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一名系统性红斑狼疮患者的原发性乳腺弥漫性大B细胞淋巴瘤:病例报告及文献复习

Primary breast diffuse large B-cell lymphoma in a patient with systemic lupus erythematosus: A case report and review of the literature.

作者信息

Shen Feifei, Li Gang, Jiang Huifeng, Zhao Shupeng, Qi Fengjie

机构信息

Department of Pathology.

Department of Orthopedics, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong.

出版信息

Medicine (Baltimore). 2020 Aug 14;99(33):e21736. doi: 10.1097/MD.0000000000021736.

Abstract

RATIONALE

Pilot studies have reported that patients with systemic lupus erythematosus (SLE) appear more likely to develop into neoplasia, especially lymphatic hyperplasia diseases. To our knowledge, this is the first case report of the concomitant onset of SLE and primary breast diffuse large B-cell lymphoma (PB-DLBCL).

PATIENT CONCERNS

We reported an unusual case of the occurrence of primary breast diffuse large B-cell lymphoma in a 25-year-old female patient who had been diagnosed with SLE and treated with immunosuppressive drugs for about 4 years. She presented a 7-week history of a painless mass above the left breast and no history suggestive of any nipple discharge, fever, and weight loss.

DIAGNOSIS

Ultrasonography of the breast showed that there was 1 mass in the left breast. After breast mass surgical resection, histopathological examinations were performed and revealed that it was primary breast diffuse large B-cell lymphoma.

INTERVENTIONS

Treatment strategy with vincristine and dexamethasone was used to improve symptoms. However, the patient's renal function deteriorated and the blood potassium rose continuously and she and their family members refused the follow-up treatments.

OUTCOMES

The patient died 8 months after she was discharged from the hospital.

LESSONS

PB-DLBCL is a rare occurrence in SLE patients. Therefore, a careful examination is very important in SLE cohort, as activity of the disease and malignancy may mimic each other. Meanwhile, when symptoms cannot be explained or insensitive to treatment, the occurrence of malignant tumors must be highly considered.

摘要

理论依据

初步研究报告称,系统性红斑狼疮(SLE)患者似乎更易发展为肿瘤,尤其是淋巴增生性疾病。据我们所知,这是首例系统性红斑狼疮与原发性乳腺弥漫性大B细胞淋巴瘤(PB-DLBCL)同时发病的病例报告。

患者情况

我们报告了一例不寻常的病例,一名25岁女性患者被诊断为系统性红斑狼疮并接受免疫抑制药物治疗约4年,之后发生了原发性乳腺弥漫性大B细胞淋巴瘤。她有左乳上方无痛性肿块7周病史,无乳头溢液、发热及体重减轻等病史。

诊断

乳腺超声检查显示左乳有1个肿块。乳腺肿块手术切除后进行组织病理学检查,结果显示为原发性乳腺弥漫性大B细胞淋巴瘤。

干预措施

采用长春新碱和地塞米松治疗方案改善症状。然而,患者肾功能恶化,血钾持续升高,她及其家属拒绝后续治疗。

结果

患者出院8个月后死亡。

经验教训

原发性乳腺弥漫性大B细胞淋巴瘤在系统性红斑狼疮患者中罕见。因此,在系统性红斑狼疮患者队列中进行仔细检查非常重要,因为疾病活动和恶性肿瘤可能相互模拟。同时,当症状无法解释或对治疗不敏感时,必须高度考虑恶性肿瘤的发生。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8455/7437807/66dec49f9302/medi-99-e21736-g001.jpg

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