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- 女性/61岁 骨髓活检
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| 简要病史： | 反复发热3月、体温最高达40.0℃。B超发现左颈部、双侧腹股沟多个淋巴结肿大，脾脏显著肿大，腹腔积液。血常规WBC3.5*10^9/L，Hb86g/l，PLT59*10^9/L.。抗感染治疗体温无显著下降。骨髓涂片见39%分类不明细胞，考虑淋巴瘤骨髓侵犯可能。外周血流式示：CD2+、CD7+、CD13+、CD11c+、CD56+、HLA-DR+。全身PET-CT仅见肝脾肿大及脾代谢轻度增高，未见淋巴结代谢异常增高灶。 | ||||
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本帖最后由 于 2010-04-20 09:24:00 编辑
- xljin8
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I agree with the comments above that it is a T-cell lymphoma with cytotoxic molecular expression and bone marrow involvement. The one of the interesting points of this case is the the bone marrow involvement pattern is intravascular shown as in the third and fifth H&E slides and again in in the CD3 and CD7 immunoslides. Although we can not diagnose this case as intravascular T-cell lymphoma because of enlarged LN and spleen, but this pattern is very useful to know. Do we know that if the patient had skin rash sometime in the early stage of the disease presentation? There are about 25 cases of intravascular T-cell lymphoma reported in the literature as a paper stated (published in 2005). Intravascular B-cell lymphoma is much common than T-cell counterpart.
CD13 and CD11c are myelomonocytic markers, and maybe expressed on T-cell lymphomas. One paper stated that about 15-20% of ALCL have these antigens expressed. We call this phenomenon as aberrant expression, and which most time does not have much significant in the diagnosis and prognosis. However, it may cause a little confusion of the lineage at the time of diagnosis.
| 以下是引用侯军在2010-4-26 11:18:00的发言： I agree with the comments above that it is a T-cell lymphoma with cytotoxic molecular expression and bone marrow involvement. The one of the interesting points of this case is the the bone marrow involvement pattern is intravascular shown as in the third and fifth H&E slides and again in in the CD3 and CD7 immunoslides. Although we can not diagnose this case as intravascular T-cell lymphoma because of enlarged LN and spleen, but this pattern is very useful to know. Do we know that if the patient had skin rash sometime in the early stage of the disease presentation? There are about 25 cases of intravascular T-cell lymphoma reported in the literature as a paper stated (published in 2005). Intravascular B-cell lymphoma is much common than T-cell counterpart. 同意上述评论，这是一个伴有细胞毒性分子表达和骨髓累及的T 细胞淋巴瘤。本例最有趣的一点是骨髓累及模式是血管内，显示于第三和第五张HE切片，以及在CD3和CD7的免疫组化切片上。尽管我们不能诊断该例为血管内T细胞淋巴瘤，因为增大的淋巴结和脾脏，但是知道这种模式是非常有用的。我们是否知道假如该病人有时候在疾病早期有皮疹？（发表于2005年）的文章曾报道认为大约有25例文献中的血管内T细胞淋巴瘤。血管内B细胞淋巴瘤比血管内T细胞淋巴瘤要常见的多。 CD13和CD11c是髓单核细胞的标记，可以表达于T细胞淋巴瘤。有文章认为大约15-20%的ALCL表达这些抗原。我们叫这个现象为异常表达，这个大多数在诊断和预后上没有什么显著的意义。然而，有时候可以在诊断的时候导致对（肿瘤细胞）的谱系产生疑惑。 |
