一致的浆细胞，浆细胞瘤？好像是成熟的。图3，4反应性的滤泡，仔细看，排除慢性炎。

以下是引用月儿在2007-9-17 22:06:00的发言：  一致的浆细胞，浆细胞瘤？好像是成熟的。图3，4反应性的滤泡，仔细看，排除慢性炎。

月儿的眼力好sharp!
In hematopoietic neoplasm, you basically have three colors in low power: blue, pink and purple. Purple color represents plasma cells aggregation. This case is so purple from low power, your first differential is to make sure if these cells are plasma cell or not. I agree with yue er we should first consider a plasmacytoma. Whether this is a multiple myeloma needs radiologic images and clinical correlation.

Given the size and clinical manifestation, this is less likely a "chronic inflammatory process". Please do immunostain for CD138 and kappa/lambda to confirm the cell origin and clonality issue.

Differential diagnoses in this case will include merkel cell carcinoma, granulocytic sarcoma, and other hematopoietic neoplasms.

 考虑浆细胞瘤。

 同意楼上

 

 考虑为孤立性浆细胞瘤

 为什么两个多月就长到了6X6.5cm这样大？为什么还有压痛？是不是因为伴有炎症？看看病变周边。

以下是引用杨斌在2007-9-17 22:32:00的发言： 以下是引用月儿在2007-9-17 22:06:00的发言：  一致的浆细胞，浆细胞瘤？好像是成熟的。图3，4反应性的滤泡，仔细看，排除慢性炎。 月儿的眼力好sharp! In hematopoietic neoplasm, you basically have three colors in low power: blue, pink and purple. Purple color represents plasma cells aggregation. This case is so purple from low power, your first differential is to make sure if these cells are plasma cell or not. I agree with yue er we should first consider a plasmacytoma. Whether this is a multiple myeloma needs radiologic images and clinical correlation. Given the size and clinical manifestation, this is less likely a "chronic inflammatory process". Please do immunostain for CD138 and kappa/lambda to confirm the cell origin and clonality issue. Differential diagnoses in this case will include merkel cell carcinoma, granulocytic sarcoma, and other hematopoietic neoplasms.

翻译：
月儿的眼力好敏锐！
对于淋巴造血系统肿瘤，低倍基本有三种颜色：蓝色、红色和紫色。紫色代表浆细胞积聚。此例低倍太紫了，首先就是鉴别这些细胞是否为浆细胞。我同意你的观点，首先考虑浆细胞瘤。是否为多发性骨髓瘤需要结合影像学和临床。
考虑到病变大小和临床表现，这不像“慢性炎症过程”。请作CD138和kappa/lambda以确定细胞起源和克隆性。
鉴别诊断包括Merkel细胞癌，粒细胞肉瘤，以及其它淋巴造血系统肿瘤。

 对于淋巴造血系统肿瘤，低倍基本有三种颜色：蓝色、红色和紫色。紫色代表浆细胞积聚

请问杨斌 老师，蓝色、红色又代表什么呢？

以下是引用zhongshihua在2007-9-18 9:52:00的发言：  考虑浆细胞瘤。

细胞异型性很大,并且有侵上皮现象,有压痛可能存在出血坏死.

 由图5来看，几乎是清一色的浆细胞。

猜一个：浆细胞瘤。

唉，片子要是切得再薄些，一定更好看。

以下是引用月儿在2007-9-17 22:06:00的发言：  一致的浆细胞，浆细胞瘤？好像是成熟的。图3，4反应性的滤泡，仔细看，排除慢性炎。

好细心,好眼力,佩服

 有坏死，恶性，除浆细胞瘤，需鉴别的还有肺的小细胞癌转移