Carson Jeffrey, Bedrnicek Jiri, Abdessalam Shahab
Department of General Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA.
Case Rep Pediatr. 2012;2012:791602. doi: 10.1155/2012/791602. Epub 2012 Oct 23.
We present a case of a 3-year-old male originally diagnosed with a CD30+ anaplastic cutaneous T-cell lymphoma with no evidence of systemic disease after CT scan, PET scan, and bone marrow aspiration. Sentinel lymph node biopsy (SLNB) was performed as an additional step in the workup and showed microscopic disease. Current management/recommendations for cutaneous T-cell lymphoma do not include SLNB. Medical and surgical management of cutaneous malignancies is dramatically different for local versus advanced disease. Therefore adequate evaluation is necessary to properly stage patients for specific treatment. Such distinction in extent of disease suggests more extensive therapy including locoregional radiation and systemic chemotherapy versus local excision only. Two international case reports have described SLNB in cutaneous T-cell lymphoma with one demonstrating evidence of node positive microscopic disease despite a negative metastatic disease workup. This case is being presented as a novel case in a child with implications including lymphoscintigraphy and SLNB as a routine procedure for evaluation and staging of cutaneous T-cell lymphoma if the patient does not demonstrate evidence of metastatic disease on routine workup.
我们报告一例3岁男性病例，最初诊断为CD30+间变性皮肤T细胞淋巴瘤，经CT扫描、PET扫描和骨髓穿刺检查后未发现系统性疾病证据。前哨淋巴结活检（SLNB）作为进一步检查步骤进行，结果显示存在微小病变。目前皮肤T细胞淋巴瘤的管理/建议中不包括SLNB。皮肤恶性肿瘤的内科和外科治疗在局部疾病与晚期疾病方面有显著差异。因此，进行充分评估对于为患者进行适当的分期以制定特定治疗方案是必要的。疾病范围的这种差异表明，对于局限性疾病仅行局部切除，而对于更广泛的疾病则需要更广泛的治疗，包括局部区域放疗和全身化疗。两篇国际病例报告描述了皮肤T细胞淋巴瘤的SLNB，其中一篇显示尽管转移性疾病检查结果为阴性，但仍有淋巴结阳性微小病变的证据。本病例作为儿童中的一个新病例呈现，其意义包括，如果患者在常规检查中未显示转移性疾病证据，淋巴闪烁显像和SLNB可作为评估和分期皮肤T细胞淋巴瘤的常规程序。
