Matsushita Hiromichi, Nakamura Naoya, Asai Satomi, Yabe Miharu, Hayama Naoki, Kondo Yusuke, Urano Tetsuya, Miyachi Hayato
Department of Laboratory Medicine, Tokai University School of Medicine, Isehara.
Intern Med. 2008;47(23):2057-62. doi: 10.2169/internalmedicine.47.1297. Epub 2008 Dec 1.
We report an 81-year-old man who had leukemic presentation of ALK-positive anaplastic large cell lymphoma (ALCL) as an initial manifestation. He had been well after chemotherapy and irradiation for the advanced lung adenocarcinoma, but suddenly suffered from severe lactic acidosis and hypotension. The peripheral blood smear and bone marrow aspiration revealed the infiltration of atypical large cells with horseshoe-shaped or lobulated nuclei. The detection of CD30 expression and the t (2;5) (p23;q35) translocation in these cells was confirmatory of a diagnosis of common variant ALK-positive ALCL in a leukemic phase. He deteriorated rapidly and died before administration of the chemotherapy. An adequate, prompt diagnosis is necessary for this rare disease status in oncologic emergency to improve the disease management.
我们报告了一名81岁男性，其最初表现为ALK阳性间变性大细胞淋巴瘤（ALCL）的白血病表现。他在接受晚期肺腺癌化疗和放疗后情况良好，但突然出现严重乳酸酸中毒和低血压。外周血涂片和骨髓穿刺显示有核呈马蹄形或分叶状的非典型大细胞浸润。这些细胞中CD30表达的检测以及t(2;5)(p23;q35)易位证实了白血病期常见变异型ALK阳性ALCL的诊断。他病情迅速恶化，在化疗给药前死亡。对于这种肿瘤急症中的罕见疾病状态，及时做出充分诊断对于改善疾病管理至关重要。
