■毛细胞白血病(HCL)是一种罕见的,惰性,B细胞,淋巴增生性疾病通常涉及外周血,脾和骨髓。它通常表现为全血细胞减少症,单核细胞减少和大量脾肿大,而占淋巴样白血病的2%。由HCL引起的结外病变的病例很少见,尽管这些都有报道。这里,我们报告一例HCL表现为椎旁肿块,无全身受累.
■一名58岁的男子因进行性行走困难一个月入院,没有其他症状。血液检查发现轻度贫血,Hb=12.6g/dl,轻度血小板减少为140,000/μl。磁共振成像(MRI)和计算机断层扫描(CT)成像显示T6椎旁后部肿块病变,沿胸椎和腰椎延伸到椎管并伴有转移性骨病变。进一步的CT影像学检查显示轻度脾肿大(13.4cm)和腹腔分叉附近的腹部淋巴结肿大(3.5cm)。
■对椎旁肿块进行芯针活检。结果显示小细胞有圆形或卵圆形细胞核,和苍白的细胞质,具有免疫表型:具有CD20+的B细胞起源,细胞周期蛋白D1+,DBA.44+,Annexin+和BRAF+,指示HCL。
结论:毛细胞白血病(HCL)相对少见,占所有白血病病例的2%。HCL的髓外和骨骼受累很少,并且与其他周围小B细胞淋巴瘤肿瘤具有形态学特征。脊柱活检对这些病例的诊断至关重要,因为缩小鉴别诊断总是有帮助的。正确的诊断对于HCL的治疗至关重要,并导致大多数患者临床缓解,有时甚至是长期治愈。
UNASSIGNED: Hairy cell leukaemia (HCL) is an uncommon, indolent, B-cell, lymphoproliferative disorder typically involving peripheral blood, spleen and bone marrow. It is commonly presenting with pancytopenia, monocytopenia and massive splenomegaly, while accounting for 2% of lymphoid leukaemias. Cases of extranodal lesions caused by HCL are rare, although these have been reported. Here, we report a case of HCL presenting as a paravertebral mass without systemic involvement.
UNASSIGNED: A 58-year-old man was admitted to our hospital due to progressive difficulty walking for a month, without any other symptoms. Blood examination noted mild anaemia with Hb=12.6 g/dl and mild thrombocytopenia of 140,000/μl. Magnetic resonance imaging (MRI) and computed tomography (CT) imaging demonstrated a T6 posterior paravertebral mass lesion, extending into the spinal canal with metastatic bone lesions along the thoracic and lumbar spine. Further imaging study with CT indicated mild splenomegaly (13.4 cm) and an enlarged abdominal lymph node (3.5 cm) near celiac trifurcation.
UNASSIGNED: A core-needle biopsy from the paravertebral mass was performed. Results showed small-sized cells with round or oval nuclei, and pale cytoplasm with immunophenotype: B-cell origination with CD20+, Cyclin D1+, DBA.44+, Annexin+ and BRAF+, indicative of HCL.
CONCLUSIONS: Hairy cell leukaemia (HCL) is relatively uncommon, accounting for 2% of all leukaemia cases.Extramedullary and skeletal involvement in HCL is rare and shares morphological characteristics with other peripheral small B-cell lymphoma neoplasms.Spine biopsy is essential for diagnosis in these cases, since it is always helpful to narrow the differential diagnosis.Correct diagnosis is essential for treatment of HCL and leads most patients to clinical remission and sometimes long-term cures.