切缘淋巴细胞瘤 - 病例报告

Grace Hingtgen, Rafael Mojica, Douglas Robins
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摘要

如果不进行组织活检并对表现、组织学和免疫组化进行全面审查,切缘淋巴细胞瘤(LC)往往会被误诊为其他良性疾病或恶性病变,如皮肤 B 细胞淋巴瘤(CBCL)。一名 36 岁的女性患者因耳前区出现进行性凹陷性水肿斑块就诊两年。就诊时,患者的实验室检查结果为血小板减少和嗜酸性粒细胞增多。最初使用局部类固醇激素治疗后,病变并未得到临床改善。穿刺活检发现反应性淋巴增生,伴有小淋巴细胞、组织细胞、嗜酸性粒细胞和浆细胞的多克隆淋巴浸润。诊断结果为 LC,患者接受了连续 5 毫克曲安奈德内注射治疗。两个月后,患者的临床症状有所改善。诊断 LC 尤为困难,因为其临床表现无处不在,可能与其他几种疾病相似,如 CBCL、皮肤红斑狼疮、类肉芽肿或超敏反应。要做出正确的诊断,通常需要识别典型的组织学特征,即真皮混合细胞浸润以及免疫组化的多克隆 kappa 和 lambda 杂交。确诊为 LC 后,建议进行长期监测,因为有可能发生恶性转化。
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Lymphocytoma Cutis - A Case Report
Without tissue biopsy and holistic review of presentation, histology, and immunohistochemistry, lymphocytoma cutis (LC) can often be misdiagnosed as other benign conditions or malignant pathologies such as cutaneous B cell lymphoma (CBCL). A 36-year-old female presented with a two-year history of a progressive indurated, edematous plaque in the preauricular area. At presentation, the patient also had labs significant for thrombocytopenia and eosinophilia. Original treatment with topical steroids did not lead to clinical improvement of the lesions. Punch biopsy revealed reactive lymphoid hyperplasia with polyclonal lymphoid infiltrates of small lymphocytes, histiocytes, eosinophils, and plasma cells. Diagnosis of LC was made and our patient was treated with serial 5 mg intralesional triamcinolone injections. Clinical improvement was seen beginning at 2 months. Diagnosing LC can be particularly difficult as the clinical presentation is ubiquitous and can resemble several other conditions such as CBCL, cutaneous lupus erythematosus, sarcoid, or hypersensitivity reactions. Recognition of the typical histologic findings of top-heavy dermal mixed-cellular infiltrates along with polyclonal kappa and lambda hybridization on immunohistochemistry is often essential in arriving at the correct diagnosis. Following diagnosis of LC, long-term surveillance is recommended as malignant transformation is a possibility. 
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