急性单核细胞白血病伴皮肤浸润1例

患者女，51岁。2002年1月出现上唇肿痛，经血液和骨髓穿刺检查证实为急性单核细胞性白血病(M5b)。经化疗后缓解，2003年2月患者出现左下唇红色肿块，背部、双上肢皮肤多个结节，血象与骨髓象正常，皮肤组织病理为单核细胞皮肤浸润，经化疗后皮损减轻。     

系统疾病的皮肤表现

20 0 2 32 6 5　皮肤白血病 1例 /蔡林 (北大医院皮肤科 )…∥临床皮肤科杂志 .- 2 0 0 2 ,31(3) .- 186～ 187患者男 ,2 2岁。1999年 5月出现发热 ,经血液和骨髓穿刺证实为急性髓性白血病 MS型 (急性单核细胞性白血病 )。 2 0 0 0年 2月行自身外周干细胞移植并顺利植活。移植后 4个月患者发现前胸部出现紫红色结节、斑块 ,组织病理为“继发皮肤白血病”,骨髓穿刺和皮损免疫组化诊断为“急性髓性白血病 MS型复发”。图 4参 9　 (余春艳 )2 0 0 2 32 6 6　 2 8例皮肤转移性肿瘤临床病理分析 /郭坚(上海建工医院病理科 )…∥临床皮肤科杂志 .- 2 0 0 2 ,31(2 ) .- 91～ 93男 2 1例 ,女 7例 ,平均年龄 6 4岁。临床表现为逐步增大的皮肤或皮下结节 ,4例为多发 ,其余为单发 ,平均病程 9个月 ,转移距原发瘤手术的时间平均为13.6月。其中 14例皮肤转移瘤为临床首发症状 ,其中6例原发瘤在皮肤转移瘤确诊后经查被发现 ,分别原发于肺 (3例 )、乳房 (2例 )、胃 (1例 ) ;转移部位以胸、腹壁为多 ,其...     

急性髓细胞性白血病(M4型)

报告1例急性髓细胞性皮肤白血病(M4型).患者女,48岁.全身出现丘疹、红色结节14d,伴剧烈瘙痒.体格检查:全身泛发大小不等的红色丘疹、结节,质韧,无压痛.皮损组织病理检查:真皮内弥漫淋巴样细胞浸润,有明显异形及较多核分裂象.免疫组化组织病理检查:CD68阳性(灶性),MPO阳性(少量).骨髓穿刺:白血病细胞大量增生,免疫标记:CD68、CD11b、MPO及HLA-DR均阳性.诊断:急性髓细胞性白血病(M4型).患者经过2次DA(伊达比星、阿糖胞苷)方案化疗后,再次行骨髓穿刺示缓解,但皮损仍有复发.     

银屑病合并急性髓细胞白血病一例的治疗观察

目的 报告继发急性髓细胞白血病(M4EO型)的慢性斑块状银屑病1例临床研究及骨髓移植治疗.方法采用临床资料收集,组织病理检查,骨髓和外周血涂片检查,利用流式细胞仪进行细胞免疫分型,用骨髓细胞体外培养做染色体检查及G显带分析.结果患者女,33岁,有寻常性银屑病史20余年,反复出现红斑鳞屑,皮损以斑块为主,有家族史,用多种方法治疗(以中药为主).近来不明原因肌肉酸痛,牙龈出血,发热伴胸骨叩痛.骨髓检查发现异常幼稚单核细胞及早幼粒细胞,并见含有粗大嗜碱颗粒的嗜酸粒细胞,确诊为急性髓细胞白血病M4EO型,经骨髓细胞免疫分型检查符合诊断.骨髓细胞体外培养做染色体检查,+G-显带发现inv(16)的克隆异常和+8克隆异常,染色体核型为46,XX,inv(16)/47,XX,inv(16),+8(2/22).经异基因骨髓移植治疗,银屑病皮损完全消退,急性髓性白血病症状缓解,骨髓异常幼稚细胞减少,病情得到有效控制.结论为国内首例寻常性银屑病(斑块状)继发急性髓细胞白血病M4EO型的临床研究及骨髓移植治疗     

长期以头部皮肤损害为表现的急性髓细胞性白血病1例

报告1例长期以头部皮肤损害为表现的急性髓性白血病(AML)并分析皮肤损害特征、组织病理及髓过氧化物酶(MPO)免疫组化染色特点。该患者为男性,63岁,以局限性头部皮损反复发作7月为其主要症状。皮损呈多形性,以红斑、脓疱、糜烂及溃疡为主,短期内四肢出现浸润性斑块。骨髓病理及流式细胞术提示急性髓性白血病M2型。头部皮肤组织病理见血管周围散在的肿瘤细胞,表达MPO阳性。白血病临床表现复杂,头部浸润是其皮肤受累部位之一。在白血病的诊断以前出现头部皮疹,活检提示有异型细胞浸润,提示白血病的进展及预后不良。     

