皮下脂膜炎样T细胞淋巴瘤二例误诊报告并文献复习

A Report and Literature Review of Two Misdiagnosed Cases of Subcutaneous Panniculitis-like T-cell Lymphoma

目的探讨皮下脂膜炎样T细胞淋巴瘤(subcutaneous panniculitis-like T-cell lymphoma,SPTCL)的临床特点及诊断要点,以减少误诊。方法回顾性分析SPTCL 2例误诊病例资料,并复习相关文献。结果本文2例均以皮肤红斑、结节伴疼痛为首发表现,进而伴发热、双下肢水肿,先后误诊为多发性疖肿、脂膜炎及血管炎,予相应治疗无明显改善。经活检病理及免疫组织化学染色检查确诊为SPTCL,误诊时间3个月和8个月。由于病情严重,分别于确诊后1周、1个月后死亡。结论对原因不明的皮肤单个或多个深在红色至紫色斑块或结节,伴发热、消瘦、盗汗、肝脾增大者,应高度警惕SPTCL的可能,及时行活检病理及免疫组织化学染色检查,以减少误诊误治。

Objective To study the clinical features and main points of the diagnosis of subcutaneous panniculitis-like T-cell lymphoma （SPTCL） to avoid misdiagnosis, and related literature was also reviewed. Methods Clinical data of two mis-diagnosed cases of SPTCL was retrospectively analyzed, and related literature was also reviewed. Results Two patients visited doctors for skin erythema, nodi pain as the primal symptoms, following fever with aggravating conditions and edema in both lower extremities. The patients had been misdiagnosed as having multiple furuncle, panniculitis and vasculitis, but the patients＆#39;condi-tions were not improved after corresponding treatments. The SPTCL was confirmed by histopathologic and immunohistochemistry examinations, and the misdiagnosis durations were 3 months and 8 months respectively. The patients died of the grave conditions one week and one month after the final diagnosis. Conclusion Clinicians should pay more attention to inexplicable single or multiple red-purple plaques or nodi patients with fever, emaciation, night sweat and enlargement of the spleen and liver, and SPTCL should be highly suspected. Histopathology and immunohistochemistry examinations should be performed to reduce misdi-agnosis rate and mistreatment rate.