皮下脂膜炎样T细胞淋巴瘤误诊为慢性感染伤口临床报告并文献复习

A Clinical Report and Literature Review of Subcutaneous Panniculitis-like T-cell Lymphoma Misdiagnosed as Chronic Wound Infection

目的探讨皮下脂膜炎样T细胞淋巴瘤的临床特点及误诊原因,为临床识别该病提供参考。方法对长期误诊为慢性感染伤口的皮下脂膜炎样T细胞淋巴瘤1例的临床资料进行回顾性分析,并复习相关文献。结果本例因慢性伤口感染7月余就诊,曾因双腋下皮肤结节在外院行2次活组织病理检查均提示炎性反应,予相应处理病情加重入我院。后又经2次组织病理学和免疫组织化学检查确诊为皮下脂膜炎样T细胞淋巴瘤,给予化学治疗5 d,患者伤口进行性坏死扩大、剧痛,于确诊后7 d患者及家属要求出院,医护人员坚持门诊随访。出院后50 d在家中继发急性腹痛死亡。结论皮下脂膜炎样T细胞淋巴瘤临床表现各异,容易误诊。伤口反复感染、迁延难愈,具有慢性伤口的临床特征是本例误诊的主要原因。提示临床医师对本病进行诊治需联合病理及肿瘤等多科专家会诊,以早期确诊。

Objective To explore the wound characteristics of subcutaneous panniculitis-like T-cell lymphoma （ SPTCL） and the misdiagnosed causes in order to provide evidence for recognition. Methods Clinical data of one case of SPTCL misdiagnosed as chronic infective wound for a long time was analyzed retrospectively, and relevant literature was re-viewed. Results This patient first visited for his chronic wound infection for more than seven months. The patient complained of subcutaneous nodosity near the bilateral axilla. Two biopsy tests and histological tests were made and the results indicated inflammation. The patient received appropriate treatment, which did not respond and condition became progressively worse. In our hospital, the patient was diagnosed as having SPTCL by two biopsy tests and immunohistochemistry tests and then receivednbsp;chemotherapy for five days, but the wound area tumed more extensive, necrotic with severe pains. The patient and their fami-lies were required to discharge 7 d after confirmed diagnosis. The patient died of complicated intestinal colic 50 d after dis-charge. Conclusion The clinical manifestations of SPTCL are various and tend to be misdiagnosed. The wounds may be re-peatedly infected and difficult to heal. The clinical features of chronic wounds may be the main cause of misdiagnosis of this case. Clinicians should take joint consultations with pathologists and oncologists in order to confirm the diagnosis early.