CAJ | 학술논문

患者男,74岁,确诊套细胞淋巴瘤5年,躯干、四肢丘疱疹伴瘙痒10个月就诊.皮疹瘙痒剧烈,给予抗组胺药物对症治疗不能缓解.体检:躯干、四肢皮肤见散在绿豆至黄豆大小红色丘疹及丘疱疹,部分表面见浅表结痂,以双上肢皮损为主,颈部、双侧腹股沟可触及肿大淋巴结,约2cm×l cm.颈部淋巴结病理示,正常淋巴结结构完全破坏,中等大淋巴样细胞呈结节状或弥漫增生浸润,免疫组化示CD20(+++),CD79α(+++),Bcl-2(++),细胞周期蛋白Dl(+++),CD5(++弱),CD43(++),Bcl-6(++),PAX-5(+++),κ(+++),λ(±),Ki-67(10％～30％+不均).皮损组织病理及免疫组化:表皮大致正常,真皮浅中层血管、附属器周围见以中等大小淋巴样细胞为主的团灶状浸润,其间散在嗜酸性粒细胞；免疫组化:CD3(部分+),CD5(弥漫性+),CD20(部分+),细胞周期蛋白D1(部分+),Ki-67(10％+).根据临床资料、淋巴结及皮损组织病理及免疫组化,诊断为套细胞淋巴瘤伴皮肤虫咬样反应.
환자남,74세,학진투세포림파류5년,구간、사지구포진반소양10개월취진.피진소양극렬,급여항조알약물대증치료불능완해.체검:구간、사지피부견산재록두지황두대소홍색구진급구포진,부분표면견천표결가,이쌍상지피손위주,경부、쌍측복고구가촉급종대림파결,약2cm×l cm.경부림파결병리시,정상림파결결구완전파배,중등대림파양세포정결절상혹미만증생침윤,면역조화시CD20(+++),CD79α(+++),Bcl-2(++),세포주기단백Dl(+++),CD5(++약),CD43(++),Bcl-6(++),PAX-5(+++),κ(+++),λ(±),Ki-67(10％～30％+불균).피손조직병리급면역조화:표피대치정상,진피천중층혈관、부속기주위견이중등대소림파양세포위주적단조상침윤,기간산재기산성립세포；면역조화:CD3(부분+),CD5(미만성+),CD20(부분+),세포주기단백D1(부분+),Ki-67(10％+).근거림상자료、림파결급피손조직병리급면역조화,진단위투세포림파류반피부충교양반응.
A 74-year-old man presented with a 5-year history of mantle cell lymphoma and 10-month history of pruritic papulovesicles on the trunk and extremities.The icthing was severe and resistant to antihistamine treatment.Physical examination revealed discrete mung bean-to soybean-sized,erythematous papules and papulovesicles on the trunk and extremities,especially on the upper limbs.Superficial scars were observed on the surface of some lesions.Enlarged lymph nodes sized 2 cm × 1 cm were palpable in cervical and inguinal areas.The histopathology of cervical lymph nodes revealed that the normal structure of lymph nodes was ultimately destroyed with nodular or diffuse infiltrate of medium-sized lymphoid cells,which were immunohistochemically positive for CD20 (strongly),CD79 alpha (strongly),Bcl-2 (moderately),CyclinD1 (strongly),CD5 (weakly to moderately),CD43 (moderately),Bcl-6 (moderately),PAX-5 (strongly),κ chain (strongly),λ chain (slightly) and Ki-67 (weakly,10％ to 30％ inequality).Histopathological examination of the skin lesions revealed roughly normal epidermis,as well as perivascular and periadnexal focal infiltrate of medium-sized lymphoid cells mingled with scattered eosinophils in the superficial and mid dermis; immunohistochemically,the lymphoid cells stained positive for CD3 (partial),CD5 (diffuse),CD20 (partial),CyclinD1 (partial),Ki-67 (10％).According to the clinical feature,histopathological and immunohistochemical manifestation of lymph node and skin lesions,the patient was diagnosed with mantle cell lymphoma with insect bite-like reaction.