中华皮肤科杂志 ›› 2003, Vol. 36 ›› Issue (2): 67-69.

• 论著 • 上一篇    下一篇

以环形红斑为初发表现的T淋巴母细胞性淋巴瘤的临床研究

王强1, 朱鹭冰1, 宿杰·阿克苏2, 陈莲3   

  1. 1. 上海复旦大学附属中山医院皮肤科 200032;
    2. 上海复旦大学附属中山医院病理科 200032;
    3. 上海复旦大学附属儿科医院病理科 200032
  • 收稿日期:2002-03-19 出版日期:2003-02-15 发布日期:2003-02-15

Erythema Annulare as the First Presentation in T-Lymphoblastic Lymphoma:A Case Report

WANG Qiang1, ZHU Lu-bing1, SUJIA. Akesu2, CHEN Lian3   

  1. Department of Dermatology, Zhongshan Hospital of Fu Dan University, Shanghai 200032, China
  • Received:2002-03-19 Online:2003-02-15 Published:2003-02-15

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摘要： 目的 报告一例罕见的以环形红斑为初发表现的成人T淋巴母细胞性淋巴瘤。方法 对其临床、组织病理、免疫组化、分子生物学和各种特殊的实验室检查进行研究。结果 颈部、腹股沟肿大数10个淋巴结,全身百余个环形红斑。胸部CT示:前上纵隔占位性淋巴瘤表现。胸水中找到异形细胞。骨髓片示:淋巴瘤累及骨髓。外周血中未发现瘤细胞。淋巴结结构破坏,瘤细胞弥漫分布,呈“满天星”图像,部分瘤细胞细胞核呈曲核型;免疫组化示:LCA、CD43、UCHL-1、TdT均阳性。皮肤损害示真皮浅层带状淋巴样细胞浸润,部分向表皮性,可见Pautrier微脓肿,少数淋巴样细胞细胞核呈曲核型,与淋巴结的瘤细胞相似;免疫组化示:LCA、CD43、UCHL鄄1均阳性,TdT阴性。原位杂交示EBER1/2在淋巴结组织中呈阳性;皮肤组织中呈阴性。结论 此例为首例报告罕见的以环形红斑为初发表现的T淋巴母细胞性淋巴瘤。

关键词: 淋巴母细胞, 淋巴瘤, 红斑

Abstract: Objective To report a rare case of T-lymphoblastic lymphoma with erythema annulare as an initial manifestation.Methods The clinical、histopathologic、immunohistochemical、molecular biological and several special laboratory examinations of the disease were evaluated.Results Numerous enlarged lymph nodes were found in both neck and inguinal region.More than one hundred annular lesions were found all over the body.CT of chest showed the anterior superior mediastinum was occupied by lymphoma.Atypical cells were found in pleural fluid.The bone marrow smear showed the involvement of lymphoma.Notumor cells were found in the peripheral blood.The histopathologic examination of lymph nodes showed the structure of lymph nodes was destructed and tumor cells diffusely infiltrated,manifesting as "starry sky" appearance,with convoluted nuclei in some tumor cells.The tumor cells were of T-lineage[CD43+,leukocyte-common antigen(LCA)+,UCHL-l(CD45RO)+] and lymphoblast(terminal deoxynucleotidyl transferase,TdT+).The pathologic examination of skin lesions(erythema annulare)showed band-like lymphoid cell infitration in superficial dermis.Some lymphoid cells showed epidermotropism and Pautrier microabscess was also found.Convoluted nucleus was observed in a few lymphoid cells which was similar to the tumor cells in the lymph nodes.The lymphoid cells of the skin lesions were of T-lineage(CD43+,LCA+,UCHL-l+,TdT-).Epstein-Barr virus encoded RNA(EBER)l/2 was positive in involved lymph nodes,but negative in skin lesions,by in situ hybridization(HIS-RNA)technique.Conclusion This is the first case reported in China that erythema annulare is the initial manifestation of T-lymphoblastic lymphoma.

Key words: Lymphoma, lymphoblastic, Erythema