以嗜酸细胞增多综合征为表现的Epstein-Barr病毒阳性弥漫大B细胞淋巴瘤

A case of EBV-positive diffuse large B-cell lymphoma presented with hypereosinophilic syndrome

报告1例以嗜酸细胞增多综合征为表现的Epstein-Barr病毒(EBV)阳性弥漫大B细胞淋巴瘤。患者女,30岁。因全身红斑、丘疹伴瘙痒5个月,面部红肿脱屑10 d入院。实验室及辅助检查:嗜酸性粒细胞计数6.62×109/L,白细胞分类中嗜酸性粒细胞0.597,骨髓涂片示各阶段嗜酸性粒细胞比例均增高。皮损组织病理检查:角化过度伴角化不全,局部可见可疑Munro微脓肿,血管周围少量淋巴单一核细胞浸润,个别细胞核大;右腋下肿块组织病理检查:肿瘤组织位于真皮深部及皮下组织层,由密集的淋巴细胞组成,异形及病理性核分裂象明显,片状胶原及脂肪组织凝固性坏死,并可见血管浸润,符合恶性淋巴瘤。免疫组化:异形细胞CD20(+)、B细胞淋巴瘤/白血病因子(Bcl)-2(+)、多发性骨髓瘤癌基因(MUM)-1(+)、细胞增殖核抗原(Ki-67)(>90%+)及EBV编码小RNA(EBER)原位杂交(+)。诊断:EBV阳性弥漫大B细胞淋巴瘤(DLBCL)。治疗:予静脉滴注甲泼尼龙(80 mg/d)及对症支持治疗,确诊淋巴瘤后转血液科化疗。

A case of EBV-positive diffuse large B-cell lymphoma （DLBCL） presented with hypereosinophilie syndrome is reported. A 30-year-old female presented with itchy erythemas and papules all over the body for 5 months, and facial swelling and desquamation for 10 days. Laboratory examination showed that eosinophil count was 6.62×109/L, and percentage of eosinophilics was 59.70%. Bone marrow pathology revealed that the ratio of eosinophils at all stages increased. Histopatho- logical examination revealed hyperkeratosis accompanied by parakeratosis, suspicious focal Munro microabscesses, perivascular infiltration of a few lymphocytes and monocytes. Histopathologieal examination of the fight axillary tumor showed that the neo- plasm resided in the deep dermis and subcutaneous layers composed of dense lymphocytes characterized by atypia and pathologic mitosis. Coagulative necrosis of collagen fibers and adipose tissue together with vascular infiltration were also ap- parent. Immunohistochemistry showed CD20 （＋）, Bcl-2 （＋）, MUM- 1 （＋）, Ki-67 （〉90%＋）, and EBER in situ hybridization （＋）. The diagnosis of EBV-positive DLBCL was made. The patient was given methylprednisolone 80 rag/d, symptomatic and sup- portive treatment,and chemotherapy in hematological department after the diagnosis.