套细胞淋巴瘤相关的虫噬样反应:临床病理学、免疫病理学及分子研究

作     者：Khamaysi Z. Dodiuk- Gad R.P. Weltfriend S. R.Bergman 李政霄 

作者机构：Dr. Department of Dermatology Rambam Medical Center Haifa 31096 Israel 

出 版 物：《世界核心医学期刊文摘（皮肤病学分册）》 (Digest of the World Core Medical JOurnals:Dermatology)

年 卷 期：2005年第1卷第12期

页      面：24-25页

学科分类：1002[医学-临床医学] 100206[医学-皮肤病与性病学] 10[医学] 

主　　题：套细胞淋巴瘤 免疫病理学 临床病理学 基因重排 红斑丘疹 克隆形成 炎细胞浸润 嗜酸性粒细胞 直接免疫荧光 脂肪小叶 

摘      要：A cutaneous eruption simulating insect bites has been repeatedly described in association with chronic lymphocytic leukemia (CLL). It was only rarely described with mantle cell lymphoma (MCL). Our study was performed to elucidate the clinical, histologic, immunopathological, and molecular characteristics of insect bite like reaction (IBLR) associated with MCL. The clinical presentation and histologic findings in 3 IBLR cases associated with MCL were found to be similar to 3 IBLR cases associated with CLL. The eruptions consisted of itchy erythematous papules, nodules, plaques, and vesicles. Non- vesicular lesions were characterized histologically by normal or mildly spongiotic epidermis. Vesicular lesions were characterized by marked spongiosis and intraepidermal spongiotic vesicles containing eosinophils, or marked subepidermal edema occasionally leading to a dermoepidermal separation. Most of the lesions were characterized by superficial and mid dermal to deep perivascular and interstitial, and occasionally periadnexal, inflammatory- cell infiltrate consisting of mononuclear cells and eosinophils. The densities of the infiltrates varied and the inflammatory- cell infiltrate extended often into the fat lobules. Neutrophils and nuclear dust were found more frequently and abundantly in the IBLR lesions associated with MCL. Immunophenotyping, direct immunofluorescence (DIF)- tests, and IgH gene rearrangement studies were performed in the lesions associated with MCL only. The majority of the infiltrating lymphocytes were CD3+ , CD5+ and CD43+ , more CD4+ than CD8+ , and only a small minority was CD20+ . The cells did not stain for bcl- 1 protein and CD30, and with no evidence of clonality. The DIF test result was negative. The IBLR eruption associated with MCL resembles clinically and histologically IBLR associated with CLL. The eruption seems to be reactive rather than neoplastic, because there is no evidence of MCL involvement in the skin lesions.