摘要
报告1例以红斑丘疹为首发表现的慢性淋巴细胞白血病。患者男,69岁。因全身红斑、丘疹伴瘙痒19 d就诊。皮肤科检查:腰腹部、双上肢可见片状红斑、斑丘疹和丘疹;四肢可见片状碎瓷样裂纹,伴有渗出、结痂,以下肢为著,双小腿可见凹陷性水肿。皮损组织病理检查:真皮浅层血管周围少量淋巴单一核细胞浸润;皮损免疫组化:CD45(+++),CD43(+++),CD5(+++),CD10(++),CD20、CD23、CD117及配对盒基因(PAX)5均(-)。骨髓组织病理检查:淋巴细胞在骨小梁间小灶增生,胞体小,胞浆量少,核圆或椭圆,核染色质粗,未见核仁,约占有核细胞的5%;骨髓免疫组化:CD3散在(+),CD5(+),CD20(+++),PAX5(++),CD23(+),CD10、G1/S-特异性周期蛋白(Cyclin)D1及性别决定区Y框蛋白(SOX)11均(-)。诊断:慢性淋巴细胞白血病。
A case of chronic lymphocytic leukemia with erythematous papules as the first presentation is reported. A 69-year-old male presented with erythema, papule and exudation with pruritus for 19 days. Dermatological examination showed scaly erythema, maculopapule and papule on the abdomen and upper limbs. All limbs presented with porcelain-like cracks with ex udation and scab, especially in lower limbs, and pitting edema was found in bilateral calves. Histopathological examination revealed a small number of mononuclear lymphocytes infiltrated around the superficial vessels of the dermis. Skin immunohistochemistry showed CD45(+++), CD43(+++), CD5(+++), CD10(++), CD20(-), CD23(-), CD117(-), PAX5(-). Bone marrow biopsy proved small focal proliferation of lymphocytes between bone trabeculae with small cell body, scant cytoplasm, round or oval nuclei, thick chromatin and no nucleoli, which accounting for 5% of the karyocytes. Bone marrow immunohistochemical staining showed CD3(scattered+), CD5(+), CD10(-), CD20(+++), PAX5(++), CD23(+), Cyclin D1(-), SOX11(-). The diagnosis of chronic lymphocytic leukemia was made.
作者
宋乐彬
鲁严
许阳
SONG Le-bin;LU Yan;XU Yang(Department of Dermatology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)
出处
《临床皮肤科杂志》
CAS
CSCD
北大核心
2020年第7期426-429,共4页
Journal of Clinical Dermatology
