皮肤真性组织细胞性淋巴瘤的诊断与误诊分析

Analysis of misdiagnosis and diagnosis of primary true histiocytic lymphoma of skin

目的 探讨右大腿皮肤组织细胞性恶性淋巴瘤的诊断、误诊原因及预防对策。方法 对 1例皮肤组织细胞性淋巴瘤的标本 ,采用 10 %的福尔马林固定 ,石蜡切片 ,HE、网状纤维染色及多种免疫组化染色 ,光镜观察、会诊及病理读片会讨论。结果 临床因早期表现为局部单发肿块 ,皮肤改变不明显而误诊为皮肤纤维瘤 ,病理则因组织学上既象淋巴瘤样细胞弥漫分布又有瘤细胞互相粘着不松散而似癌细胞巢 ,且瘤细胞核大 ,核仁明显又似恶性黑色素瘤 ,凭HE切片难以诊断 ,免疫组化及会诊结果为皮肤组织细胞性恶性淋巴瘤。结论 原发于皮肤的组织细胞性恶性淋巴瘤非常少见。组织学上注意与蕈样霉菌病、美克耳细胞癌、恶性黑色素瘤、恶性组织细胞增生症等鉴别。免疫组化不支持上述病变时要想到本病的可能。误诊的主要原因是早期临床表现不具有特征性 ,肿瘤发病部位及类型罕见 ,临床及病理对此类型淋巴瘤认识不深 ,未能及时进行免疫组化检查。

Objective To investigate the diagnosis of the primary true histiocytic lymphoma of skin and misdiagnosis causes and countermeasure.Methods Specimen from one of primary true histiocytic lymphoma of skin were fixated with 10% formalin.The sections had HE staining,reticular fiber staining and various immunohistochemical staining,and were observed under light microscope and analyzed by consultation.Results Skin fibroma was diagnosed by clinic and in pathology,because of its histologic likeness between lymphoma,carcinoma and malignant meanoma,diagnosis of primary true histiocytic lymphoma of skin couldn't be made until consulatation.Conclusion Primary true histiocytic lymphoma of skin is rare.In pathology,differentiation diagnosis in which immunohistochemical method plays a key role among mycosis fungoides,merkel cell carcinoma,malignant melanoma and malignant histiocytosis.The main causes of misdiagnosis are little characteristics in early clinic manifestation,rare lesion location and type which aren't completely understood,immunohistochemical staining which is not performed in time.