关键词: 弥漫性血管内大B细胞淋巴瘤；诊断

Abstract:

An 82-year-old Chinese woman presented with skin eruptions on the thigh and abdomen accompanied by intermittent fever of unknown origin for more than 2 months. No hepatosplenomegaly, lymphadenopathy or neurological abnormality was found with physical examination. There were irregular, tender, indurated, dark-erythematous plaques on bilateral thigh and lower abdomen, along with nonpitting edema and peau d′orange appearance. A significant decrease was observed in the count of white blood cells, red blood cells and platelets, but the serum level of lactate dehydrogenase was elevated. Tumor aspiration and the first pathology yielded no confirmed diagnosis, and the patient had ever been diagnosed with chronic lymphangitis, allergic cutaneous vasculitis and fever of unknown origin in other hospitals. Antibiotic therapy leaded to no improvement, and the lesions gradually spread from the thigh to lower abdomen. The second histopathology revealed the presence of atypical lymphoid cells with hyperchromatic nuclei and irregular morphology in the lumens of small blood vessels in subcutaneous tissue. Immunohistochemically, the atypical lymphoid cells were positive for lymphocytotoxic antibody （LCA）, CD20, CD79α and bcl-2, but negative for bcl-6, CD10, CD3, CD45RO, CD30, EMA, AE1/3 or CK, and vascular endothelial cells were positive for CD34. The diagnosis of intravascular large B-cell lymphoma was made based on the histopathological features and immunohistochemical findings. The patient died in two months.