CAJ | 학술논문

目的：探讨皮下脂膜炎样T细胞淋巴瘤的临床特点及误诊原因,为临床识别该病提供参考。方法对长期误诊为慢性感染伤口的皮下脂膜炎样T细胞淋巴瘤1例的临床资料进行回顾性分析,并复习相关文献。结果本例因慢性伤口感染7月余就诊,曾因双腋下皮肤结节在外院行2次活组织病理检查均提示炎性反应,予相应处理病情加重入我院。后又经2次组织病理学和免疫组织化学检查确诊为皮下脂膜炎样T细胞淋巴瘤,给予化学治疗5 d,患者伤口进行性坏死扩大、剧痛,于确诊后7 d患者及家属要求出院,医护人员坚持门诊随访。出院后50 d在家中继发急性腹痛死亡。结论皮下脂膜炎样T细胞淋巴瘤临床表现各异,容易误诊。伤口反复感染、迁延难愈,具有慢性伤口的临床特征是本例误诊的主要原因。提示临床医师对本病进行诊治需联合病理及肿瘤等多科专家会诊,以早期确诊。
목적：탐토피하지막염양T세포림파류적림상특점급오진원인,위림상식별해병제공삼고。방법대장기오진위만성감염상구적피하지막염양T세포림파류1례적림상자료진행회고성분석,병복습상관문헌。결과본례인만성상구감염7월여취진,증인쌍액하피부결절재외원행2차활조직병리검사균제시염성반응,여상응처리병정가중입아원。후우경2차조직병이학화면역조직화학검사학진위피하지막염양T세포림파류,급여화학치료5 d,환자상구진행성배사확대、극통,우학진후7 d환자급가속요구출원,의호인원견지문진수방。출원후50 d재가중계발급성복통사망。결론피하지막염양T세포림파류림상표현각이,용역오진。상구반복감염、천연난유,구유만성상구적림상특정시본례오진적주요원인。제시림상의사대본병진행진치수연합병리급종류등다과전가회진,이조기학진。
Objective To explore the wound characteristics of subcutaneous panniculitis-like T-cell lymphoma ( SPTCL) and the misdiagnosed causes in order to provide evidence for recognition. Methods Clinical data of one case of SPTCL misdiagnosed as chronic infective wound for a long time was analyzed retrospectively, and relevant literature was re-viewed. Results This patient first visited for his chronic wound infection for more than seven months. The patient complained of subcutaneous nodosity near the bilateral axilla. Two biopsy tests and histological tests were made and the results indicated inflammation. The patient received appropriate treatment, which did not respond and condition became progressively worse. In our hospital, the patient was diagnosed as having SPTCL by two biopsy tests and immunohistochemistry tests and then received chemotherapy for five days, but the wound area tumed more extensive, necrotic with severe pains. The patient and their fami-lies were required to discharge 7 d after confirmed diagnosis. The patient died of complicated intestinal colic 50 d after dis-charge. Conclusion The clinical manifestations of SPTCL are various and tend to be misdiagnosed. The wounds may be re-peatedly infected and difficult to heal. The clinical features of chronic wounds may be the main cause of misdiagnosis of this case. Clinicians should take joint consultations with pathologists and oncologists in order to confirm the diagnosis early.