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患者男,75岁,反复皮肤肿块11年。1个月前第3次复发伴语言、记忆和生活自理能力减退。头颅MRI示:左额叶,右顶叶多发占位,颅内淋巴瘤浸润。左大腿肿块组织病理示:真皮内大量异型细胞,体积较大,形态不规则,核扭曲,核分裂相可见;免疫组化:CD3(+),UCHL-1(+),CD30(+),ALK(-),MIB-1>90%。诊断:皮肤CD30+间变性大细胞淋巴瘤。中枢神经系统(central nerve system,CNS)累及可以是皮肤间变性大细胞淋巴瘤发生皮外累及的唯一部位,患者的意识改变是进行CNS筛查的重要提示。
Male patient, 75 years old, repeated skin lumps for 11 years. 1 month ago 3rd relapse with language, memory and self-care ability diminished. Head MRI showed: left frontal lobe, right parietal multiple occupying, infiltration of intracranial lymphoma. Histopathology of the left thigh mass showed that a large number of abnormal cells in the dermis were bulky, irregular in shape, distorted in nuclei and showed mitotic phases. Immunohistochemistry showed that CD3 (+), UCHL-1 (+), CD30 (-), MIB-1> 90%. Diagnosis: skin CD30 + anaplastic large cell lymphoma. The involvement of the central nervous system (CNS) may be the only site of extracutaneous involvement of anaplastic large cell lymphoma. The patient’s change of consciousness is an important indicator of CNS screening.