Olaniyi J A, Ibijola A A
Department of Haematology, PMB 5116University College Hospital, Ibadan, Nigeria.
Med Princ Pract. 2009;18(2):152-4. doi: 10.1159/000189815. Epub 2009 Feb 10.
To report a case of Richter's syndrome found in one of the teaching hospitals in Nigeria in the context of sparse earlier reports of Richter's syndrome in western Africa.
A 52-year-old male had been diagnosed earlier as having chronic lymphocytic leukaemia (CLL) and treated for 6 months with chlorambucil, although compliance was poor and the patient eventually stopped treatment. He presented to our hospital 18 months later with clinical features in keeping with Richter's syndrome. The blood and bone marrow smear review, together with fine-needle aspiration cytology of the masses, showed diffuse large cells of non-Hodgkin lymphoma consistent with the Richter's syndrome stage of CLL. There was significant improvement in response to the first 4 cycles of CHOP chemotherapy (consisting of cyclophosphamide, doxorubicin, vincristine and prednisolone) instituted, but then there were features of relapse.
The case report serves to increase awareness and improve the index of suspicion about the terminal phase of CLL and low-grade lymphoma. It equally emphasizes the great need to strengthen further the laboratory diagnosis of haematological malignancies in developing countries.
鉴于西非关于里氏综合征的早期报道稀少，报告尼日利亚一家教学医院发现的一例里氏综合征病例。
一名52岁男性此前被诊断为慢性淋巴细胞白血病（CLL），并接受了6个月的苯丁酸氮芥治疗，尽管依从性差且患者最终停止了治疗。18个月后，他因符合里氏综合征的临床特征前来我院就诊。血液和骨髓涂片检查，以及肿块的细针穿刺细胞学检查显示，弥漫性大细胞为非霍奇金淋巴瘤，符合CLL的里氏综合征阶段。开始的前4个周期CHOP化疗（由环磷酰胺、阿霉素、长春新碱和泼尼松龙组成）治疗后有显著改善，但随后出现复发特征。
该病例报告有助于提高对CLL终末期和低度淋巴瘤的认识，并提高怀疑指数。它同样强调了发展中国家进一步加强血液系统恶性肿瘤实验室诊断的迫切需要。
