Nagao K, Kikuchi A, Kawai Y, Kizaki M, Ikeda Y, Nishikawa T
Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
Dermatology. 1997;194(2):168-71. doi: 10.1159/000246089.
Acute promyelocytic leukemia (APL) is a type of acute leukemia showing unique clinical, morphological and cytogenetic features. A skin infiltration by APL cells is an extremely rare occasion, but there have been several case reports of leukemia cutis in APL, in which all-trans retinoic acid (ATRA) may have induced the skin infiltration. However, no immunohistochemical analyses of the APL cells in the skin have been done to date. A 30-year-old woman with APL developed multiple reddish purple nodules on the extremities in her second complete remission. Histological findings revealed a dense infiltration of medium to large atypical cells, which were positive for myeloperoxidase, throughout the dermis. Despite the conventional chemotherapy and ATRA therapy she died from disseminated intravascular coagulation during her third relapse. Leukemic cells in the peripheral blood before the treatment with ATRA revealed CD3-/CD4-/CD5-/CD7-/CD8-/CD10-/CD13++/CD14-/CD19 -/ CD20-/CD33++/CD38++/CD41-/Ia-, but they expressed CD3-/CD4-/CD5-/CD7++/ CD8-/CD10-/CD13++/CD14-/CD19-/CD20-/CD33++ /CD38++/CD41+/Ia+ after the treatment. We suggest that the alternation of the surface molecules on the tumor cells is closely associated with the skin infiltration of APL cells.
急性早幼粒细胞白血病（APL）是一种具有独特临床、形态学和细胞遗传学特征的急性白血病。APL细胞浸润皮肤极为罕见，但已有数例APL皮肤白血病的病例报告，其中全反式维甲酸（ATRA）可能诱发了皮肤浸润。然而，迄今为止尚未对皮肤中的APL细胞进行免疫组织化学分析。一名30岁的APL女性患者在第二次完全缓解期时四肢出现多个红紫色结节。组织学检查发现真皮内有密集的中到大的非典型细胞浸润，这些细胞髓过氧化物酶呈阳性。尽管接受了传统化疗和ATRA治疗，她在第三次复发时死于弥散性血管内凝血。在接受ATRA治疗前，外周血中的白血病细胞显示为CD3-/CD4-/CD5-/CD7-/CD8-/CD10-/CD13++/CD14-/CD19 -/ CD20-/CD33++/CD38++/CD41-/Ia-，但治疗后它们表达为CD3-/CD4-/CD5-/CD7++/ CD8-/CD10-/CD13++/CD14-/CD19-/CD20-/CD33++ /CD38++/CD41+/Ia+。我们认为肿瘤细胞表面分子的改变与APL细胞的皮肤浸润密切相关。
