以皮肤损害首诊的皮肤继发淋巴瘤17例临床分析并文献复习

Clinical Analysis of 17 Cases of Secondary Lymphoma with Skin Lesions as Initial Symptom and Literatwre Review

目的提高皮肤科医生对以皮肤损害首诊的皮肤继发淋巴瘤的认识,减少临床工作中的漏诊、误诊。方法回顾性分析本院2013年1月-2016年8月诊治的17例以皮疹为首发表现的淋巴瘤患者的流行病学、临床特点及辅助检查等资料。同时在各数据库检索近15年来国内外皮肤继发淋巴瘤文献予以复习。结果文献搜索共检索到以皮肤损害首诊的皮肤继发淋巴瘤58例,结合本院17例,共75例。其中发病年龄3~91岁,男性多于女性,占65%,女性占35%。皮损呈多形性,以泛发的红斑、丘疹、瘀点、瘀斑多见。半数以上患者伴有无痛性淋巴结肿大、不明原因发热、体重突然下降等全身症状,同时患者血细胞计数常出现明显异常。病理类型多系非霍奇金淋巴瘤,且预后差。结论皮疹复杂多样,缺乏特异性,伴其他系统损害时皮肤科医生需警惕淋巴瘤的可能,及时行病理活检明确诊断对于淋巴瘤的早期发现和及时治疗有重要意义。

Objective To expand the clinical knowledge of secondary lymphoma with initial skin lesions and avoid the misdiagnosis.Methods The data of seventeen patients with secondary lymphoma in our hospital, who presented with skin lesions initially, such as epidemiology, clinical features and laboratory data, were analyzed retrospectively from January 2013 to August 2016.Meanwhile, literatures in the latest fifteen years were reviewed from several databases.Results There were 75 cases of secondary lymphoma patients with initial skin lesions, including 58 patients from literature search engines and 17 patients from our hospital.Among those cases, the onset age was 3 to 91 years old, males accounting for 65% and females accounting for 35%.The eruptions were polymorphous and were mainly manifested as erythematous macules, papules, petechia, or ecchymosis.Over half of the patients were accompanied with systemic symptoms, such as indolent palpable lymph node, fever of unknown origin, sudden weight loss, etc.At the same time complete blood cell counts were always abnormal.Most of these cases were diagnosed pathologically as non-Hodgkin＇s lymphoma with a poor prognosis.Conclusion The rashes were various and nonspecific.More attention should be paid by every dermatologist to the possibility of lymphoma when the damages of other internal organs were involved.Moreover, biopsy was important for early detection and prompt treatment of lymphoma.