Department of Pathology, Tulane University, New Orleans, LA 70112, USA.
Hum Pathol. 2013 Apr;44(4):670-5. doi: 10.1016/j.humpath.2012.09.014. Epub 2013 Jan 11.
Composite lymphoma of T-cell and B-cell type is uncommon, and the one occurring primarily on skin is extremely rare. Herein, we report a unique case of composite lymphoma of mycosis fungoides and cutaneous small B-cell lymphoma in a 73-year-old male patient. The patient presented with multiple erythematous patches, plaques, and nodules on the upper arms, scalp, and trunk. Four punch biopsies of arm and scalp lesions demonstrated lymphoid infiltrate in superficial to deep dermis with a characteristic zone distribution of T-cell and B-cell components. T cells were distributed in papillary and perifollicular dermis and displayed a larger size with convoluted nuclei, whereas B cells were small sized, assuming nodular infiltrate in mid-deep dermis with coexpression of CD5. Molecular test detected clonal rearrangement of both TCRG and IGH/K genes with identical amplicons for each gene in all 4 biopsies. Clinical staging revealed no extracutaneous lesions. A multidisplinary approach is emphasized to establish a definitive diagnosis.
T 细胞和 B 细胞混合型复合淋巴瘤并不常见，而主要发生于皮肤的更是极为罕见。本文报道了 1 例 73 岁男性患者发生的蕈样霉菌病和皮肤小 B 细胞淋巴瘤的复合淋巴瘤，该患者上肢、头皮和躯干有多个红斑性斑块和结节。4 处臂部和头皮皮损的打孔活检显示，在真皮浅层到深层有淋巴样浸润，具有 T 细胞和 B 细胞成分的特征性区域分布。T 细胞分布在乳头层和毛囊周围真皮，体积较大，核呈卷曲状，而 B 细胞体积较小，在真皮中深部呈结节状浸润，共表达 CD5。分子检测显示 TCRG 和 IGH/K 基因均有克隆性重排，所有 4 处活检的每个基因的扩增子均相同。临床分期未发现皮肤外病变。强调采用多学科方法来明确诊断。
