白血病皮肤浸润的临床和组织病理特点  

Clinical and pathological characteristics of leukemia with skin infiltration

作　　者：王冰心 冒丹丹 陈雪[1] WANG Bing-xin;MAO Dan-dan;CHEN Xue(Department of Dermatology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院,100044 [2]石家庄市人民医院

出　　处：《实用皮肤病学杂志》2021年第1期12-15,20,共5页Journal of Practical Dermatology

摘　　要：目的探讨白血病皮肤浸润的临床表现、皮损组织病理及预后的特点.方法总结近5年来北京大学人民医院确诊为白血病且伴皮肤浸润患者的临床表现、皮损组织病理改变及疾病转归情况.结果20例患者中疾病类型以髓系白血病为主,其中急性单核细胞白血病(AML-M5)例数最多,急性淋巴细胞白血病(ALL)和慢性粒细胞白血病(CML)相对较少.有10例为经异基因造血干细胞移植(allo-HSCT)后出现皮肤浸润.浸润性皮损多为多发,其形态以结节和丘疹为主,多累及躯干和四肢.皮损组织病理可见真皮和(或)皮下脂肪组织有未成熟白血病细胞,经免疫组化染色确定来源.9例患者于出现皮肤浸润后2~18个月内死亡,其余11例目前仍在随访中.结论白血病皮肤浸润多在白血病确诊之后出现,皮损以躯干、四肢的多发结节和丘疹为主要表现,组织病理具有特征性.出现皮肤浸润者预后差。Objective To study the clinical,histopathological and prognosis features of leukemia with skin infiltration.Methods The clinical manifestations,histopathology and disease outcome of the patients diagnosed as leukemia with skin infiltration by Peking University People's Hospital in recent 5 years(Sep 2013 to Feb 2019)were summarized.Results Among the 20 patients,myeloid leukemia was the predominant subtype,among which acute monocytic leukemia(AML-M5)was the most common,while acute lymphoblastic leukemia(ALL)and chronic myeloid leukemia(CML)were relatively rare.Skin infiltration occurred in 10 patients after allogeneic hematopoietic stem cell transplantation(alloHSCT).Most of the infiltrative lesions were multiple,mainly nodules and papules,involving the trunk and limbs.There were immature leukemic cells in dermis and/or subcutaneous adipose tissue,which were identified by immunohistochemistry.Nine patients died within 2 to 18 months after skin infiltration occurred,and the rest 11 patients were still under follow-up.Conclusion Leukemic skin infiltration often occurs after the diagnosis of leukemia.The main manifestations of skin lesions are multiple nodules and papules on the trunk and limbs,and the histopathology is characteristic.The prognosis of the patients with skin infiltration is poor.

关 键 词：白血病 皮肤浸润 临床表现:组织病理 

分 类 号：R733.7[医药卫生—肿瘤]