of chemical and toxic substances, smoking, drinking alcoholic beverages, infectious lesions. Maloloma provocateurs can be a stomach disease, such as ulcers, gastritis.

Of particular importance is the genetic predisposition. In many patients, the next relatives also suffered from similar diseases.

Clinical picture

The intensity of symptoms depends on the development stage of pathology. In addition, signs are manifested in accordance with the localization of the pathological process.

Most often, patients complain about painful sensations in the area of \u200b\u200bthe stomach, spleen, liver or upper respiratory tract. Usually they wear a good character.

Among common symptoms vomiting is also observed, belching, increased temperature Body, reinforced sweating predominantly at night. There is a quick occurrence of a sense of saturation when eating.

Against the background of the spread of the pathological process may occur gastric bleedingPatients have psycho-emotional exhaustion.

In the area of \u200b\u200bthe armpits, the lymphatic nodes increases in the area of \u200b\u200bthe axillary. During palpactor research, pain may occur. The affected lymph nodes are elastic and movable at the initial stages.

It was noted that in the last stages of the development of Maltoma, in which the defeat affects the tissues of the stomach, the disease in their signs is similar to a cancer injury.

Signs that indicate the presence of neoplasms are practically absent. As a result, patients later appeal to a specialist.

Diagnostic methods

In suspected of the development of Maltoma, the doctor conducts an inspection and studies the history of the patient. In order to establish an accurate diagnosis and definition of the course of therapy, instrumental and laboratory research methods are prescribed.

Get a complete picture of pathology allows blood test. The study is assigned to determine the changes in the composition and the presence of oncomarckers.

Also, the patient is appointed MRI, CT, ultrasound. The techniques allow to establish localization and the degree of propagation of the pathological process.

Also used biopsy to produce modified fabric images. Biopaths are directed to a cytological study, which makes it possible to determine the presence of cancer cells.

Treatment methods

When establishing Maltoma, first of all, treatment is aimed at eliminating bacteria such as Helicobacterpylori. According to studies, it has been established that the probability of remission after therapy is about 80%.

If the treatment has begun at the first stage of the development of pathology, only in 5% of cases there is a repeated occurrence of the pathological process.

Patients, when identifying malt lymphoma, antibacterial drugs are prescribed. Nifuratel, "Amoxicilli," Tetracycin "or" Rifaximin "is popular with popularity. In the case when drugs do not bring a positive effect, surgical intervention is appointed.

But the operation is used only in 5% of cases. Usually patients prescribe a comprehensive treatment, which includes the use of radiation or chemotherapy.

Radiation therapy

The effect on the affected tissues is carried out by radioactive radiation. The technique allows you to slow down or completely stop the growing of the neoplasm and eliminate the appearance of complications.

According to the results of studies, it is established that radiation therapy in 90% of cases brings a positive result. The disadvantage of the method is high risk The occurrence of side effects, since radioactive radiation has a negative impact on healthy fabrics.

Chemotherapy

The use of chemotherapeutic drugs allows you to improve the forecast. The duration of the course of therapy is determined by the attending physician and depends on the stage of development of pathology. Medicines are selected by a specialist, taking into account the research results.

According to experts, most often Malt Lymphoma at 1 and 2 degrees of development can be treated with chemotherapy without difficulty.

Chemotherapeutic drugs, when the disease is in 3 or 4 stages, help slow down the process of mutating tissue cells in half cases.

Possible complications

The absence of therapy is the cause of the development of complications. Patients have gastric bleeding, severe pain.

As the pathological process is distributed, there is a violation of the work of many organs and systems. Also over time, metastatic lesions may develop.

Most. dangerous consequence Exodus is considered. Death comes as a result of complications.

Forecast

When establishing malt lymphoma, the forecast is ambiguous. It depends on the set of features of the disease, the correctness of the selection of the course of therapy and the capabilities of the patient's body.

If treatment has begun at the first or second stage, the forecast is most often favorable. With the help of drugs and chemotherapy, more than 90% survival rate is achieved over five years.

