皮肤原发性间变性大细胞淋巴瘤合并急性髓细胞白血病一例并文献复习

 目的　探讨原发性皮肤间变性大细胞淋巴瘤（C-ALCL）伴发急性髓细胞白血病（AML）的病理形态、免疫表型特征及预后特点。方法　对1例C-ALCL伴AML进行HE形态学观察、免疫组化标记及随访，并结合相关文献进行探讨。结果　患者，女性，69岁。以右手指皮损为首发症状伴骨髓象异常就诊。皮损组织形态学表现为肿瘤细胞多形性，大小不一，细胞质丰富，核大，不规则，伴有多量中性粒细胞和嗜酸性粒细胞浸润。免疫表型瘤细胞均表达CD30、CD3、CD43，不表达ALK。血常规显示外周血WBC 15.5×109／L，每百个有核细胞中有原始细胞51个。骨髓穿刺检查示骨髓增生明显活跃，原始粒细胞78 %。诊断原发性C-ALCL伴AML，部分分化型（AML-M2a）。结论　C-ALCL合并AML非常罕见，诊断依赖于临床资料、组织病理学及免疫组化标记。治疗首选化疗，但预后较差。

Clinicopathological study of cutaneous anaplastic large cell lymphoma complicated with acute myeloid leukemia

Objective To explore the morphological, immunohistochemical characters and prognosis in one case of patients with cutaneous anaplastic large cell lymphoma complicated with acute myeloid leukemia (C-ALCL-AML). Methods The histopathology, immunohistochemical markers and follow-up information of one case of ALCL-AML was analyzed and the correlated literature was reviewed. Results The patient, 69 year-old, female, was initially present with shin lesion on one finger and abnormal myelogram. The histopathology of shin lesion showed that tumor cells were composed of large cells with abundant cytoplasm,the nuclei were large and irregular, and were infiltrated by Neutrophil and eosinophil. The CD30,CD3 and CD43 of tumor cells were positive, but ALK negative by immunohistochemical method. The number of WBC in peripheral blood was 15.5×109/L and 51 archaeocytes were in every 100 karyotes. Bone marrow aspiration detection showed that bone marrow was hyperplasia and the ratio of myeloblast was 78 %. This patient was diagnosed as C-ALCL-AML, partly differentiation type(AML-M2a). Conclusion C-ALCL-AML is very rare. Its diagnosis is dependent on clinical data, histopathology and immunohistochemical markers. The first choice of treatment is chemotherapy, but its prognosis is poor.