以播散性带状疱疹为首发表现的血管免疫母细胞性T细胞淋巴瘤1例

A Case of Angioimmunoblastic T-cell Lymphoma with Disseminated Herpes Zoster

患者男,68岁,右侧头部疱疹伴疼痛1周,躯干、四肢皮疹3 d。既往身体健康。体格检查:右侧头部可见成簇疱疹,部分破溃,部分已结痂。双侧颈部及双侧腋窝可触及肿大淋巴结。躯干及四肢散在红色丘疹,上有小水疱、周围绕以红晕,部分结痂。皮损组织病理示:淋巴结活检可见淋巴结结构破坏,未见明显淋巴滤泡,淋巴结内多形性细胞浸润,瘤细胞生长活跃,核分裂象易见。淋巴结免疫组织化学显示CD3广泛阳性;CD10片状阳性;BCL6片状阳性;CXCL13广泛阳性;Ki-67(70%~80%阳性);PD1广泛阳性;EBER散在阳性。

A 68-year-old male was admitted to the dermatology department due to herpes on the right side of his head accompanied by pain for a week and rash on his trunk and limbs for the last three days.The patient was otherwise healthy.Physical examination showed that clusters of herpes could be seen on the right side of the head,some of them ulcerated.Enlarged lymph nodes were palpable in both neck and axilla.Trunk and limbs covered in red papules,small blisters surrounded by a red halo and scabs.Pathological examination:lymph node biopsy showed damaged lymph node structure,lack of lymph follicles,pleomorphic cell infiltration in the lymph node,visible nucleoli,active growth and mitosis of tumor cells.Immunohistochemistry of lymph nodes demonstrated extensive CD3 and PD1 staining,patched CD10,BCL6,and CXCL13 staining;scattered EBER stain.Ki-67 marker was positive in 70%~80%of the sample.