异基因造血干细胞移植治疗顽固性银屑病并发慢性粒细胞白血病1例

目的：探讨异基因造血干细胞移植治疗1例经常规治疗效果不佳,且并发慢性粒细胞白血病的顽固性银屑病患者的疗效和安全性。方法：患者男,36岁。经皮损组织病理检查确诊为银屑病,经常规治疗效果不佳,并出现白细胞增高,经骨髓穿刺检查确诊为慢性粒细胞白血病。采用改良的BuCY方案（羟基脲、阿糖胞苷、白消安、环磷酰胺）进行预处理,移植物抗宿主病的预防采用抗胸腺细胞球蛋白（ATG）＋环孢素（csA）＋甲氨蝶呤（MTX）方案。观察患者移植后临床表现、造血等指标的变化。结果：患者移植后银屑病皮损完全消退,完全供者植入,Ph染色体阴性,慢性粒细胞白血病获治愈。结论：随访12个月后,该例患者经异基因造血干细胞移植治疗的近期疗效显著,虽然远期疗效尚在进一步观察中,但随访结果提示该例患者有望获得根治。     

急性白血病的非特异性皮肤表现2例及文献复习

2例患者均为急性白血病,其中1例无明显诱因双下肢皮肤出现红斑、结节,伴有疼痛,后自行消退遗留色素沉着,经检查诊断为急性白血病;另1例双足部皮肤出现红斑伴压痛,经检查诊断为急性单核细胞白血病。在临床看到不典型皮损伴有外周血异常(红细胞、白细胞、血红蛋白或血小板异常)时应考虑白血病皮肤表现的可能,需通过组织病理、骨髓涂片、骨髓病理和流式细胞学检查确诊,以免怠误病情。     

有皮肤损害的急性粒细胞白血病1例

患者女 ,30岁 ,病期2年。2年来四肢躯干反复出现丘疹、紫癜、结节 ,伴瘙痒 ,曾多次诊断为湿疹。检查可见周身散在淡红丘疹、结节、水疱及紫癜。左上肢丘疹组织病理检查符合皮肤白血病。骨髓检查及细胞免疫分型确诊急性粒细胞性白血病M2型。     

皮肤粒细胞肉瘤

报告1例皮肤粒细胞肉瘤.患者男,50 岁.3 年前不慎被竹片刺伤,皮损处出现结节,逐渐增大、增多,沿淋巴管方向分布于双上肢.曾行外周血常规及骨髓穿刺检查均正常.入院行组织病理检查示低分化髓细胞髓外(皮肤和皮下脂肪组织)浸润.免疫病理示髓过氧化物酶(MPO)(++)、Ki67(++)、CD43(+).组织病理诊断为皮肤粒细胞肉瘤.确诊后行骨髓穿刺提示急性粒细胞白血病(AML,M2).转血液科接受化疗,化疗无效很快死亡.     

以皮肤损害为首发症状的单核细胞性白血病1例

患者男,81岁,无明显诱因躯干部位出现数个紫红色结节,无自觉症状,半月后出现食欲减退、乏力、血尿、黑便。皮肤科情况:胸腹部多发浸润性紫红色丘疹、结节,1cm×1cm～2cm×3cm,质韧似橡皮样,与表皮粘连,无压痛。见少许淤点、淤斑,结节结合骨髓穿刺及皮肤组织病理诊断:急性单核细胞性白血病(M5b型)。     

Leucemia cutánea en un paciente con leucemia mieloide aguda M2

—The leukemia cutis is the cutaneous infiltration by leukemics cells. Patients with acute myelogenous leukemia (AML) present specific cutaneous involvement in approximately 10% of the cases.We report the case of a leukemia cutis in a 73-year-old male with AML-M2. The patient presented with a one-week history of general malaise, asthenia, cough, dysnea and fever. Physical examination revealed and indurated red-brown plaque on his back of two moths duration, which was pruritic. Concomitance blood and bone marrow findings were diagnostic of AML-M2. A cutaneous biopsy was consistent with leukemia cutis. A CT and a bronchial biopsy showed pulmonary involvement. Since starting chemotherapy the patient had complete remission and the cutaneous lesion cleared, but 15 days later the skin lesion reappeared. A new bone marrow examination revealed recurrent leukemia. He died one month later.     

皮肤白血病1例

患者男性，５７岁，病期１个月，患者先出现乏力、发热、面色苍白，半月后于颈部、双上肢发现皮疹，无自觉症状。右前臂结节组织病理报告为皮肤白血病，经骨髓检查及免疫单抗检测确诊为急性粒细胞性白血病Ｍ２型。化疗后１７天，皮疹完全消退。１个月后，皮疹又再次出现。     

Aleukemic leukemia cutis presenting as benign-appearing exanthema.

