成人T细胞白血病/淋巴瘤与皮肤淋巴瘤的鉴别  

Distinction Between Adult T-cell Leukemia/Lymphoma and Cutaneous Lymphoma

作　　者：汪晨[1] 陈国敏[2] 马一盖[1] 罗羽 姚志远[1] 李静[1] 何静文[1] 陈锡唐[1] 张永利[2] 曾毅[2] 

机构地区：[1]中日友好医院,北京100029 [2]中国预防医学科学院病毒学研究所

出　　处：《中华皮肤科杂志》1997年第4期237-239,共3页Chinese Journal of Dermatology

摘　　要：伴皮肤损害的成人T细胞白血病/淋巴瘤(ATLL)与皮肤T细胞淋巴瘤有极相似的临床病理和免疫分型,为了区别两者,对4例伴皮肤损害的ATLL和18例皮肤淋巴瘤进行临床病理、免疫学分型及嗜人T淋巴细胞病毒Ⅰ型(HTLV-Ⅰ)前病毒DNA的比较性研究,2例光线性类网织细胞增多症和2例皮肤淋巴细胞浸润症为阴性对照。结果:4例ATLL出现皮肤损害的同时表现系统症状如:广泛的浅淋巴结肿大,乳酸脱氢酶和白介素2受体异常增高,外周血有花瓣样细胞和骨髓异常。其外周血、骨髓、皮肤和淋巴结的HTLV-1前病毒DNA均阳性,而18例皮肤淋巴瘤均阴性。提示:具有皮肤T细胞淋巴瘤样的皮疹和病理模型及免疫分型同时伴周围血花瓣样细胞和HTLV-1阳性者应诊断本病。Adult T-cell leukemia/lymphoma (ATLL) and cutaneous T-cell lymphoma (CTCL) have similar clinieopathology and immunophenotype, in order to differentiate the two diseases, 4 eases of ATLL associated cutaneous lesions and 18 eases of CL were studied for elinieopathology, immunophenotype and HTLV-I provirus DNA. Two eases of actinic reticuloid and two eases of lymphocytic infiltration of the skin were selected as negative control. The results showed that four patients of ATLL manifested cutaneous lesions, at same time, they had additional systemic diseases, such as generalized lymphadenopathy, increased levels of LDH and IL-2R, rosette-like cells in their peripheral blood and abnormal bone marrow. The HTLV-I provirus DNA was detected in the peripheral blood, bone marrow, cutaneous lesions and lymph node biopsy specimens of the four patients by PCR amplification of specific HTLV-I DNA fragment. 18 cases of CL were negative for HTLV-I. The study indicates that ATLL may be diagnosed if the patients are associated with CTCL-Iike cutaneous lesions, characteristic histopathological pattern and immunophenotype, rosette-like cells in the peripheral blood and positive HTLV-I provirus DNA.

关 键 词：白血病 T细胞 淋巴瘤 ATLL 皮肤肿瘤 鉴别诊断 

分 类 号：R733.704[医药卫生—肿瘤] R739.504[医药卫生—临床医学]