Department of Dermatology and Plastic, Reconstructive and Aesthetic Surgery, La Sapienza University of Rome, Umberto I Polyclinics, Rome, Italy.
In Vivo. 2012 Mar-Apr;26(2):311-4.
The reported case of Hairy cell leukemia (HCL) refers to a 47-year-old man with pancytopenia, splenomegaly, a month and a half history of dyspnea on mild effort and in common daily activities and a purplish-brown cutaneous node on the back of the left hand at the time of hospital admission. Bone marrow aspiration showed an infiltration by a lymphoproliferative malignancy and the following cytochemical studies on bone marrow sample led to diagnosis of HCL. The biopsy of the skin lesion revealed a infiltrate of medium and large-size cells in the dermis with the the same cytologic features of leukemic blasts appearing in the bone marrow, upon which the diagnosis of Leukemia cutis was established. The differential diagnosis of leukemia includes other neoplastic hematopoietic disorders, such as lymphoma, myelodysplastic syndromes, multiple myeloma, aplastic anemia, severe megaloblastic anemia, severe lymphocytosis, severe monocytosis, and bone marrow failure. In our case, the skin lesion was surgically removed and then left to heal by secondary intention due to the presence of bacterial infection by Staphylococcus aureus and Streptococcus pyogenes. The wound was finally medicated to total healing with Promogran®, an advanced dressings which consists of a sterile, freeze-dried matrix composed of collagen and oxidised regenerated cellulose. The importance of our case lies in the fact that cases with association of HCL with leukemia cutis are very rare, and furthermore that after the excision of the skin lesion of the left hand, the surgeons heal to let the wound close by secondary intention.
本报告的毛细胞白血病（HCL）病例涉及一名 47 岁男性，表现为全血细胞减少、脾肿大，在入院时已有半月余的轻度体力活动和日常活动时呼吸困难病史，左手背部有一个紫褐色皮肤结节。骨髓抽吸显示存在淋巴增殖性恶性肿瘤浸润，骨髓样本的以下细胞化学研究导致 HCL 的诊断。皮肤病变活检显示真皮中有中等和大细胞浸润，具有与骨髓中白血病原始细胞相同的细胞学特征，据此确立了皮肤白血病的诊断。白血病的鉴别诊断包括其他肿瘤性造血障碍，如淋巴瘤、骨髓增生异常综合征、多发性骨髓瘤、再生障碍性贫血、严重巨幼细胞贫血、严重淋巴细胞增多症、严重单核细胞增多症和骨髓衰竭。在我们的病例中，由于金黄色葡萄球菌和化脓性链球菌的细菌感染，皮肤病变被手术切除，然后通过二期愈合。最后使用 Promogran®进行治疗，伤口完全愈合，Promogran®是一种高级敷料，由胶原蛋白和氧化再生纤维素组成的无菌冻干基质组成。我们病例的重要性在于 HCL 与皮肤白血病相关的病例非常罕见，而且在手的皮肤病变切除后，外科医生让伤口通过二期愈合来愈合。
