Hu Shih-Wen, Huang Shu-Pin, Yang Sheau-Fang, Chai Chee-Yin
Department of Pathology, Kaohsiung Medical University, Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2004 Oct;20(10):506-11. doi: 10.1016/S1607-551X(09)70250-5.
Chloroma, or granulocytic sarcoma, is a rare extramedullary solid hematologic cancer that affects many sites, usually in concert with acute myeloid leukemia. It is infrequently associated with other myeloproliferative disorders or chronic myelogenous leukemia. Chloroma of the testis after allogeneic bone marrow transplantation is particularly sparsely represented in the literature. It is often incorrectly diagnosed as malignant lymphoma, especially large-cell lymphoma, owing to the similarity of the histologic morphology, scanty eosinophilic myelocytes, and no or overlooked history of leukemia. Although erroneous diagnosis is decreasing with the advent of ancillary studies, the diagnosis of chloroma continues to be a nightmare for pathologists. It is thus suggested that an appropriate panel of marker studies be performed in conjunction with clinical correlation and circumspection to avoid reaching a misleading conclusion and improper treatment of patients. We report an interesting case of a 35-year-old male with a clinical history of chronic myelogenous leukemia post allogeneic peripheral blood stem cell transplantation and complete molecular remission, who was found to have chloroma of the left testis.
绿色瘤,即粒细胞肉瘤,是一种罕见的髓外实性血液系统癌症,可累及多个部位,通常与急性髓系白血病同时发生。它很少与其他骨髓增殖性疾病或慢性粒细胞白血病相关。异基因骨髓移植后发生的睾丸绿色瘤在文献中报道尤为稀少。由于组织形态学相似、嗜酸性髓细胞稀少以及无白血病病史或被忽视,它常被误诊为恶性淋巴瘤,尤其是大细胞淋巴瘤。尽管随着辅助检查的出现,错误诊断有所减少,但绿色瘤的诊断对病理学家来说仍然是一场噩梦。因此,建议结合临床相关性和审慎态度进行适当的标志物检查组合,以避免得出误导性结论和对患者进行不当治疗。我们报告了一例有趣的病例,一名35岁男性,有慢性粒细胞白血病异基因外周血干细胞移植病史且处于完全分子缓解状态,被发现左侧睾丸患有绿色瘤。