Hull D R, Alexander H D, Markey G M, Lyness R W, Morris T C
Department of Haematology, Belfast City Hospital, Northern Ireland, UK.
J Clin Pathol. 2000 Oct;53(10):788-90. doi: 10.1136/jcp.53.10.788.
A 58 year old man presented in 1995 with a swollen testicle. After orchidectomy, a diagnosis of poorly differentiated lymphoma was made. Lymphoid, epithelial, and seminoma markers were all negative. Six months later he developed a buccal lesion, which was biopsied and reported as a high grade non-Hodgkin's lymphoma. It responded completely to chemotherapy but within a year he developed a forearm swelling, which was biopsied and imprints made before fixation of the material. Immunocytochemistry on the imprints showed positivity with antibodies to CD4, CD68, and muramidase, and the non-specific esterase cytochemical stain was strongly positive, leading to a diagnosis of true histiocytic lymphoma. Despite further treatment, the patient entered a terminal acute leukaemic phase, the blasts marking as monoblasts. Review of all the biopsies, including molecular investigations and further immunohistochemistry studies performed retrospectively on the original biopsy, demonstrated that this was the same malignant cell line throughout, and we conclude that this is a case of histiocytic lymphoma, initially presenting as a testicular tumour and terminating in acute monoblastic leukaemia. A diagnosis of histiocytic lymphoma should be considered when lymphoid markers are negative in an apparent lymphoma, but should not be made without recourse to appropriate immunophenotypic and molecular studies.
一名58岁男性于1995年因睾丸肿大就诊。睾丸切除术后，诊断为低分化淋巴瘤。淋巴、上皮和精原细胞瘤标志物均为阴性。6个月后，他出现颊部病变，活检报告为高级别非霍奇金淋巴瘤。该病变对化疗完全缓解，但1年内他又出现前臂肿胀，对其进行活检并在固定材料前制作印片。印片的免疫细胞化学显示对CD4、CD68和溶菌酶抗体呈阳性，非特异性酯酶细胞化学染色呈强阳性，从而诊断为真性组织细胞淋巴瘤。尽管进行了进一步治疗，患者进入终末期急性白血病阶段，原始细胞标记为原单核细胞。回顾所有活检结果，包括分子研究以及对原始活检进行回顾性进行的进一步免疫组织化学研究，表明整个过程中这是同一恶性细胞系，我们得出结论，这是一例组织细胞淋巴瘤，最初表现为睾丸肿瘤，最终发展为急性原单核细胞白血病。当明显的淋巴瘤中淋巴标志物为阴性时，应考虑诊断为组织细胞淋巴瘤，但在未进行适当的免疫表型和分子研究之前不应轻易做出诊断。
