nasal malignant granuloma
Introduction
Introduction to nasal malignant granuloma Malignant granuloma begins in the nose and then gradually spreads to the midline of the face. It is a rare granuloma with clinical necrotizing ulcers. The etiology of this disease is unknown, pathological examination is mostly chronic non-specific granulation tissue and necrosis, in which there are many components of inflammatory cell infiltration. Because pathological entities vary, they are named and classified, such as necrotizing granulomas. Fatal linear granuloma, mid-faceted idiopathic granuloma and midline malignant reticulosis. Malignant granuloma is currently used clinically. According to the characteristics of the lesion and pathological changes, it can be classified into two types: buccal tumor type and allergic type (autoimmune type). Buccal tumor type: lesions occur in the nose, but also in the upper jaw, pharynx, consequences and nasal, the lesions are mainly located in the facial midline and upper respiratory tract, mainly for granulomatous ulcer necrosis, its destructive For a wide range, can invade bone and cartilage, and even disfigured, advanced patients die of major bleeding or failure; allergic type (autoimmune type): Wegener granulomas are mostly of this type, usually divided into two types: localized and systemic. Mainly caused by vascular allergic inflammation, in addition to multiple granuloma, it also manifests as intractable progressive ulcer necrosis, can be limited to the upper respiratory tract, and can involve the lungs and organs of the body. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: nasal septum perforation
Cause
Cause of nasal malignant granuloma
Allergic reaction (20%):
Allergic or autoimmune studies in recent years suggest that the disease may be an early vascular disease caused by allergies, that is, allergic reactions of blood vessels to bacterial toxins, much like Arthur necrosis, immunoglobulin deposition in the capillary wall, The immune complexes were detected in the serum of patients with active disease, and the symptoms were alleviated by immunosuppressive therapy. The immunofluorescence test showed that C3 and IgG were on the glomerular basement membrane, and the immune complex was thick in the basement membrane by electron microscopy. Granules, ring immune complexes are elevated, so some people think that nasal malignant granuloma, nodular arteritis and Wegener granulomatosis belong to the same type of disease, but the clinical manifestations are different, all three are autoimmune diseases, The clinical use of corticosteroids is effective and supports this theory.
Viral infection (20%):
Infection theory The pathology of this disease is mostly chronic inflammatory changes, but it is difficult to identify specific pathogens, viruses and fungi. Recent studies have found that the Crox virus is found in cell cultures and serum of patients taking malignant granulomatous tissue. Small body, it is believed that this disease is related to this virus infection.
Tumor metastasis (20%):
Many scholars believe that this disease is a malignant tumor of the lymphoid tissue system. The pathological tissue resembles reticulum cell sarcoma or lymphoma, and has abnormal cells and mitotic phase of tumor hyperplasia, but no necrotizing blood vessels and multinucleated giant cells, because the lesion is limited to the nose. And the respiratory tract, and to the late stage of the disease, the body such as internal organs, lymph nodes and bone marrow can show the same lesions, similar to malignant tumor metastasis, most patients are sensitive to radiation, in line with oncology, but so far there is no clear evidence of clinical and pathological.
Prevention
Nasal malignant granuloma prevention
No special, early diagnosis and treatment, prognosis is better, clinical should pay attention to the identification of nasal tuberculosis, atrophic rhinitis, malignant tumors, the only method is repeated biopsy.
Complication
Nasal malignant granuloma complications Complications, nasal septum perforation
Patients with advanced stage often have persistent relaxation heat and progressive wasting and systemic failure.
Symptom
Nasal malignant granuloma symptoms Common symptoms Ankle perforation Nasal mucosa swelling Relaxation heat Intermittent nasal obstruction with bloody secretions Nasal septum perforation Nasal external expansion bulge
According to the characteristics of the lesions and pathological changes, they can be classified into two categories:
(a) buccal tumor type
The lesions are mostly in the nose, and also in the upper jaw, the pharynx, the consequences and the nose. The lesions are mainly located in the midline of the face and the upper respiratory tract, mainly for granulomatous ulcer necrosis, and its destructiveness is extensive. Invasion of bone and cartilage, and even disfigurement, advanced patients died of major bleeding or failure, the pathological changes of this disease are more diverse, mainly seen in the following four types:
1 non-specific inflammatory granulation tissue contains various forms of inflammatory cells;
2 non-specific inflammatory granulation tissue contains many giant cells;
3 non-specific inflammatory granulation tissue contains a large number of tissue cells;
4 Non-specific inflammatory granulation tissue has obvious necrosis.
Most of the above four types are mixed, and often are mainly lymphocytes, mixed with more plasma cells and a different number of tissue cells. These cells are centered on blood vessels and have a tendency to infiltrate around blood vessels, although these cells have Moderate atypia, but still can not be diagnosed as a malignant tumor, although the pathological changes of Wegener granulomatosis are also non-specific granulomas, but characterized by multinucleated giant cells and necrotizing vasculitis, which is malignant granuloma and Wegener granulomatosis The differential diagnostic criteria.
