以播散型环状肉芽肿为皮肤表现的T幼淋巴细胞白血病1例

A Case of Generalized Granuloma Annulare as A Cutaneous Manifestation of Underlying T-cell Prolymphocytic Leukemia

患者男,48岁,面部、颈部、躯干和四肢弥漫红斑丘疹伴瘙痒9个月,加重2个月,间断发热伴乏力1个月余。查体可见患者面部、颈部、躯干和四肢弥漫分布的红色丘疹伴瘙痒。血常规显示白细胞计数204.3×10^9,淋巴细胞计数172.9×10^9,骨髓活检病理提示小T淋巴细胞异常增生(76%),以成熟小淋巴细胞为主,主要表达CD2、CD5、CD4、CD3、CD28,部分表达CD7和CD52,诊断为T幼淋巴细胞白血病。皮损组织病理提示诊断:播散型环状肉芽肿。

A 48-year-old man presented multiple pruritic dark red papules for nine months and his lesion got worse in the last two months.He also had mild fever and fatigue for a month.A dermatological examination revealed symmetrical,generalized red papules distributed on his face,hands,feet,trunk and limbs.Laboratory tests revealed a white blood count of 204.3×10^9/L(lymphocytes:172.9×10^9).Bone marrow biopsy revealed an increased number of mature T cells(76%of marrow cells),positive for CD2,CD4,CD5,CD7(partially),CD28 and CD52(partially).These results were consistent with the diagnosis of T-cell prolymphocytic leukemia.A biopsy of skin lesion showed a granulomatous infiltrate composed of lymphocytes and epithelioid cells around small vessels.Several histocytes and many multinucleated giant cells surrounding degenerated collagen in the upper dermis were seen,consistent with granuloma annulare.