LYMPHOEPITHELIOMA

From Big Medical Encyclopedia

LYMPHOEPITHELIOMA (lymphoepithelioma; lat. lympha pure water, moisture + epithelioma; synonym: Shminke's tumor, syncytial carcinoma, Schmincke's tumor) — malignant tumor of a throat, kind of planocellular cancer. For the first time L. it is described in 1921 Mr. A. Schmincke in Germany, Revershon and Kutar (L. Reverchon, H. Coutard) in France. One authors carry L. to tumors of the hemopoietic fabric, others — consider it as anaplazirovanny cancer, the third — as a Schmincke's tumor. The widespread term «lymphoepithelioma» does not reflect essence patol, process since gives a wrong idea of developing of a tumor from adenoid and epithelial tissue.

As a rule, L. arises in the oral and nasal parts of a throat rich with an adenoid tissue. She meets more often at the age of 30 — 40 years, but maybe at children.

Microscopic picture of a lymphoepithelioma: 1 — nests and tyazh of tumor cells, 2 — accumulations of lymphoid cells in a stroma.

Macroscopically L. has the form of a node or krupnobugristy formation of a plotnoelastichesky consistence of the covered with originally not changed mucous membrane, pale gray color on a section. Microscopically L. it is constructed of the large lamellar cells lying it is separate or forming compact nests and rykhlo the connected tyazh (fig., 1). Tumor cells have various form, their contours are vague; cytoplasm pale, sometimes otrostchaty; kernels are large, light, usually rounded or oval shape, with fuchsinophil kernels. In fabric L. sometimes the centers of planocellular differentiation up to keratinization of separate cells and formation of so-called cancer pearls meet. The stroma of a tumor consists of nezhnovoloknisty connecting fabric, infiltrirovanny lymphoid cells (fig., 2) and penetrated by numerous capillaries. Allocate the so-called type of Shminke which is characterized by a reticular arrangement epithelial both abundance of lymphoid cells and Rego's type with compact placement of epithelial cells and a small amount of lymphocytes in the form of the separate centers.

Wedge, current L. it is caused by the infiltrative nature of growth of a tumor, tendency to early innidiation in deep limf, nodes of a neck and bystry generalization of process. Features a wedge, symptoms depend on localization and prevalence of L. (e.g., initial symptom of L. in a nasal part of a throat — the complicated nasal breath; at defeat of a pipe almond — a hearing impairment; at L. a back surface of a soft palate — the complicated swallowing and change of a timbre of a voice). By means of a usual back rinoskopiya or a fibrorinoskopiya is more often on a sidewall of a nasal part of a throat or in its arch krupnobugristy formation of a plotnoelastichesky consistence is defined (unlike soft adenoid growths). In process of growth the tumor sticks out a soft palate, can extend in a nasal cavity, okolonosovy bosoms and an eye-socket. Sometimes L. sprouts bones of a base of skull and infiltrirut an average cranial pole, affecting at the same time many cranial nerves.

At localization of a tumor in the field of an oral part of a throat, hl. obr. palatine tonsils, the first symptoms are the feeling of a foreign body and small pain during the swallowing. The palatine tonsil is increased in sizes, condensed; the mucous membrane is stretched and hyperemic, mouths of lacunas are almost not visible. Germination of L. in tissues of a throat and a root of language is followed by an ulceration. At the same time pain amplifies, hypersalivation, a putrefactive smell from a mouth appears, chewing, breath is at a loss and exhaustion accrues.

According to various authors, metastasises of L. in regional limf, nodes (upper parts of a neck are more often) are observed in 80 — 95% of cases; in 20 — 25% of cases increase limf, nodes of a neck is the first symptom of L., and growth of metastasises can advance development of primary tumor in the subsequent considerably. Bilateral localization of metastasises under an upper third grudino - a clavicular and mastoidal muscle is characteristic of L. nasal part of a throat; an arrangement of metastatic nodes behind and below a corner of a mandible — for L. oral part of a throat. The remote metastasises develop early, are found in limf, nodes of various areas, in lungs, a liver, went. - kish. path.

Diagnosis put on the basis of data a wedge, and morfol, researches of primary tumor and increased dense limf, nodes of a neck.

Treatment: radiation therapy, at generalized forms L. appoint sarcolysine or cyclophosphamide.

Forecast adverse, depends on localization and a wedge, stages of a disease.

See also Throat, tumors .


Bibliography: Vakha P. N., etc. Histologic classification of tumors of an oral cavity and a stomatopharynx, the lane with English, M., WHO, 1974; Malignant tumors, under the editorship of H. N. Petrova and S. A. Holdin, t. 3, p.1, page 330, L., 1962, bibliogr.; Masson P. Tumors of the person, the lane with fr., page 99, M., 1965; SchminckeA. Uber lympho-epitheliale Geschwtilste, Beitr. path. Anat., Bd 68, S. 161, 1921.


A. I. Paches.

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