Primary cutaneous ALK+CD30+ anaplastic large cell lymphoma: a case report

患者男,27岁.左侧腹股沟包块2个月,间断发热伴疼痛3周.皮损初起于左腹股沟内侧皮肤,为暗红色丘疹,后增大破溃,伴左腹股沟淋巴结肿大、发热.体检:左腹股沟内侧可触及直径约4 cm浸润性肿块,中央约1 cm溃疡,少许血性浆液渗出,明显触痛,皮损外侧可触及数个蚕豆大小肿大淋巴结,质硬,粘连呈条索状,活动度差.皮损组织病理检查:真皮深层至皮下脂肪层致密片状异形淋巴样细胞浸润,淋巴结穿刺部分区域见团片状异形淋巴样细胞.浸润细胞免疫组化标志示:CD30、CD43、CD45阳性,ALK表达为核浆型,诊断为ALK+ CD30+原发性皮肤间变性大细胞淋巴瘤.治疗:患者接受3次环磷酰胺+表阿霉素+长春新碱+醋酸泼尼松化疗(CEOP)后,皮疹完全消退,破溃处愈合.A 27-year-old male presented with painful masses in the left inguinal region for 2 months and intermittent fever for 3 weeks.The lesion began as a dark erythematous papule in the left inguinal region,then enlarged and developed into ulcer,with adjacent lymphadenectasis,tenderness and intermittent fever.Physical examination revealed palpable infiltrated masses (measuring 4 cm in diameter) with central ulceration (measuring 1 cm in diameter),small amounts of serous hemorrhagic exudates and obvious haphalgesia in the left inguinal region.There were several broad bean-sized,enlarged and indurated lymph nodes with little mobility around the masses,which adhered and gave a trab-like appearance.Histopathology of the cutaneous masses revealed a dense patch-like atypical lymphoid cell infiltrate in deep dermis and subcutaneous fat tissue,and lymph node puncture showed clumps of atypical lymphoid cells.The infiltrating cells stained positive for CD30,CD43,CD45 and cytoplasmic ALK.The case was diagnosed as primary cutaneous ALKYD30+ anaplastic large cell lymphoma.After 3 courses of CEOP (cyclophosphamide,epirubicin,vincristine and prednisone acetate) chemotherapy,the masses subsided and the ulcer healed.中国科技核心期刊(ISTIC)03139-1413