非特指型EBV阳性弥漫大B细胞淋巴瘤并发下肢淋巴水肿

A case of EBV-positive diffuse large B-cell lymphoma not otherwise specified with lower limb lymphedema

患者女,63岁。右下肢水肿12年,多发红色斑块、结节半年。皮肤科检查:右小腿多发红色斑块、结节,黄豆至核桃大;大腿多发钱币大红色斑块,质韧,明显浸润。右大腿红色斑块组织病理检查:表皮萎缩,可见境界带,真皮上中部胶原纤维呈均一化改变,真皮下部及皮下组织内见大量异形中等和大淋巴细胞浸润。免疫组化:CD20(+),血浆配对盒蛋白(PAX5)(+),EB病毒编码的小RNA(EBER)原位杂交(+),CD10(-),B细胞淋巴瘤(Bcl)-6(约10%+),Bcl-2(-),多发性骨髓瘤癌基因(MUM)-1(+),原癌基因c-Myc(约5%+),细胞增殖核抗原(Ki-67)(约80%+)。诊断:非特指型EBV阳性弥漫大B细胞淋巴瘤。治疗:患者因经济原因放弃治疗。

The patient was a 63-year-old female with right lower limb lymphedema for 12 years and multiple red plaques and nodules for half a year.Dermatological examination showed Multiple red plaques and nodules with the size ranging from soybeans to walnuts on the right lower limb and multiple red,firm,obvious infiltrated plaques on the right thigh.Histopathological examination of red plaque in right thigh revealed epidermal atrophy,the grenz zone,homogeneous changes of collagen fibers in the upper and middle dermis,and a large amount of abnormal medium and large lymphocyte infiltration in the subdermal and subcutaneous tissues.Immunohistochemistry demonstrated CD20(+),PAX5(3+),EBER(+),CD10(-),Bcl-6(10%+),Bcl-2(-),Mum-1(+),c-Myc(5%+),Ki-67(80%+).The patient was diagnosed with EBV-positive diffuse large B-cell lymphoma,not otherwise specified.The patient gave up treatment for financial reasons and was lost to contact.