Aleukemic leukemia cutis is a rare condition characterized by the infiltration of the skin by leukemic cells before their appearance in the peripheral blood or bone marrow. We report here a 62-year-old seemingly healthy patient who presented with disseminated erythematous maculae. A skin biopsy showed leukemia cutis of monocytic type. No involvement of bone marrow or peripheral blood was found. The patient developed acute monocytic leukemia 7 months later. We present this case to illustrate how leukemia cutis can masquerade as a clinically benign-appearing cutaneous eruption without leukemic changes in blood or bone marrow. To confirm the diagnosis of aleukemic leukemia cutis, immunohistochemistry of the skin lesions as well as a complete staging procedure is necessary.     

Aleukemic leukemia cutis

A 46-year-old man presented with nodular skin lesions, a biopsy specimen of which demonstrated a poorly differentiated malignancy. Touch preparations with histochemical staining and electron microscopy confirmed leukemia cutis. Results from a bone marrow aspirate disclosed focal areas of increased myeloblasts, and cytogenetic analysis revealed an abnormal karyotype as follows 46,XY, t(1;2) (q44p13). Antileukemic therapy resulted in prompt disappearance of the skin nodules, and a return of the patient's bone marrow to normal was noted, but after six months of intensive chemotherapy leukemia cutis recurred without morphologically identifiable leukemia in the bone marrow. The patient underwent successful bone marrow transplantation from an HLA-identical sibling but died 70 days after the transplant from disseminated aspergillosis.     

Leucemia cutánea aleucémica: presentación de un caso

—The term aleukemic leukemia cutis describes the invasion of the skin by leukemic cells in the absence of peripheral blood and/or bone marrow involvement. Although the pathogenic mechanisms of this disease are still unknown, it is widely recognized its poor prognosis. Most of the reported patients completely developed the hematologic disease (the majority acute granulocytic or monocytic leukemias) in 10-14 months after diagnosis of aleukemic leukemia cutis, and they had a median survival of 22 months.We report on a case of a 77-year-old man with aleukemic leukemia cutis who presented with numerous erythematous to violaceous papulonodular lesions, mainly located on the trunk and head, lack of peripheal blood involvement and very early alterations in the bone marrow aspirate. Inmunohistochemical stains of skin and bone marrow biopsies revealed the infiltration of both tissues by blast cells of monocyte-histiocytic lineage. Our patient presented spontaneous resolution of skin lesions and his hematological disease showed no progression during 9 months after diagnosis, although he did not undergo any treatment.We emphasize the low incidence of association between myelodysplastic syndromes and aleukemic leukemia cutis as well as the surprising spontaneous remission of cutaneous lesions in our patient.     

Graft Versus Host Disease with Mixed Chimerism

We report a patient with graft versus host disease (GVHD) with mixed chimerism (MC). The patient had chronic myelogenous leukemia and received bone marrow transplantation (BMT) from his elder sister. Eighty days after BMT, erythematous lesions appeared on his chest. Histological examination from the skin lesion revealed lymphocytic infiltration into the upper dermis. Eosinophilic necrotic keratinocytes were scattered through the epidermis. Liquefaction degeneration was also recognized. Sicca syndrome appeared from 110 days after BMT. Detection of host origin Y-chromosome-specific DNA by polymerase chain reaction (PCR) method in bone marrow and peripheral blood showed that all bone marrow samples obtained 6 months from BMT were positive for Y-specific DNA, while peripheral blood became positive in the 60th month after BMT. The host origin normal karyotype (46,XY) in the bone marrow samples was identified for the first time in the 60th month after BMT. These results indicate that host-origin hematopoietic cells survived after BMT.     

以皮疹为首发症状的皮肤白血病一例

报道1例以皮疹为首发症状的急性淋巴细胞白血病.患者女,31岁,胸、腹部红斑伴轻度疼痛3个月就诊.初诊时血常规正常,皮疹活检提示皮肤白血病.1个月后原有红斑上出现瘀点,外周血及骨髓细胞学检查确诊为急性淋巴细胞白血病,腹部皮损免疫组化标记与外周血流式细胞仪分析,证实瘤细胞来源于前驱B淋巴细胞.脑脊液检查示中枢神经系统受累.化疗两次后缓解,1个月后复发,并死于呼吸循环衰竭.     

A Case of Congenital Leukemia Cutis

Congenital leukemia is a rare condition diagnosed at birth to 6 weeks of life with an estimated incidence of 4.7 per million live births. In a review, about 25~30% of cases were well documented as leukemia cutis. We report a case of a 3-month-old infant presented with asymptomatic multiple erythematous to bluish patches and nodules, which had developed about two months ago. Biopsy of the cutaneous lesions revealed immature cells which are overall monotonous with large kidney shaped nucleus, prominent nucleoli and moderate cytoplasm. These atypical cells stained positive for leukocyte common antigen, lysozyme and CD68. With this result, a congenital leukemia cutis was diagnosed. Six months later, she underwent cord blood stem cell transplantation. Seven months after the cord blood stem cell transplantation, the bone marrow examination revealed a normal result. Leukemia can be presented in the skin, the eruption may be nonspecific and it may precede systemic involvement. The recognition is important because early diagnosis can lead to appropriate treatment, followed by better prognosis.