发生于非特殊型外周T细胞淋巴瘤后的EB病毒阳性弥漫性大B细胞淋巴瘤一例

患者女,70岁.因自觉右耳后肿块3个月、持续低热1个多月于2008年7月入院.起病以来,患者纳差、乏力,体重明显减轻.体检:全身浅表淋巴结肿大.CT示双侧颈部、耳后、腋下、纵隔、腹股沟可触及多发肿大的淋巴结.实验室检查:红细胞3.38×1012/L,血小板计数96×109/L.骨髓涂片:骨髓增生活跃,粒系增生活跃,嗜酸细胞比例增高.取右腋下淋巴结活检.     

发生于非特殊型外周T细胞淋巴瘤后的EB病毒阳性弥漫性大B细胞淋巴瘤一例

患者女,70岁.因自觉右耳后肿块3个月、持续低热1个多月于2008年7月入院.起病以来,患者纳差、乏力,体重明显减轻.体检:全身浅表淋巴结肿大.CT示双侧颈部、耳后、腋下、纵隔、腹股沟可触及多发肿大的淋巴结.实验室检查:红细胞3.38×1012/L,血小板计数96×109/L.骨髓涂片:骨髓增生活跃,粒系增生活跃,嗜酸细胞比例增高.取右腋下淋巴结活检.     

郎格罕细胞组织细胞增生症

1.病例简介:患儿男,1岁。因发热伴颈部淋巴结肿大10d,面色苍白1个月,于2003年11月5日入院。体检:全身浅表淋巴结肿大,但无红肿、压痛,活动度差;肝肋下3cm,脾肋下4cm。实验室检查:(1)外周血常规:红细胞2.01×1012/L,血红蛋白3.8g/L,白细胞5.3×109/L,未见异型淋巴细胞。(2)血清学:EB病毒壳抗原IgM阳性,EB病毒壳抗原IgG阳性。(3)骨髓活检报告:骨髓增生活跃,其中红系增生旺盛,粒系增生不良。2.病理检查:送检淋巴结1枚,大小2.0cm×2.0cm×0.8cm,包膜完整,剖面灰粉、质软。镜下观察:淋巴结结构局部破坏,可见残留的淋巴滤泡,淋巴窦扩张,窦内…     

46,XX,del(18)伴急性髓细胞白血病一例

患者　女 ,2 7岁。因间断性发热 ,面色苍白就诊。查体 :神清 ,贫血貌 ,颈部、腋下可触及 6个肿大的淋巴结 ,肝、脾未触及 ,左大腿皮肤有少量出血点。血象检查 :Hb70 g/ L,WBC96 .6× 10 9/ L,PL T11× 10 9/ L;中性粒细胞 0 .0 3,淋巴细胞0 .0 4,单核细胞 0 .0 1,幼稚细胞 0 .92。骨髓检查 :骨髓增生活跃 ,M∶ E=2 2 8∶ 1,粒系增生活跃占 91.2 % ,其中原粒细胞占5 3.2 % ,早幼粒细胞占 6 % ,原粒细胞的胞体较大 ,胞浆量较少 ,核染色质呈细沙状 ,核仁明显。全片未找到巨核细胞。过氧化酶染色阳性率占 34 %。诊断为急性髓细胞白血病 M2…     

伴8号染色体五体和add(20)(q13)异常的急性单核细胞白血病一例

患者女,47岁,头昏、乏力、皮肤青紫1年。因皮肤青紫加剧,偶有鼻衄及少量牙龈渗血、发热,下肢水肿2个月入院。查体:中度贫血貌,胸骨叩击痛,皮肤有较多瘀点、出血点,左颌下及右腋下淋巴结肿大,脾肋下5cm,肝未扪及,双下肢轻度凹陷性水肿。血常规:Hb60g/L,白细胞62·2×109/L,血小板27×109/L,肌酐214μmol/L。B超:双肾结构模糊,脾大,腹水。骨髓象:有核细胞增生极度活跃,单核细胞增生极度活跃,原始单核细胞占0·25,幼稚单核细胞占0·605。这类细胞圆形,类圆形,体积较大,核圆形,少数细胞核扭曲、折叠,核染色质纤细,疏松呈网状,有的可见1~2个大…     

