原发性皮肤侵袭性亲表皮性CD8^＋细胞毒性T细胞淋巴瘤一例并文献复习

A case of primary cutaneous invasive epidermo-tropic CD8 positive cytotoxicity T-cell lymphoma and literature review

目的 进一步阐述原发性皮肤侵袭性亲表皮性CD8＋细胞毒性T细胞淋巴瘤的发病特点、诊断、治疗及预后.方法 对1例原发性皮肤侵袭性亲表皮性CD8＋细胞毒性T细胞淋巴瘤患者的发病特点、诊断、治疗经过进行总结,并结合文献复习,进一步总结诊治经验.结果 中年男性患者,因四肢、躯干反复发作渗出性斑丘疹1年余就诊,经皮肤活组织检查、免疫组织化学、T细胞基因重排、PET-CT检查,确诊为原发性皮肤侵袭性亲表皮性CD8^＋细胞毒性T细胞淋巴瘤T2N0M0Ⅰ期.经过鸦胆子油乳联合GDP方案化疗的中西医结合治疗,疗效评估达完全缓解,仍在继续治疗、随访中.结论 原发性皮肤侵袭性亲表皮性CD8^＋细胞毒性T细胞淋巴瘤临床罕见,早期诊断困难,病理组织检查联合T细胞基因重排可确诊.为避免误诊,应认真询问病史,仔细查体,对反复发作迁延不愈的皮损要及早行病灶活组织检查,同时行免疫组织化学检查以及时诊断,为下一步治疗提供良好的基础.

Objective To further elaborate the clinical characteristics,diagnosis,treatment and prognosis of primary cutaneous invasive epidermotropic CD8 positive cytotoxicity T-cell lymphoma.Methods The clinical characteristics,diagnosis and treatment of a patient with primary cutaneous invasive epidermotropic CD8 positive cytotoxicity T-cell lymphoma were summarized,and diagnosis and treatment of the disease from published literature were reviewed.Results After one year long,recurrence of exudative maculopapule on his body and limbs,a middle-aged male patient visited our hospital.Then,the patient was diagnosed as T2N0M0 Ⅰ phase of primary cutaneous invasive epidermo-tropic CD8 positive cytotoxicity T-cell lymphoma based on results of skin biopsy,immunohistochemistry,T-cell gene rearrangement and PET-CT.Through integrative medicine treatment （combination of bruceolic oil emulsion and chemotherapy with GDP regimen）,the patient achieved complete remission （CR）.The treatment and follow-up continues till now and his condition was stable.Conclusions Clinical occurrence of primary cutaneous invasive epidermo-tropic CD8 positive cytotoxicity T-cell lymphoma is rare and early diagnosis is difficult.It could be diagnosed with histopathology combined with T-cell gene rearrangement.In order to avoid misdiagnosis,great caution should be taken during disease history inquiry and physical examination,should be early lesion for delayed healing of recurrent lesions,biopsy should be conducted as soon as possible and immunohistochemistry should be performed simultaneously,which will provide a good basis for further treatment.