以面部肿物首发的B淋巴母细胞淋巴瘤的诊断学特征并文献复习

Diagnostic features of B-lymphoblastic lymphoma with facial mass as the first symptom and literature review

目的探讨以面部肿物为首发表现的B淋巴母细胞淋巴瘤(B-LBL)的诊断学特征。方法回顾性分析2021年3月5日哈尔滨医科大学附属第一医院颌面外科收治的1例B-LBL患者的临床资料,并复习相关文献,总结B-LBL的诊断学特征。结果患者女性,52岁,无明显诱因右面部出现肿胀,右眶下区肿胀明显,触诊可扪及一直径约5.0 cm团块;入院时外周血白细胞计数16.98×10^(9)/L,乳酸脱氢酶754.6 U/L。头颅磁共振成像(MRI)平扫示:右侧颌面部软组织增厚,右侧上颌窦、右侧颞肌及右鼻甲病变;腹部多普勒超声检查提示腹腔积液;正电子发射计算机体层显像仪(PET/CT)提示右侧颌面部软组织肿块,可见18^(F)-脱氧葡萄糖(FDG)摄取增高。腹水细胞学见瘤细胞(倾向非霍奇金淋巴瘤);面部肿物穿刺组织免疫组织化学染色示:末端脱氧核苷酸转移酶(TdT)(部分细胞+),配对盒基因5(PAX-5)(+),CD79a(+),增殖细胞核抗原(Ki-67)(+90%),CD10(+),符合非霍奇金B淋巴母细胞淋巴瘤/白血病(B-LBL/B-ALL)。结论B-LBL临床表现缺乏特异性,易误诊及漏诊,病理诊断及特异性免疫组织化学染色TdT阳性对该疾病诊断有提示作用。

ObjectiveTo investigate the diagnostic features of B-lymphoblastic lymphoma(B-LBL)with facial mass as the first symptom.MethodsThe clinical data of a B-LBL patient admitted to the Department of Maxillofacial Surgery,the First Affiliated Hospital of Harbin Medical University on March 5,2021,were retrospectively analyzed,and the relevant literatures were reviewed.ResultsA female patient,52,was taken to the hospital after 20 days of right face edema that had no apparent explanation.Right suborbital edema was evident,and palpation revealed a mass with a diameter of approximately 5 cm.Leukocytes were 16.98×10^(9)/L in peripheral blood,and lactate dehydrogenase was 754.6 U/L.MRI of the skull revealed thickening of the right maxillofacial soft tissue,as well as lesions of the right maxillary sinus,right temporal muscle,and right turbinate.Doppler ultrasound of the abdomen revealed abdominal effusion was discovered.PET/CT imaging revealed a soft tissue mass in the right maxillofacial region with increased 18^(F)-deoxyglucose(FDG)uptake.Ascites cytology revealed tumor cells(predisposed to non-Hodgkin′s lymphoma);Hodgkin′s immunohistochemical staining revealed terminal deoxynucleotide transferase(TdT)(partial cell+),paired box 5(PAX-5)(+),CD79a(+),proliferating cell nuclear antigen(Ki-67)(+90%),and CD10(+),all of which were consistent with non-Hodgkin′s B-LBL/B-ALL.ConclusionsB-LBL clinical manifestations lack specificity,making it easy to misdiagnose or missed diagnose.Pathological diagnosis and specific immunohistochemical staining of TdT are useful in determining B-LBL.