Abstract：
OBJECTIVE: Diffuse Large B-Cell Lymphoma (DLBCL), NOS, constitutes 25-35% of adult non-Hodgkin lymphomas in developed countries, and a higher percentage in developing countries; older people are prone to the disease. Three frequent morphological variants have been recognized, including centroblastic, immunoblastic, and anaplastic variants. However, there are still other rare morphological variants of DLBCL, presenting challenge in diagnosis and treatment.
METHODS: A 62-year-old woman sought medical attention with a previous 6-month history of intermittent fever and leukocytosis. Bone marrow (BM) aspiration presented AML with acute monocytic leukemia-like morphologic features. The results of the immunophenotypic analysis suggested mature B cell lymphoma without obvious subtype characteristics. Lymph node biopsy indicated DLBCL of non-germinal centre B-cell subtype (n-GCB). Cytogenetic analysis of the BM cells revealed a 46,XX, trp(1)(q21q32),del(7)(q32q36),t(9;14)(p13;q32) [4]/46,XX [16] karyotype. The patient was diagnosed with EBV-positive DLBCL, NOS based on the combination of lymph node biopsy, clinical, cytological, immunophenotypic, and cytogenetic analyses.
CONCLUSIONS: To date, no case reports of a patient diagnosed with DLBCL mimicking acute monocytic leukemia with complex karyotype have been reported. We present the case given its rarity, easy misdiagnosis, and poor prognosis. The case highlights the importance of awareness about the rare morphological variant to laboratory staff and hematologists.
METHODS: A 62-year-old woman sought medical attention with a previous 6-month history of intermittent fever and leukocytosis. Bone marrow (BM) aspiration presented AML with acute monocytic leukemia-like morphologic features. The results of the immunophenotypic analysis suggested mature B cell lymphoma without obvious subtype characteristics. Lymph node biopsy indicated DLBCL of non-germinal centre B-cell subtype (n-GCB). Cytogenetic analysis of the BM cells revealed a 46,XX, trp(1)(q21q32),del(7)(q32q36),t(9;14)(p13;q32) [4]/46,XX [16] karyotype. The patient was diagnosed with EBV-positive DLBCL, NOS based on the combination of lymph node biopsy, clinical, cytological, immunophenotypic, and cytogenetic analyses.
CONCLUSIONS: To date, no case reports of a patient diagnosed with DLBCL mimicking acute monocytic leukemia with complex karyotype have been reported. We present the case given its rarity, easy misdiagnosis, and poor prognosis. The case highlights the importance of awareness about the rare morphological variant to laboratory staff and hematologists.
摘要：
目标：弥漫性大B细胞淋巴瘤（DLBCL），NOS,占发达国家成人非霍奇金淋巴瘤的25-35%，发展中国家的比例更高；老年人容易患这种疾病。已经认识到三种常见的形态学变异，包括着丝粒,免疫母细胞，和间变性变体。然而,还有其他罕见的DLBCL形态变异,在诊断和治疗方面提出了挑战。
方法：一名62岁的女性因之前有6个月的间歇性发热和白细胞增多病史而就医。骨髓（BM）抽吸显示AML具有急性单核细胞白血病样形态特征。免疫表型分析结果提示成熟B细胞淋巴瘤无明显亚型特征。淋巴结活检提示DLBCL为非生发中心B细胞亚型（n-GCB）。BM细胞的细胞遗传学分析显示46，XX，trp（1）（q21q32），del(7)(q32q36)，t(9;14)(p13;q32)[4]/46,XX[16]核型。患者被诊断为EBV阳性DLBCL，NOS结合淋巴结活检，临床,细胞学，免疫表型,和细胞遗传学分析。
结论：迄今为止，目前尚无病例报告有1例患者被诊断为DLBCL,其模拟急性单核细胞白血病并具有复杂核型.鉴于案件的稀有性，我们提出了这个案件，容易误诊,预后不良。该病例强调了实验室工作人员和血液学家对罕见形态变异的认识的重要性。
方法：一名62岁的女性因之前有6个月的间歇性发热和白细胞增多病史而就医。骨髓（BM）抽吸显示AML具有急性单核细胞白血病样形态特征。免疫表型分析结果提示成熟B细胞淋巴瘤无明显亚型特征。淋巴结活检提示DLBCL为非生发中心B细胞亚型（n-GCB）。BM细胞的细胞遗传学分析显示46，XX，trp（1）（q21q32），del(7)(q32q36)，t(9;14)(p13;q32)[4]/46,XX[16]核型。患者被诊断为EBV阳性DLBCL，NOS结合淋巴结活检，临床,细胞学，免疫表型,和细胞遗传学分析。
结论：迄今为止，目前尚无病例报告有1例患者被诊断为DLBCL,其模拟急性单核细胞白血病并具有复杂核型.鉴于案件的稀有性，我们提出了这个案件，容易误诊,预后不良。该病例强调了实验室工作人员和血液学家对罕见形态变异的认识的重要性。
