Stavem P, Rørvik T, Brandtzaeg P, Brosstad F, Nordhagen R, Grabner P
Medical Department A, Rikshospitalet, Oslo, Norway.
J Intern Med. 1991 Feb;229(2):193-6. doi: 10.1111/j.1365-2796.1991.tb00330.x.
A 34-year-old man was found to have granulocytopenia with a white blood count of 2.3 x 10(9) l-1, consisting of 10% segmented neutrophils, 50% monocytes and 40% lymphocytes. A bone marrow aspirate showed 20% promyelocytes and 10% blasts with monoblastic features, and a smouldering myelomonocytic leukaemia was considered to be a possible diagnosis. In cold weather the patient experienced cold intolerance with acrocyanosis and small ulcerations on the ears. The test for heparin-precipitable protein ('cryofibrinogen') was strongly positive. During the following year, these signs and symptoms persisted, and the patient also developed constant moderate pain in the epigastric region. Gastroscopy revealed a large lymphoma of the stomach, which was a high-grade malignant centroblastic type of non-Hodgkin's lymphoma. After successful removal of the tumour, and six courses of potent cytostatic combinations, the patient recovered completely, and the granulocytopenia and cold intolerance disappeared.
一名34岁男性被发现粒细胞减少，白细胞计数为2.3×10⁹/L，其中分叶核中性粒细胞占10%，单核细胞占50%，淋巴细胞占40%。骨髓穿刺显示20%早幼粒细胞和10%具有单核母细胞特征的原始细胞，考虑可能诊断为冒烟型骨髓单核细胞白血病。在寒冷天气下，患者出现冷不耐受，伴有肢端发绀和耳部小溃疡。肝素沉淀蛋白（“冷纤维蛋白原”）检测呈强阳性。在接下来的一年里，这些症状持续存在，患者还出现了上腹部持续中度疼痛。胃镜检查发现胃内有一个大的淋巴瘤，为高级别恶性中心母细胞型非霍奇金淋巴瘤。成功切除肿瘤并进行六个疗程的强效细胞毒性联合治疗后，患者完全康复，粒细胞减少和冷不耐受症状消失。
