骨髓瘤和淋巴瘤之间的差异

Key Difference – Myeloma vs Lymphoma

骨髓瘤and Lymphoma are two inter-related malignancies having a lymphoid origin.脊髓瘤通常发生在骨髓而淋巴瘤可以在可用的淋巴组织的任何部位都会出现。This is the key difference between myeloma and lymphoma. The specific etiology of these diseases is unknown but certain viruses,辐照，，，，immune suppression and cytotoxic poisons are believed to have some influence on the malignant transformation of the cells that leads to these malignancies.

CONTENTS

1。概述和关键差异
2。什么是淋巴瘤
3。What is Myeloma
4。并排比较,骨髓瘤vs T淋巴瘤abular Form
6。概括

什么是淋巴瘤？

恶性肿瘤lymphoid system称为淋巴瘤。如前所述，它们可以在存在淋巴组织的任何部位都会出现。这是5^Thmost common malignancy in the Western world. The overall incidence of lymphoma is 15-20 per 100000. Peripheral lymphadenopathy is the commonest symptom. However, in about 20% of the cases, lymphadenopathy of the primary extra nodal sites is observed. In a minority of patients, lymphoma associated B symptoms such as weight loss, fever, and sweats may appear. According to WHO classification, lymphomas can be divided into two categories as Hodgkin’s and Non-Hodgkin’s lymphomas.

霍奇金的淋巴瘤

在西方世界，霍奇金淋巴瘤的发生率为每100000。该广泛类别可以分为较小的组为经典的HL和结节性淋巴细胞主要HL。在占90-95％病例的经典HL中，标志性的特征是Reed-Sternberg细胞。在结节性淋巴细胞主要HL中，“爆米花细胞”，可以在显微镜下观察到芦苇 - 塞堡的变体。

病因

爱泼斯坦 - 巴尔病毒DNA已在霍奇金淋巴瘤患者的组织中发现。

Clinical Features

Painless cervical lymphadenopathy is the commonest presentation of HL. Thesetumorsare rubbery on examination. A small proportion of patients may present with acough由于纵隔淋巴结肿大。有些人可能会在淋巴结肿大的部位发展瘙痒和酒精相关的疼痛。

Investigations

• Chest X-ray for mediastinal widening
• CT scan of chest, abdomen, pelvis, neck
• PET scan
• 骨髓活检
• Blood counts

Management

医学科学的最新进展改善了这种情况的预后。该疾病早期的治疗包括2-4个阿霉素，博霉素，长南碱和达卡巴嗪的循环，无毒性，然后进行辐射，其固化速率超过90％。

Advanced disease can be treated with 6-8 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine along with chemotherapy.

Non-Hodgkin’s Lymphoma

根据WHO分类，非霍奇金的80％的淋巴瘤是B细胞的起源，而其他淋巴瘤是T细胞的起源。

病因

• 家史
• Human T-cell Leukemia Virus type-1
• Helicobacter pylori
• 衣原体psittaci
• EBV
• 免疫抑制药物和感染

发病

During different stages of淋巴细胞development, malignant clonal expansion of lymphocytes can happen, giving rise to different forms of lymphomas. Errors in the class switching or gene recombination forimmunoglobulinT细胞受体是前后病变，后来发展为恶性转化。

非霍奇金淋巴瘤的类型

• 卵泡
• Lymphoplasmacytic
• 地幔细胞
• 扩散大B细胞
• Burkitt’s
• 变性
  

  Figure 01: Burkitt lymphoma, touch prep

Clinical Features

The commonest clinical presentation is painless lymphadenopathy or symptoms that occur due to the mechanical disturbances by the lymph node mass.

What is Myeloma?

由骨髓中的浆细胞引起的恶性肿瘤称为骨髓瘤。该疾病与浆细胞的过度增殖有关，导致过度产生单克隆pro蛋白，主要是Igg。Excretion of light chains in urine (Bence Jones proteins) can occur in paraproteinaemia. Myelomas are commonly seen among elderly males.

Cytogenetic abnormalities have been identified by FISH and microarray techniques in most cases of myeloma. Bone lytic lesions can be typically seen in the spine, skull, long bones and ribs due to dysregulation of bone remodeling. The osteoclastic activity is increased with no increment in the osteoblastic activity.

临床病理特征

骨骼破坏会导致长骨和高钙血症的椎骨塌陷或断裂。脊髓压缩可能是由软组织浆细胞瘤引起的。骨髓用浆细胞浸润可能会导致贫血，，，，neutropenia, and thrombocytopenia. Kidney injury can be caused by multiple reasons such as secondary hypercalcemia or hyperuricemia, use of NSAIDs and secondary amyloidosis.

症状

• 贫血的症状
• Recurrent infections
• 症状of renal failure
• Bone pain
• 高钙血症的症状

Investigations

• Full blood count- Hemoglobin, white cells and platelet counts are normal or low
• ESR(Erythrocyte Sedimentation Rate)-usually high
• 血片
• Urea and electrolytes
• 血清钙正常或升高
• 总蛋白质水平
• 血清蛋白电泳 - 特征显示单克隆带
• 可以看到骨骼调查 - 特定裂解病变

Management

尽管通过良好的支持性护理和化学疗法，骨髓瘤患者的预期寿命已改善了大约五年，但仍无法治愈这种疾病。该疗法旨在预防进一步的并发症和生存的延长。

Supportive Therapy

贫血可以通过输血来纠正。在患有高视力的患者中，应缓慢进行输血。红细胞生成素可以使用。高钙血症，肾脏损伤和高视力应适当治疗。感染可以用抗生素治疗。如有必要，可以进行年度疫苗接种。放疗和全身化疗或高剂量地塞米松可以减少骨痛。通过骨科手术可以预防病理骨折。

具体疗法

• 化学疗法- thalidomide/Lenalidomide/bortezomib/类固醇/Melphalan
• Autologous bone marrow transplant
• 放疗

骨髓瘤和淋巴瘤有什么区别？

骨髓瘤与淋巴瘤
由骨髓中的浆细胞引起的恶性肿瘤称为骨髓瘤。	恶性肿瘤lymphoid system are called lymphomas.
Commonness
骨髓瘤is less common.	Lymphoma is commoner than myelomas.
Location
这通常在骨髓中产生。	This can occur in any place where lymphoid tissues are present.

概括-骨髓瘤与淋巴瘤

淋巴瘤是淋巴系统的恶性肿瘤，而骨髓瘤是由骨髓中的浆细胞引起的恶性肿瘤。这是骨髓瘤和淋巴瘤之间的差异。由于这些疾病是相当严重的，并且要危及生命的条件，因此在疾病管理期间应特别注意患者的心态。为了提高患者的生活标准，应获得家庭的支持。

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Reference:

1。Kumar, Parveen J., and Michael L. Clark. Kumar & Clark clinical medicine. Edinburgh: W.B. Saunders, 2009. Print.

图片提供：

1. KGH假定的“多发性骨髓瘤（2）染色”（基于版权主张）。（CC BY-SA 3.0）通过下议院维基梅迪亚
2。“伯基特淋巴瘤，触摸准备，赖特污渍”埃德·乌斯曼（Ed Uthman）- （公共领域）通过下议院维基梅迪亚