以扁桃体周脓肿为首发症状的慢性粒细胞白血病诊治体会

The diagnosis and treatment of chronic granulocytic leukemia with tonsillar abscess being the initial symptom

目的探讨慢性粒细胞白血病以扁桃体周脓肿为首发症状的的诊治过程,以探讨其临床病理特征及合理的治疗策略。方法回顾性分析我科收治的1例以扁桃体周脓肿为首发症状的慢性粒细胞白血病临床表现、临床病理学资料及诊疗过程,并复习相关文献。结果患者以扁桃体周脓肿为首发症状,行扁桃体周穿刺见少许脓性分泌物,完善检查提示伴有血液系统异常,骨髓穿刺骨髓涂片示BM有核细胞增生明显活跃,粒系明显增生占82.5%,原始细胞3%,MPD骨髓流式细胞学检查示FCM可见粒系比例增高,约占有核细胞比例的86.9%,其中部分粒系可见CD11b、CD13、CD15、CD16表达紊乱;骨髓标本送成都金域检验中心查：FLT3-ITD未检测到突变;NPM1未检测到突变;AML中的C-KIT未检测到突变;AML-E;TO阴性;BCR/ABL融合基因（P190）阳性。诊断为：慢性粒细胞性白血病,经积极的规范性化疗,预后较好,病情好转出院,随访1年,未见复发。结论当遇及以咽喉部感染为首发症状合并血液系统异常的疾患者时,要及时进行相关实验室检查,争取早发现、早诊断、早治疗,改善患者的预后,以期减少误诊、漏诊率,尽量避免传统的扁桃体周脓肿的治疗方法如扁桃体周穿刺、扁桃体周脓肿切开、扁桃体切除等有创操作造成不可逆性损伤。

Objective To investigate the clinicopathological features and propose viable treatment strategy of chronic myelogenous leukemia（CML） with tonsillar abscess being the initial symptom. Methods Retrospective analysis was conducted on 1 case of CML with peritonsillar abscess in our department. Its clinical manifestation,pathology documentations,clinical diagnosis/treatment and related literatures were reviewed. Results The patient suffered peritonsillar abscess as the initial symptom. line peritonsillar puncture showed little purulent secretion. Further tests revealed abnormal blood status. Bone marrow biopsy smear showed obvious intensified nucleated cell proliferation activities. Granulocyte accounted for 82. 5% of the hyperplasia whole original cells accounted for 3%. MPD bone marrow fluid cytology in FCM showed increased granulocyte ratio at 86. 9%. CD11 b,CD13,CD15,CD16 expression disorders can be observed in some granulocyte populations; The bone marrow specimen was sent to the chengdu jinzun inspection center. No NPM1 and C-kit mutations were found; AML-E; TO negative; BCR/ABL fusion gene（P190） positive. Diagnosis： CML. Thanks to refined and active treatments,improved prognosis helped the patient＇s condition recovers. Our one-year follow-up showed no sign of CML re-occurrence. Conclusion When throat infection combined with abnormal blood status was detected in patients,timely and thorough inspections ought to be made to identify early stage CML cases,which ultimately benefits improved diagnosis,treatment and prognosis of the patient. Meanwhile,traditional peritonsillar treatments such as peritonsillar abscess puncture,peritonsillar abscess incision and tonsil excision invasive operation need to be excluded to prevent irreversible damage to the patient.