(two) allergic type (autoimmune type)
Wegener granuloma is of this type and is usually divided into two types: localized and systemic. It is mainly caused by vascular allergic inflammation. In addition to multiple granuloma, it also shows refractory progressive ulcer necrosis, which can be limited to the upper respiratory tract. It can affect the lungs and organs of the whole body. Invading the lungs is characterized by multiple nodules, often with cavities. The kidneys are characterized by localized renal necrosis, glomerulonephritis, and can also cause systemic vascular damage. There may be fibrous exudate and granulation tissue in the blood vessels. Ulgener's granulomatous ulcer necrosis occurs in the body, involving the nose, upper jaw, throat, trachea, kidney, spleen, adrenal gland and lungs. The patient died of systemic failure. And uremia.
Clinical manifestations:
Stewart divides the clinical manifestations of malignant granuloma into three phases:
1. Forequarters: for general cold or sinusitis, intermittent nasal obstruction, accompanied by watery or bloody secretions, can also be characterized by nasal dryness and scarring, local examination for general inflammation, granulomatosis can occur in the nasal septum Ulcers, this period can last 4 to 6 weeks.
2. Active period: nasal ventilation is not smooth or completely blocked, there are purulent sputum, often smelly, general condition is acceptable, sweating, poor appetite, often low fever, a few have high fever, with general antibiotic treatment is invalid, local examination See the swelling of the nasal mucosa, erosion and ulceration, granulation, grayish white necrosis on the surface, involving the nasal inferior or nasal septum first, obviously can cause external expansion of the nose, lesion development can cause perforation of the nasal septum or perforation of the ankle. It lasts for weeks to months.
3. End-stage: patients with weakness, cachexia, local disfigurement, nasal mucosa, cartilage, bone and surrounding tissues (such as the face, eyelids, forehead and even the skull base) can be severely extensively damaged, swelling of the eyelids and conjunctiva, prominent eyeballs, vision loss Finally, he died of exhaustion, bleeding or complicated meningitis.
Examine
Nasal malignant granuloma
1, pathological biopsy presents chronic non-specific granulomatous lesions, if the appearance of heterologous reticulocytes or mitotic phase can diagnose the disease.
2, laboratory tests: white blood cell count is low, erythrocyte sedimentation rate is accelerated; immunoglobulin levels are high, no special discovery of bacteria, fungi and virus culture.
3, CT scan of the tomographic X-ray film.
Nasopharyngeal malignant granuloma: necrosis of the nasopharynx, ulcer formation, mass as the main performance, histology showed a large number of medium-large heterogeneous T lymphocyte hyperplasia, cell pleomorphism, less cytoplasm, nuclear polymorphism, The chromatin is fine, the nucleoli are not obvious, the cell division is more common, the interstitial small blood vessels proliferate, and the tumor cells infiltrate the blood vessel wall. The tumor cells are confirmed by immunohistochemistry as T lymphocytes, so they are also called vascular central T cells. Lymphoma.
Diagnosis
Diagnosis and diagnosis of nasal malignant granuloma
diagnosis
According to clinical manifestations, histopathology and laboratory tests, the diagnosis is not difficult.
Diagnostic points:
1 All cases of progressive granulogenous ulcer necrosis occurring in the nose and face should consider the disease first.
2 pathological examination: chronic non-specific granulomatous lesions, while seeing atypical reticulocytes or mitotic phase, you can diagnose the disease.
3 local damage is serious, but the whole body performance is still good.
4 local lymph nodes are generally not enlarged.
5 laboratory examination: white blood cell count is low, erythrocyte sedimentation rate is accelerated.
6 advanced patients often have persistent relaxation heat and progressive weight loss and systemic failure. Early diagnosis and treatment have a better prognosis.
Differential diagnosis:
Clinical attention should be paid to the identification of nasal tuberculosis, atrophic rhinitis, malignant tumors, etc. The only method is repeated biopsy.
