摘要
蕈样肉芽肿病情进展缓慢,但发生大细胞转化则提示病情恶化,预后较差.蕈样肉芽肿发生大细胞少见,容易误诊.我们报道一例伴大细胞转化的蕈样肉芽肿.患者男,40岁,因躯干四肢红斑、丘疹伴瘙痒10年,颈后结节5月就诊.患者红斑性皮损显示典型蕈样肉芽肿改变,肿瘤细胞体积较小,表达CD3、CD4,少数细胞表达CD30;而颈后结节性皮损显示有较多的大细胞浸润,可见大细胞亲表皮现象,大细胞阳性表达CD3和CD4,约40%的大细胞表达CD30.结合患者临床病史和组织学改变诊断为蕈样肉芽肿的大细胞转化,给予患者阿维A口服（30 mg/d）,干扰素皮下注射（1周3次,每次2×106 IU）,浅层X线局部照射等治疗,3周后患者皮损好转,目前在随访中.
The clinical course of mycosis fungoides is indolent except when large cell transformation occurs. Large cell transformation of MF is rare and easy to misdiagnose. A case of large cell transformation of mycosis fungoides is reported. A 40-year-old man presented with a 10-year history of pruritic erythema and papules in the trunk and extremities as well as a 5-month history of nodules on the nape of the neck.Histopathologically, the erythematous patch showed typical changes of mycosis fungoides, while the tumor cells were small and expressed CD3 and CD4, and only a small number of tumor cells expressed CD30. Pathological examination of nodular lesions revealed the infiltration of large pleomorphic lymphoid cells expressing CD3 and CD4 throughout the entire dermis. There was an epidermotropism of large cells, and about 40% of these cells expressed CD30. Based on the medical history and histological findings, the patient was diagnosed with large cell transformation of mycosis fungoides. The lesions improved markedly after 3-week treatment with oral acitretin （30 mg once daily）, subcutaneous interferon-alpha （2 × 106 IU thrice a week） and local superficial X-ray irradiation for nodular lesions. Up to the time of this writing, the patient had been followed.
出处
《中华皮肤科杂志》
CAS
CSCD
北大核心
2011年第2期88-90,共3页
Chinese Journal of Dermatology
关键词
真菌病
蕈样
大细胞转化
抗原
CD30
Mycosis fungoides
Large cell transformation
Antigens, CD30