When pathology is on 3 or 4 stages, the chance of recovery is reduced. Patients should regularly undergo a medical examination, including endoscopic examination.

Prevention

Special measures for the prevention of malt lymphoma do not exist, since the exact causes of the disease is not established. Specialists recommend complying with general rules:

1. Right feed In the diet should be vegetables and fruits, as they contain many vitamins. You also need to reduce the amount of oily, salt and fried food.
2. News healthy image life. Patients should abandon bad habits, such as smoking and drinking alcoholic beverages.
3. Treat timely infectious Diseases. According to scientists, it is they who become the causes of the development of pathology.
4. Regularly pass surveys. Timely diagnosis allows you to improve the forecast.

Compliance with prevention measures will reduce the risk of maltoma and complications against the background of the disease.

Malt Lymphoma refers to the type of malignant lesions. The pathological process most often affects the tissues of the stomach, but may also affect the internal organs.

The danger of the disease is that in the initial stages to diagnose pathology is difficult. This is due to the lack of explicit signs. Treatment is carried out in accordance with the development stage and features of the disease.

To destroy cancer cells are used as medicationsand other methods of therapy. But even after passing the course, patients should regularly visit the doctor to reduce the risk of recurrence.

Feature extrangal B-cell lymphoma marginal zone MALT-type It is the histological similarity with the lymphoid fabric associated with mucous membranes: Mucosa-Associated Lymphoid Tissue (Malt). The term "B-cell lymphoma marginal zone" emphasizes the genetic similarity with B-cells of the marginal zone of the follicle of the lymphatic node.

Extranitive Malt lymphoma There are in various organs: stomach, intestines, salivary glands, respiratory tract, thyroid gland, fork iron, urogenital tract, leather, etc.

Most often tumor It occurs in the stomach. A characteristic feature of the MALT lymphoma of this localization is their antigenic dependence on infection with the helicobacter pylori stomach mucosa (HP). HP persistence in a gastric mucus layer leads to the occurrence of organized lymphoid tissue in the gastric mucosa, and in the future and to the occurrence of the tumor, which makes it possible to consider HP as a etiological factor of Malt-lymphoma of the stomach.

Early cytogenetic changes when developing Malt- T (LL; 18) (Q21; Q21) and trisomy 3 are genetic damage resulting from genetic instability, which is indicated by the English abbreviation "Replication Error Repair (RER)", as well as P53 and C-MYC mutations.

At this stage of the disease growth of lymphomathe fabric Directly depends on the interaction of tumor B cells with N. pylori-specific T-lymphocytes present in the tumor substrate. In this regard, the eradication of the microbe can lead to the regression of the lymphoma.

AT result t (ll; 18) (Q21; Q21) The YuCstaposition of the API2 gene (Apoptosis Inhibitor-2), located on the 11th Chromosome, and Malt-Gene (Malt Lymphoma-Associated Translocation Gene) on the 18th chromosome. This is one of the most frequent chromosomal damage for MALT lymphomas (noted in 25-50% of cases).

Later may occur t (L; 14) (P22; Q32)which is associated with a tumor ability to autonomous growth, loss of sensitivity to H. pylori and the dissemination of cells beyond the gastric or intestine. This is due to the movement of the BCL-10 suppressor gene, located in the region of 1Р22, to the IG heavy chain gene. Violation of tumor suppression contributes to the progression of lymphoma.

Transformation of Malt Lymphoma In the tumor, the high degree of malignancy can also be associated with the inactivation of the R53 gene, the deletion of P16 and T (8; 14).

Immunophenotype Malt Lymphom It is characterized by the expression of pan-B-cell antigens (CD19, 20 and 79a), surface immunoglobulins, as well as CD21 and CD35 characteristic of the B-cells of the marginal zone.

