早期呈丹毒样损害的原发性皮肤弥漫大B细胞淋巴瘤  

Primary cutaneous diffuse large B cell lymphoma in early stage manifested as erysipelas

作　　者：朱建建[1] 李昕[1] 龙剑[1] 何平[1] 陈霄霄 杜维[2] 覃瑾[1] ZHU Jian-jian;LI Xin;LONG Jian;HE Ping;CHEN Xao-xiao;DU Wei;QIN Jin(Department of Dermatology,The First People's Hospital of Changde City in Hunan Province)

机构地区：[1]常德市第一人民医院皮肤科,湖南常德415000 [2]常德市第一人民医院病理科,湖南常德415000

出　　处：《临床皮肤科杂志》2019年第7期423-428,共6页Journal of Clinical Dermatology

基　　金：湖南省技术创新引导计划(2017SK51301)资助项目

摘　　要：患者男,69岁。右下肢红肿3个月,结节1个月余。患者早期右下肢皮肤红肿呈丹毒样损害,抗感染治疗欠佳,病程进展出现肿胀加重及多个紫红色结节。皮肤科检查:右下肢肿胀,可见多个紫红色结节,部分融合。右大腿及颈部散在豌豆大的红色或肤色结节。皮损组织病理检查:表、真皮可见无浸润带,真皮内及皮下脂肪层可见弥漫淋巴样细胞浸润,淋巴样细胞核大、深染,异形性明显,部分呈泡状核,有单个中位核仁,可见核分裂象。免疫组化:肿瘤细胞表达CD20、CD10、转录因子(MUM)-1、B细胞淋巴瘤/白血病(Bcl)-2;灶状表达Bcl-6;不表达CD3、CD5、CyclinD1及CD30;原癌基因(Cmyc)约70%阳性;核增殖抗原(Ki-67):阳性细胞约90%。诊断:原发皮肤弥漫大B细胞淋巴瘤(腿型)ⅢA期。予化疗后,皮损明显好转。A 69-years-old male presented with erythema and edema for three months, and nodules for over a month on the right lower limb. Lesions started with erysipelas-like manifestations in early stage, and did not respond well to anti-infection therapy. Later on, the edema became worse, and multiple purple nodules developed. The histopathological examination revealed non-infiltrating zone between the epidermis and the dermis, and a diffuse infiltration of atypical lymphoid cells with large hyperchromatic nuclei, partly vesicular nucleus, single central nucleus and mitotic figures in the dermis and the subcutis.Immunohistochemical staining of the tumor cells showed positive for CD20, CD10, MUM-1, Bcl-2, focal positive for Bcl-6,and negative for CD3, CD5, CyclinD1 and CD30;C-myc positive cells were≈70%, and Ki-67 positive cells were≈90%.These findings were consistent with primary skin diffuse large B cell lymphoma(leg type) stage ⅢA. The skin lesions were markedly improved after R-CHOP chemotherapy.

关 键 词：弥漫性大B细胞淋巴瘤 皮肤 原发性 丹毒 

分 类 号：R739.5[医药卫生—肿瘤]