肝脾γδT细胞淋巴瘤一例

患者女 ,4 5岁。上腹胀痛伴发热 ,月经量多 ,鼻衄 3个月于 2 0 0 1年 3月 6日入院。体检 :消瘦 ,贫血貌 ,皮肤散在淤点紫癜 ,颈部、腋下及右滑车上淋巴结肿大。胸骨无压痛。肝肋下 2ｃｍ ,剑下 4ｃｍ。脾脏明显肿大 ,Ⅰ线 12ｃｍ ,Ⅱ线 14ｃｍ ,Ⅲ线 1ｃｍ。Ｂ超检查 :脾厚 7ｃｍ ,实质回声均匀 ,腹腔内未发现淋巴结明显肿大。实验室检查 :白细胞 4 .1× 10 9/Ｌ ,中性粒细胞 0 .5 2 ,淋巴细胞 0 .4 4 ,血红蛋白 74ｇ/Ｌ ,血小板 2 4×10 12 /Ｌ ,红细胞 2 7× 10 12 /Ｌ。临床免疫学检查 :ＣＤ385 4 % ,ＣＤ4 5 4 .2 % ,ＣＤ8正常。球蛋…     

间变性淋巴瘤激酶阳性的大B细胞淋巴瘤一例

患者男,32岁.因左颈部肿块伴低热2个月于2008年5月入院.体检:双侧腋下、腹股沟淋巴结肿大.CT示双侧颈部、腋下、腹股沟多发肿大淋巴结.骨髓活检及实验室检查未见特殊.遂行左颈部淋巴结切取活检. 病理检查:淋巴结一枚,大小2.0 cm×1.5 cm×1.5 cm.镜下观察:淋巴结内肿瘤细胞呈弥漫浸润性生长方式,由免疫母或浆母样细胞组成,具有圆形淡染的核,显著中位核仁,胞质丰富,嗜双色性.     

慢性粒-单细胞白血病染色体异常一例

患者男,74岁。因头晕、乏力1个月,活动后心悸入院。查体:贫血貌,四肢有出血点,可触及淋巴结2个,胸骨无压痛,心肺未见异常,肝脾有轻度肿大。实验室检查:血象WBC83.7×109/L,中性0.64、淋巴0.13、单核0.18、嗜酸0.05,Hb50g/L,BPC14×109/L;骨髓象骨髓增生极度活跃,M∶E=105.5∶1,粒系占0.64,其中原粒占0.06,早幼粒占0.12,部分粒系可见空泡及中毒颗粒,可见核分裂相及Ptlger氏细胞。红系受抑制。淋巴系正常。单核系占0.20,幼单0.10,部分胞体较大,可见分叶状、带状及笔架、扭曲折叠的细胞核。巨核细胞28个,血小板稀少。中性粒细胞碱性磷酸…     

慢性淋巴细胞细胞性白血病并纯红再障1例

1病例摘要患者,40岁,女性,2003年10月自觉头昏、乏力,无浅表淋巴结肿大,于当地县医院行血常规检查示:WBC20×109/L,HGB85g/L,血小板计数正常;骨髓检查:骨髓增生活跃,粒系9%,红系0,巨核细胞全片24个,小淋巴细胞91%。诊断为:慢性淋巴细胞细胞性白血病合并纯红再障。予瘤可然6mg/日×9d。治疗后白细胞由20×109/L降至4×109/L,血红蛋白由85g/L降至50g/L。3月后再次复查骨髓提示:红系仍为0。用环孢菌素400mg/日,监测血液环孢菌素谷浓度为290ng/ml。血红蛋白逐渐升至100g/L。6个月后减量停药。停药3月后血红蛋白再次下降,出现双侧颈部淋巴结肿大。再次以相同剂量环孢霉素服药6个月后停药,血红蛋白升至70g/L。效     

脾脏巨大原发性T细胞淋巴瘤一例

患者女 ,37岁。上腹部不适 8个月 ,伴阵发性上腹部隐痛 4个月 ,于 2 0 0 0年 1月入院。疼痛向腰部放射 ,进食后加重。体检 :脾肋下 2ｃｍ ,全身浅表淋巴结不肿大 ,外周血象及骨髓象正常。患者于 2个月前行胃镜检查示浅表性胃炎 ,幽门螺旋杆菌 ( )。Ｂ超示脾实质性占位改变。ＣＴ示 (1)脾梗塞 (脾门处肿块压迫血管 ) ,(2 )胰尾占位病变不能排除。全胸片未见异常。术中所见 :脾脏肿大 18.0ｃｍ× 17.0ｃｍ×11.5ｃｍ ,质硬。脾包膜下可见肿块 ,与膈肌无粘连。脾动、静脉增粗 ,胰腺正常。病理检查 :送检脾脏 18.0ｃｍ× 17.0ｃｍ× 11.5ｃｍ ,…     

