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用西达本胺治疗的胃弥漫性大B细胞淋巴瘤继发皮肤受累:一例报告

Secondary skin involvement in gastric diffuse large B-cell lymphoma treated with chidamide: A case report.

作者信息

Yang Dan, Zhang Wei-Ping, Yang Jian-Min, He Miao-Xia, Cheng Chao, Chen Jie

机构信息

Department of Hematology.

Department of Pathology.

出版信息

Medicine (Baltimore). 2018 Dec;97(49):e13093. doi: 10.1097/MD.0000000000013093.

Abstract

RATIONALE

Diffuse large B-cell lymphoma (DLBCL) is a neoplasm of large B lymphoid cells that exhibits diffuse growth patterns. Patients may present with nodal and/or extranodal disease. The most common extranodal site is the gastrointestinal tract, while skin is less common.

PATIENT CONCERNS

We report a case of secondary skin involvement of an original gastric DLBCL, which has achieved a complete response after treatment with chidamide.

DIAGNOSES

Initially, the diagnosis of gastric DLBCL is clear, and this patient responded well to systemic chemotherapy (rituximab + cyclophosphamide + epirubicin + vincristine + prednisone) after 8 cycles. Thirty months later, some rapidly enlarging skin nodules on his arm were found. These skin nodules were diagnosed as secondary cutaneous DLBCL based on the clinical features, positron emission tomography-computed tomography, and histomorphologic and immunohistochemical expression.

INTERVENTIONS

Steroids, interferon-α, and radiation had little therapeutic effect. We treated the patient with chidamide at 30 mg twice per week in combination with dexamethasone.

OUTCOMES

The skin nodules regressed 3 weeks later. During the 1-year follow-up period, the patient is still in treatment with chidamide without adverse reactions.

LESSONS

To the best of our knowledge, this is the first case of secondary skin DLBCL reported to exhibit a complete response to chidamide, which provides a novel therapeutic strategy for secondary skin DLBCL. However, more cases are still needed to further validate its efficacy.

摘要

理论依据

弥漫性大B细胞淋巴瘤(DLBCL)是一种具有弥漫性生长模式的大B淋巴细胞肿瘤。患者可能出现淋巴结和/或结外病变。最常见的结外部位是胃肠道,而皮肤则较少见。

患者情况

我们报告一例原发性胃DLBCL继发皮肤受累的病例,该患者经西达本胺治疗后已完全缓解。

诊断

最初,胃DLBCL的诊断明确,该患者在接受8个周期的全身化疗(利妥昔单抗+环磷酰胺+表柔比星+长春新碱+泼尼松)后反应良好。30个月后,发现他手臂上有一些迅速增大的皮肤结节。根据临床特征、正电子发射断层扫描-计算机断层扫描以及组织形态学和免疫组化表达,这些皮肤结节被诊断为继发性皮肤DLBCL。

干预措施

类固醇、干扰素-α和放疗的治疗效果不佳。我们以每周两次30mg的剂量用西达本胺联合地塞米松治疗该患者。

结果

3周后皮肤结节消退。在1年的随访期内,患者仍在接受西达本胺治疗,无不良反应。

经验教训

据我们所知,这是首例报告的对西达本胺表现出完全缓解的继发性皮肤DLBCL病例,为继发性皮肤DLBCL提供了一种新的治疗策略。然而,仍需要更多病例来进一步验证其疗效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7eb9/6310597/bc92c4d85a92/medi-97-e13093-g001.jpg

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