Stomach Malt Lymphoma Elderly emerges more often (median age - 57 years). Differences of the incidence between men and women are not marked. The clinical picture depends on the stage of the disease. In the early stages of Malt lymphoma, it is characterized by the lack of symptoms or minimal manifestations of dyspepsive and pain syndrome and is not much different from other chronic stomach diseases.

As progressions arises expressed disps syndrome (Heartburn, Open with air or food), pain in the epigastric area, which are not more often associated with meals. Pain syndrome more reminds chronic gastritisthan peptic disease. To features that distinguish clinical picture Malt-lymphomas of the stomach from other diseases of this organ (with the exception of cancer) include:
a) stability of symptoms;
b) Frequent (more often than 3 per year) exacerbation of the disease with the gradual increase in clinical manifestations of the lesion of the stomach.

Further development of Malt Lymphoma Stomach accompanied by the appearance of symptoms characteristic of malignant tumors- reduction of appetite, weight loss, lymphadenopathy, fever and other signs of tumor progression.

The extradodal lymphomas of the mucous membrane (MALT-lymphoma) are a group of low-grade lymphoma, which are characterized by non-specific clinical flow and unique pathological and molecular characteristics. They arise in the context of chronic lymphoid proliferation in various places of the mucous membrane. Most Malt Lymph is found in the stomach (70%); Other tumor sites include light (14%), eye adncek (12%), thyroid gland (4%) and thin gut (1%).

Malt-lymphoma was first recognized as a discrete essence in 1994 on the revised classification of European-American lymphoma (REAL). In a later system, the WHO classification system MALT-lymphoma is grouped with spleen and nodal lymphomas of a marginal zone based on a normal cell analog that these three b-cell neoplasms have a common (B-cell of the marginal zone), despite the fact that they are morphologically, phenotypically and genotypically excellent diseases. The nodal and extranodal lymphomas of the marginal zone are also significantly different depending on their clinical behavior. Unlike its nodal analogues, MALT lymphomas are characterized by a relatively favorable forecast, late distribution and higher survival rates.

Malt lymphoma is also distinguished both from the spleen and from the nodular lymphoma of the marginal zone, since they usually occur on areas that are usually devoid of organized lymphoid tissue. Lymphoid fabric, from which there is lymphomatous clones, is rather purchased under conditions of chronic infection or autoimmune disorder. In the case of the lymphoma of the stomach, a persistent infection of Helicobacter Pylori bacteria, leading to a chronic local inflammatory response, is now uniquely recognized by the background in which this type of lymphoma may develop. Malt lymphoma is approximately 8% of all non-Hodgkinsky lymphoma; They are the third most common subtype after diffuse large B-cell and follicular lymphoma. The frequency of all the lymphoma increased by 80% in the United States over the past 20 years, and similar statistical data was registered in European countries. Interestingly, this increase, apparently, is higher in extranodal than in nodal forms And especially high in the gastrointestinal tract (GI). However, since diagnostic procedures have improved significantly in the same period, a real increase in the incidence of MALT-lymphoma is uncertain. In the stomach of lymphoma are the second most common malignancy from 5% of cases, after adenocarcinoma. Among the histological types of MALT lymphoma and diffuse large B-cell lymphomes are most common in the stomach (approximately 60% and 40%, respectively), while mantle, follicular and T cell lymphoma are rarely observed (<1% каждый), хотя лимфома MALT-лимфома трансформироваться в диффузную большую В-клеточную лимфому, и часто диагностируются смешанные формы, неясно, получены ли все диффузные большие В-клеточные лимфомы из предыдущей MALT-лимфомы или могут ли они также возникать de novo. В прошлом благоприятный клинический ход MALT-лимфомы часто приводил к их описанию как «псевдолимфомы». Однако некоторые характеристики подтверждают их истинную неопластическую природу, а именно:

• Monoclonal origin of tumors in most cases;
• The presence of characteristic chromosomal aberrations;
• Their potential for transformation into high-grade diffuse large B-cell lymphoma;
• Their (low) tendency to spread to lymph nodes, spleen and other sites.