Arai N, Umeda M, Shirai T
First Department of Internal Medicine, Toho University, School of Medicine, Tokyo.
Rinsho Ketsueki. 1990 Apr;31(4):516-20.
This paper reports a case of non-Hodgkin's lymphoma concurrent with cyclic neutropenia. A 59-year-old man who exhibited a neutropenia at a periodicity of 14-20 days from July 1986 was diagnosed as having cyclic neutropenia, and was re-admitted to our hospital because of an abdominal tumor in April 1988. Gastroscopy revealed a Borrmann II-like elevated lesion, and abdominal CT scanning showed a low density area in the liver and swelling of the para-aortic lymph nodes. According to histological examination of the stomach and the liver, the patient was diagnosed as having non-Hodgkin's lymphoma (diffuse, medium-cell type). After completion of three courses of COP-BLAM III therapy, which was started on June 7, a partial response was achieved. However, the patient had a relapse and died on May 12, 1989. Cyclic neutropenia in this case was not considered to be due to an immunological abnormality mediated by lymphocytes, but may have been caused by an excessive response of the negative feedback mechanism due to an increase in CIA (Colony-inhibiting activity) of neutrophils. The fact that the patient's EB virus antibody titer became higher than at this initial hospitalization suggests the possible transition from chronic EB virus infection into malignant lymphoma.
本文报告一例非霍奇金淋巴瘤并发周期性中性粒细胞减少症的病例。一名59岁男性自1986年7月起每隔14 - 20天出现一次中性粒细胞减少症，被诊断为周期性中性粒细胞减少症，1988年4月因腹部肿瘤再次入院。胃镜检查发现类似Borrmann II型的隆起病变，腹部CT扫描显示肝脏有低密度区以及主动脉旁淋巴结肿大。根据胃和肝脏的组织学检查，该患者被诊断为非霍奇金淋巴瘤（弥漫性，中细胞型）。6月7日开始进行三个疗程的COP - BLAM III治疗后，取得了部分缓解。然而，患者复发并于1989年5月12日死亡。该病例中的周期性中性粒细胞减少症并非被认为是由淋巴细胞介导的免疫异常所致，而可能是由于中性粒细胞的集落抑制活性（CIA）增加导致负反馈机制过度反应引起的。患者的EB病毒抗体滴度比首次住院时更高这一事实提示可能从慢性EB病毒感染转变为恶性淋巴瘤。