T-immunoblastic lymphoma mimicking B-immunoblastic lymphoma

A T-cell immunoblastic lymphoma having plasmacytoid features that mimic B-cell immunoblastic lymphoma, is described. The lesion was composed of sheets of pleomorphic plasmacytoid cells that displayed a helper T-cell immunophenotype (Leu-1+, Leu-3+, Leu-4+, Leu-5+, Leu-9-, Leu-2-). Ultrastructural features were consistent with a T-cell lymphoma. Flow cytometric analysis revealed that the cells were DNA triploid and had a high proliferative activity. Although the histology of immunoblastic lymphomas alone may suggest either a T- or B-cell phenotype, immunophenotyping is essential in making this distinction.     

肝脾γδT和αβT细胞淋巴瘤

从 1990年Ｆａｒｃｅｔ等描述了 2例肝脾γδＴ细胞淋巴瘤以来 ,人们渐渐认识到肝脾γδＴ细胞淋巴瘤是一个独立的淋巴瘤亚类 ,1994年它被ＲＥＡＬ分类确认为一个临时的淋巴瘤亚类[1] ;而在新的ＷＨＯ血液和淋巴组织肿瘤分类中它被确认为一个独立的疾病[1] 。它有典型的临床病理特征 ,包括多为青年男子发病 ,有Ｂ症状 (发热、夜汗、体重减轻 ) ,肝脾肿大 ,没有淋巴结病 ,重度贫血 ,明显的血小板减少症。患者多在诊断后 1年内死亡。组织学上 ,主要为小到中等大小的肿瘤细胞浸润脾脏的脾索和脾窦 ,以及肝窦 ,骨髓血窦等。特征性的免疫表型为Ｃ…     

Extranodal lymphoma

Lymphomas arising in extranodal sites are intriguing. The types of lymphomas encountered vary widely from one extranodal site to another. For many types of extranodal lymphomas, there are distinctive clinicopathologic features, sometimes including association with an underlying immunodeficiency syndrome, autoimmune disease, infection, or other immunologic disorder, or a predilection to affect patients of certain ethnic origins. Presented below is a review of lymphomas that are encountered most often in extranodal sites.     

Mediastinal lymphoma

Malignant lymphoma may involve the mediastinum as a component of disseminated disease or as a primary lesion. The most common types of primary mediastinal lymphomas (ML) are Hodgkin's disease (HD, usually of the nodular sclerosis type), large cell lymphoma (often associated with sclerosis), and lymphoblastic lymphoma (frequently seen in conjunction with acute lymphoblastic leukemia). The characteristic clinical, morphologic, and immunophenotypic features of these three neoplasms are reviewed. ML must be distinguished from Castleman's disease, an enigmatic lymphoid proliferation that frequently involves the mediastinum.     

Mantle cell lymphoma disguised as marginal zone lymphoma

We report a case of mantle cell lymphoma histologically indistinguishable from marginal zone lymphoma. An 83-year-old man presented with a 9.0-cm, slowly enlarging axillary mass. Microscopically, the neoplastic process was largely interfollicular, surrounding residual follicular centers, some of which had discernible small lymphocyte mantles. Overall, the morphologic pattern was highly suggestive of marginal zone lymphoma. However, flow cytometric and immunohistochemical results, including cyclin D1 positivity, revealed an immunophenotype that fit with mantle cell lymphoma. The differential diagnosis of mantle cell lymphoma is broad, and it is well known that mantle cell lymphoma can assume a number of histologic appearances, including, infrequently, that of more indolent B-cell non-Hodgkin lymphomas. Although not pathognomonic, cyclin D1 positivity is highly specific for mantle cell lymphoma and is key in distinguishing these clinically dissimilar malignant lymphomas. In recent years, detection of cyclin D1 has expanded the recognizable histologic spectrum of mantle cell lymphoma.