临床病例讨论 Case Analysis

混合型急性白血病临床病理探讨并文献复习

Published at: 2015年第35卷第5期

张立英 1 , 皋岚湘 1 , 许春伟 2 , 何学鹏 1
1 北京军区总医院病理科,北京 100700
2 军事医学科学院附属医院 病理科,北京 100071
3 北京军区总医院血液科,北京 100700
通讯作者 岚湘 皋 Email: gaolx51@126.com
DOI: 10.3978/j.issn.2095-6959.10.3978/j.issn.2095-6959.2015.05.037
基金:

摘要

目的:探讨混合型急性白血病的临床病理特征、诊断和鉴别诊断、治疗及预后。方法:回顾性分析1例混合型急性白血病患者的临床资料、组织病理形态、免疫组织化学染色、流式细胞学、染色体核型分析、治疗及随访结果,并回顾相关文献。结果:光镜下,颈部淋巴结活检示淋巴结基本结构被破坏,不见明显的淋巴滤泡及套区,代之以小-中等大小的比较均匀一致的异型淋巴样细胞,其细胞质较少,细胞核圆形或卵圆形,染色质比较均匀细腻,核仁不明显或偶见,核分裂象可见。免疫组织化学染色结果显示异型淋巴样细胞LCA散在较多(+),CD7弥漫较多(+),TdT弥漫较多(+),CD10弥漫较多(+),MPO散在(+);外周血涂片和骨髓涂片可见原始幼稚细胞;第一次化疗前后流式细胞学检测分别提示急性髓系白血病和急性B淋巴母细胞白血病。第一次化疗前骨髓短期培养法染色体核型分析提示46、XY、del(11q)。上述淋巴结活检形态学、免疫组织化学染色结果、外周血及骨髓涂片、骨髓流式细胞学及染色体核型分析均支持混合型急性白血病(转换型) 的诊断。虽已更换不同的化疗方案,患者化疗效果不明显,反复出现肺部感染及骨髓抑制,均提示其预后比较差。结论:混合型急性白血病十分少见,一般需要结合形态学、免疫表型及细胞遗传学等检查才能做出诊断,对该病的鉴别诊断、治疗方案的选择及预后具有重要意义。


Mixed phenotype acute leukemia: a case report and review of the literature

Abstract

Objective: To investigate the clinical and pathological features, diagnosis and differential diagnosis, treatment and prognosis of mixed phenotype acute leukemia. Methods: Retrospective analysis of the clinical data was conducted in one case of mixed phenotype acute leukemia, and the histopathological morphology, immunohistochemistry staining, flow cytometry, karyotype analysis, treatment and follow-up data, and review of the literature. Results: Under light microscope, cervical enlarged lymph node biopsy showed that basic structure of the lymph node was damaged, significant lymphoid follicles and mantle zone couldn’t be seen, and was replaced by small to medium-sized and relatively uniform atypical lymphoid cells. The atypical lymphoid cells showed lesser cytoplasm, round or oval nuclei, the chromatin were uniform, nucleoli were inconspicuous or occasionally could be found, and the mitotic were visible. Immunohistochemically, stains revealed LCA were more scattered positive in the atypical lymphoid cells, they were strong diffused positivity for CD7, TdT and CD10, and were partly positive for MPO. Peripheral blood smear and bone marrow smear all showed primitive naive cells; it was showed acute myeloid leukemia and acute B lymphoblastic leukemia respectively before and after the first time chemotherapy by flow cytometry. Karyotype analysis of short-term bone marrow culture showed deletion of 11q. The above morphology of lymph node biopsy, immunohistochemical staining of lymph noid, peripheral blood and bone marrow smears, bone marrow flow cytometry and karyotype analysis, etc., all these results supported the diagnosis of mixed phenotype acute leukemia (conversion type). Although the patient was given different chemotherapy regimens, it got little effect, he suffered recurrent lung infections and bone marrow suppression, suggested that the prognosis of mixed phenotype acute leukemia (conversion type) was very poor. Conclusion: The incidence of mixed phenotype acute leukemia is very low; generally it requires a combination of morphology, immune phenotype and cytogenetic and other tests to make a final diagnosis, differential diagnosis of the disease, treatment options and prognosis are all important. Therefore, grasp the clinical and pathological features of the disease play an important role in the differential diagnosis, treatment and prognosis of this disease.


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引用

引用本文: 立英 张, 岚湘 皋, 春伟 许, 学鹏 何. 混合型急性白血病临床病理探讨并文献复习[J]. 临床与病理杂志, 2015, 35(5): 882-889.
Cite this article as: ZHANG Liying, Gao Lan-xiang, Xu Chun-wei, HE Xuepeng . Mixed phenotype acute leukemia: a case report and review of the literature[J]. Journal of Clinical and Pathological Research, 2015, 35(5): 882-889.