CAJ | 학술논문

目的报道1例罕见的原发于骨髓伴CD20表达的CD8阳性细胞毒性T细胞淋巴瘤患者的诊断、鉴别诊断和治疗经过.方法分析患者的发病经过、临床特点、治疗反应和转归,对患者的骨髓和皮肤标本进行包括形态学、流式细胞术、免疫组织化学和分子生物学在内的系列检测以助诊断和鉴别诊断.结果患者骨髓中有大量异常T淋巴细胞浸润,骨髓和皮肤标本经流式细胞术和免疫组化检查发现CD20弱表达、CD8、CD2、CD3、CD5及TIA阳性,PAX-5、CD4、CD56、CD57、CD30、ALK-1、P53及TdT等均阴性,Ki-67阳性≈5％,诊断为伴CD20表达的CD8阳性细胞毒性T细胞淋巴瘤,原发于骨髓,临床呈惰性经过,3年后侵犯皮肤和其他脏器并迅速进展,虽给予强化疗但患者最终死亡.结论原发于骨髓伴CD20表达的CD8阳性细胞毒性T细胞淋巴瘤非常特殊和罕见,相关的发病机制和治疗策略有待于进一步深入探索.
목적 보도1례한견적원발우골수반CD20표체적CD8양성세포독성T세포림파류환자적진단、감별진단화치료경과.방법 분석환자적발병경과、림상특점、치료반응화전귀,대환자적골수화피부표본진행포괄형태학、류식세포술、면역조직화학화분자생물학재내적계렬검측이조진단화감별진단.결과 환자골수중유대량이상T림파세포침윤,골수화피부표본경류식세포술화면역조화검사발현CD20약표체、CD8、CD2、CD3、CD5급TIA양성,PAX-5、CD4、CD56、CD57、CD30、ALK-1、P53급TdT등균음성,Ki-67양성≈5％,진단위반CD20표체적CD8양성세포독성T세포림파류,원발우골수,림상정타성경과,3년후침범피부화기타장기병신속진전,수급여강화료단환자최종사망.결론 원발우골수반CD20표체적CD8양성세포독성T세포림파류비상특수화한견,상관적발병궤제화치료책략유대우진일보심입탐색.
Objective To report the diagnosis,differential diagnosis and treatment of a rare case of primary bone marrow CD8 + cytotoxic T-cell lymphoma coexpressed CD20.Methods The clinical characteristics,therapeutic course and the outcome of this patient were reviewed.Meanwhile,a series of examinations including morphology,flow cytometry,immunohistochemistry and molecular biology of bone marrow and skin samples were also performed.Results Bone marrow biopsy showed an extensive involvement by abnormal Tlymphocytes.Flow cytometry and immunohistochemistry showed weakly positive CD20,CD8 (+),CD2(+),CD3(+),CD5(+),TIA(+),PAX-5(-),CD4(-),CD56(-),CD57(-),CD30(-),ALK-1 (-),P53(-),TdT(-),Ki-67≈5％.A final diagnosis of primary bone marrow CD8 + cytotoxic T-cell lymphoma coexpressed CD20 was made.The patient initially presented a relatively indolent course was,but he was expired in the end 3 years later due to extensive involvements of skin and other organs though timely therapy was administrated.Conclusions Primary bone marrow CD8 cytotoxic T-cell lymphoma coexpressed CD20 was encountered rarely in clinical practice,which might be a challenging in terms of diagnosis and differential diagnosis.Further investigation of pathogenesis and therapeutic strategies of this rare disease was warranted.