Choi H S, Orentreich D, Kornblee L, Muhlfelder T W
Laboratory Service, Bronx VA Medical Center, New York 10468.
Am J Dermatopathol. 1989 Feb;11(1):51-7.
While he was being treated for Waldenstrom's macroglobulinemia, a 75-year-old man developed an enlarging forearm skin nodule. On biopsy, the lesion appeared to be a malignant lymphoma. The tumor cells were negative for immunoglobulins but positive for lysozyme and alpha-1-antitrypsin. Therefore, the lesion was diagnosed as histiocytic lymphoma. Nine months later, an ipsilateral axillary lymph node biopsy revealed a small focus of tumor identical to that of the skin lesion. Three months after the lymph node biopsy, the patient developed acute myeloid leukemia. A reevaluation of the electron micrographs of the skin and lymph node lesion showed primary lysosomal granules within the tumor cell cytoplasm consistent with a diagnosis of leukemic infiltrates (granulocytic sarcoma); additionally, the naphthol AS-D chloracetate esterase activity of the skin lesion was positive, supporting the diagnosis of granulocytic sarcoma. This report shows that if not suspected, granulocytic sarcoma is difficult to diagnose in nonleukemia patients.
一名75岁男性在接受瓦尔登斯特伦巨球蛋白血症治疗期间，前臂皮肤结节不断增大。活检显示该病变为恶性淋巴瘤。肿瘤细胞免疫球蛋白呈阴性，但溶菌酶和α-1抗胰蛋白酶呈阳性。因此，该病变被诊断为组织细胞淋巴瘤。九个月后，同侧腋窝淋巴结活检显示有一小片肿瘤病灶，与皮肤病变相同。淋巴结活检三个月后，患者发展为急性髓系白血病。对皮肤和淋巴结病变的电子显微镜照片重新评估显示，肿瘤细胞质内有初级溶酶体颗粒，符合白血病浸润（粒细胞肉瘤）的诊断；此外，皮肤病变的萘酚AS-D氯乙酸酯酶活性呈阳性，支持粒细胞肉瘤的诊断。本报告表明，如果不怀疑，粒细胞肉瘤在非白血病患者中很难诊断。
