急性髓单细胞白血病伴睾丸髓外病变1例的诊断

N. Guskova, O. Selyutina, I. Lysenko, E. A. Guskova, A. Donskaya, N. Samaneva, E. Kapuza, T. F. Pushkareva
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引用次数: 0

摘要

本文报告一例急性髓细胞白血病伴睾丸髓外病变的复杂临床病例。病人于。出生于1968年,在腹股沟受伤后,他向国家肿瘤医学研究中心(顿河畔罗斯托夫)提出了申请。超声检查:右侧睾丸中三分之一处,见30 × 23 × 16 mm肿物。活检:形态学图像是典型精原细胞瘤的特征。右侧行管束切除术。组织病理学结论:形态学图像更具有典型精原细胞瘤的特征,但不能排除淋巴瘤。为了区分生殖细胞瘤和淋巴增生性疾病,对肿瘤组织进行了免疫组织化学研究,对骨髓进行了形态学和免疫表型研究。免疫组化资料显示,肿瘤细胞的形态图像和免疫表型具有Cd4共表达的睾丸结外NK/ t细胞淋巴瘤的特征。然而,根据骨髓图数据,发现20%的胚细胞形态不均匀:细胞核呈圆形或豆状,染色质网状结构精细,1-2个核仁,细胞核呈单核细胞形式,核仁不明显。细胞质具有不同程度的嗜碱性,空泡化,具有精细的亲氮粒度。单核细胞群的含量增加(19%),主要以前单核细胞为代表,与急性髓细胞白血病相对应。流式细胞术显示母细胞免疫表型符合Cd56共表达的急性髓系白血病。结合获得的新数据,随着免疫组织化学研究的扩大,组织学准备再次进行了修订。结果:急性髓单细胞白血病伴右侧睾丸组织髓外病变,肿瘤细胞形态学和免疫表型具有明显特征。最终诊断:急性髓细胞白血病伴右侧睾丸髓外病变,Cd56共表达。提出的临床病例表明,需要使用广泛的诊断技术来确定疾病的性质。骨髓形态学和细胞学检查的结果是确定诊断M4急性髓性白血病伴右睾丸髓外病变的决定性因素。
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Diagnosis of acute myelomonocytic leukemia in a patient with extramedullary testicular lesion
A complex clinical case of acute myelomonocytic leukemia with extramedullary lesion of the testis is presented. patient yu., born in 1968, applied to the National Medical Research Centre for Oncology (Rostov-on-don) after an injury to the inguinal region. ultrasound was performed: in the right testicle in the middle third, a mass of 30 × 23 × 16 mm was revealed. A biopsy was performed: the morphological picture is characteristic of a typical seminoma. Orchofuniculectomy was performed on the right. Histopathological conclusion: the morphological picture is more characteristic of a typical seminoma, but does not allow excluding lymphoma. In order to differentiate between a germ cell tumor and a lymphoproliferative disease, an immunohistochemical study of the tumor tissue, a morphological and immunophenotypic study of the bone marrow were performed. According to the immunohistochemical data, the morphological picture and immunophenotype of tumor cells are characteristic of extranodal NK/T-cell lymphoma of the testis with Cd4 co-expression. However, according to the myelogram data, 20 % of morphologically heterogeneous blast cells were found: with round or bean-shaped nuclei, delicate mesh structure of chromatin, 1–2 nucleoli and a monocytoid form of nuclei with indistinct nucleoli. The cytoplasm of varying basophilia degrees, vacuolized, with delicate azurophilic granularity. The content of the monocytoid population was increased (19 %), represented mainly by promonocytes, which corresponds to acute myelomonocytic leukemia. According to flow cytometry, the immunophenotype of blast cells corresponds to acute myeloid leukemia with Cd56 co-expression. In connection with the new data obtained, the histological preparation was revised again with the expansion of the immunohistochemical study. Result: morphological picture and immunophenotype of tumor cells are characteristic of acute myelomonocytic leukemia with extramedullary lesions of the right testicular tissue. final diagnosis: acute myelomonocytic leukemia with extramedullary lesion of the right testicle, with Cd56 co-expression. The presented clinical case showed the need to use a wide range of diagnostic techniques to determine the nature of the disease. The results of morphological and cytometric studies of the bone marrow were decisive in establishing the diagnosis of M4 acute myeloid leukemia with extramedullary lesions of the right testicle in this patient.
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