Amo Y, Tanei R, Yonemoto K, Katsuoka K, Mori M
Department of Dermatology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan.
Eur J Dermatol. 2000 Jun;10(4):306-8.
The present case, a 75-year-old man with extranodal B-cell lymphoma showed facial hemiplegia, paresthesia and cutaneous manifestations. He was initially diagnosed as having a facial paralysis of unknown etiology. One month after the original diagnosis, erythematous indurated plaques developed on his left cheek and nose. A skin biopsy from the plaque on his cheek showed dense infiltrates of large lymphocytes with irregularly shaped nuclei and prominent nucleoli in the dermis and subcutaneous tissue. The lymphocytes were positive for L26 and CD79a. A diagnosis of diffuse large B-cell lymphoma was made. A muscle biopsy from facial muscle in the area of the erythematous plaque showed massive destruction of the muscle tissues by the lymphomatous infiltrates. Furthermore, electrodiagnostic study showed peripheral cranial nerve palsies, involving the left facial and trigeminal nerves. We conclude that diffuse large B-cell lymphoma may develop symptoms such as facial hemiplegia and paresthesia prior to cutaneous manifestations. Diffuse large B-cell lymphoma must be considered as one of the important causes of palsies of cranial nerves at the peripheral level.
本病例为一名75岁的男性，患有结外B细胞淋巴瘤，表现为面部偏瘫、感觉异常和皮肤表现。他最初被诊断为病因不明的面瘫。在最初诊断一个月后，其左侧脸颊和鼻子出现了红斑性硬结斑块。对脸颊上的斑块进行皮肤活检显示，真皮和皮下组织中有大量细胞核形状不规则且核仁突出的大淋巴细胞浸润。这些淋巴细胞L26和CD79a呈阳性。诊断为弥漫性大B细胞淋巴瘤。对红斑斑块区域面部肌肉进行的肌肉活检显示，淋巴瘤浸润导致肌肉组织大量破坏。此外，电诊断研究显示周围性颅神经麻痹，累及左侧面部和三叉神经。我们得出结论，弥漫性大B细胞淋巴瘤可能在出现皮肤表现之前就出现面部偏瘫和感觉异常等症状。弥漫性大B细胞淋巴瘤必须被视为周围性颅神经麻痹的重要原因之一。
