原发皮肤结外鼻型NK/T细胞淋巴瘤一例

Primary cutaneous extranodal nasal type NK/T cell lymphoma:a case report

47岁女性患者,皮肤多发性溃疡10个月,左面颊及右颈部包块6个月。皮损免疫组化染色示:CD3、颗粒酶B(Granzyme B)、LCA均阳性,Ki-67>75%阳性,CD56灶状阳性,CD30散在阳性,CD20阴性。原位杂交EBER阳性。乳酸脱氢酶7.0μmol/L,胸腹部CT检查提示脾脏受侵。超声多谱勒示:左颈部胸锁乳突肌、大鱼际肌及左侧颊部咬肌内局部肌纤维增粗,呈结节样改变。诊断:皮肤鼻型NK/T细胞淋巴瘤。给予VIPD方案化疗2周期,GDP方案化疗4周期;对部分溃疡行姑息性放疗。疗程结束后,原包块明显消退、溃疡愈合,原肌肉及脾脏受累基本消退,疗效评价为部分缓解。

A 47-year-old female patient presented with multiple skin ulcers for 10 months and masses on the left cheek and right neck for 6 months.Dermatological examination findings included palpable masses under the skin on the left cheek and right neck,and many sunken ulcers on the limbs.Immunohistochemistry staining showed that CD3,Granzyme B and LCA were all positive,Ki-67>75%positive,CD56 focally positive,CD30 scattered positive,CD20 negative;EBER was positive for in situ hybridization.LDH was 7.0μmol/L.CT examination of the chest and abdomen showed that the spleen was invaded.B-ultrasound showed that the local muscle fibers in sternocleidomastoid muscle,thenar muscle and masseter muscle of left cheek were thickened and with nodular formation.Diagnosis:cutaneous extranodal nasal NK/T cell lymphoma.The patients were treated with VIPD regimen chemotherapy for 2 cycles,GDP regimen chemotherapy for 4 cycles,and some ulcers were treated with palliative radiotherapy.After the course of treatment,the original masses subsided obviously,the ulcers healed,and the involvement of the muscle and spleen basically disappeared.The therapeutic effect was evaluated as partial relief.