青少年急性淋巴细胞白血病孤立卵巢复发的临床病理特点  

Clinicopathologic Characteristics and Outcome of Isolated Ovarian Relapse in Adolescent with Acute Lymphoblastic Leukemia

作　　者：于亚平[1] 宋萍[1] 梅建刚[1] 安志明[1] 周晓刚[1] 李峰[1] 王利平[1] 唐玉梅[1] 翟勇平[1] 

机构地区：[1]南京军区南京总医院血液科,江苏南京210002

出　　处：《中国实验血液学杂志》2016年第5期1354-1359,共6页Journal of Experimental Hematology

摘　　要：目的:探讨青少年急性淋巴细胞白血病(ALL)孤立卵巢复发的临床病理特点及诊断和治疗。方法:1例16岁青少年女性以骨关节疼痛起病,外周血涂片分类见原幼淋巴细胞32%。骨髓细胞学检查示增生明显活跃,原幼淋巴细胞72%。骨髓细胞流式细胞免疫分型显示,原始细胞表达HLA-DR、Td T、CD10、CD19、CD22和c CD79a。骨髓细胞染色体和融合基因检查显示,t(1;19)(q23;p13)/E2A-PBX1阳性,确诊B-ALL。采用CALGB8811方案治疗,完全缓解7个月后出现下腹痛,超声检查诊为卵巢肿瘤。行双侧卵巢肿块切除术。结果:卵巢病理检查发现弥漫性幼稚淋巴细胞浸润,免疫组织化学检测显示瘤细胞表达Td T、CD20、CD43和CD79a,证实为ALL卵巢复发。进一步检查未发现其它髓外部位病变。同期的血液和骨髓细胞学检查仍显示完全缓解,但流式细胞免疫分型检测微小残留白血病阳性。再次诱导化疗后病情控制,1年后肿块再次增大,并压迫输尿管致肾积水,后患者放弃治疗。结论:尽管孤立性卵巢复发在ALL极为少见,但预后极差,对骨髓或其它髓外部位复发的女性患者,应进行常规检查以排除此种可能。Objective：To investigate the clinicopathologic characteristics,diagnosis and treatment of isolated ovarian relapse of acute lymphoblastic leukemia（ALL）.Methods：A 16-year-old girl presented with complaints of bone and joint pain.The peripheral blood and bone marrow（BM） smears showed 32%and 72%blasts,respectively,which were myeloperoxidase-negative.The blasts were positive for HLA-DR,TdT,CD10,CD19,CD22 and cCD79 a and negative for CD34,CD5,CD7,CD13,CD33,CD56 and MPO detected by flow cytometry.BM cytogenetic analysis and fusion gene screening revealed t（1;19）（q23;p13） and E2A/PBX1.She was diagnosed as B-cell acute lymphoblastic leukemia（B-ALL） and was treated with CALGB8811 protocol.She presented lower abdominal pain with intermittent colick at 7months after complete remission.The pelvic ultrasound showed a lobulated mixed echogenic mass in the right ovary,and an exploratory laparotomy was performed.Results：Pathologic examination and immunohistochemistry of resected ovarian tumor revealed extensive infiltration by lymphoblasts with positive for TdT,CD20,CD43 and CD79 a.Further investigations failed to reveal any other extramedullary involvement.Hemogram,peripheral blood and bone marrow smear examination were unremarkable at the same time.The isolated extramedullary ovarian relapse of ALL was confirmed.Simultaneous,the detection of minimal residual disease by multiparametric flow cytometry showed positive with 5.0×10-4.The reinduction chemotherapy including a high-dose methotrexate and cytarabine was given to the patients.She experienced the second ovarian relapse after 1 year and refused further treatment.Conclusion：Although uncommon,ovarian recurrence after chemotherapy for ALL should be considered in the patients with suggestive symptoms.Screening by pelvic ultrasonography may be valuble for early detection of pelvic disease in ALL.

关 键 词：急性淋巴细胞白血病 复发 卵巢 微小残留病 

分 类 号：R733.71[医药卫生—肿瘤]