急性髓系白血病完全缓解患者髓外粒细胞肉瘤性复发一例并文献复习  

Relapse presenting as granulocytic sarcoma without bone marrow involvement in acute myeloid leukemia with complete remission： a case report and review of literature

作　　者：潘莹[1] 李迎伟[1] 王会平[1] 张翠[1] 杨冬冬[1] 于倩倩[1] 翟志敏[1] 

机构地区：[1]安徽医科大学第二附属医院血液内科,合肥230601

出　　处：《白血病．淋巴瘤》2012年第2期95-97,共3页Journal of Leukemia & Lymphoma

摘　　要：目的分析粒细胞肉瘤的临床特征和诊治方法，探讨流式细胞术（FCM）对其诊断价值。方法分析1例粒细胞肉瘤患者的临床特征，并进行文献复习。结果该患者初期确诊为“急性髓系白血病（AML）－M2b”伴可重现性细胞遗传学异常。DA方案化疗1个疗程取得完全缓解（CR）后，突然出现右眼眶下内侧肿痛。CT提示白血病浸润可能，细针穿刺涂片染色，镜检发现原始髓细胞，对穿刺液行流式细胞免疫分型检测出一群免疫表型为CD34^＋、CD117^＋、CD13^＋、CD33^＋、CD45^DIRN、SSC^＋的髓系前体细胞。此间查细胞学CR，骨髓微小残留病变（MRD）阴性。最终诊断为“粒细胞肉瘤，AML髓外复发”。予大剂量阿糖胞苷（6g／d，第1天至第3天）联合替尼泊苷（50mg／d，第1天至第3天）方案化疗，肿物完全消失，仍在随访中。结论AML的髓外复发常见睾丸和中枢神经系统，但仍需高度警惕其他部位以粒细胞肉瘤形式复发可能。穿刺物细胞涂片结合FCM免疫分型具有简便、快捷、可行、创伤性小的优势，可作为首选检测手段。Objective To explore clinical characteristics and diagnosis of patients with granulocytic sarcoma （GS）, and to evaluate the value of FCM in diagnosing it. Methods Clinical data of one patient with GS was reviewed and related literature was reviewed. Results The patient was diagnosed as AML-M2, chromosomal karyotype was 46.XY, t （8;21）（q22;q22） and the AML/ETO gene was positive. Systemic chemotherapy with daunorubicin plus cytarabine was given and complete remission was received. Then a nodular in medial angle of right eye was found. Result of CT indicated the possibility of leukemia infiltration. Needle aspiration cytology was conducted and many blast cells were found by microscope. CD34^＋ CD117^＋ CD13^＋ CD33^＋ CD45^dim SSC^＋ can be found by FCM. The cytology was complete remission and minimal residual disease was negative. Finally diagnosis was GS, relapse of AML. After a systemic chemotherapy with large dose of eytarabine plus teniposide （cytarabine 6.0 g/d, d1-3; teniposide 50 mg/d, d1-3）, the mass could not be touched and the follow-up was continued. Conclusion Ahhough relapse of AML often occurs in the testicle or the central nervous system, it pay attention to the possibility of relapse of AML presenting as GS. Fine needle aspiration cytology （FNAC） combined with FCM can provide an convenient, handy, practicable and less invasive way of the diagnosis and can be a preferred detection technique.

关 键 词：白血病 髓样 急性 肉瘤 髓样 流式细胞术 诊断 

分 类 号：R733.71[医药卫生—肿瘤]