病例报道:皮肤皮疹最后诊断白血病——N Engl J Med

2021-10-27 MedSci原创 MedSci原创

以为是皮肤病就诊皮肤科,没想到竟是因为白血病!

一名 65 岁男性因手和肘部疼痛性皮疹 5 天就诊于皮肤科诊所。无其他症状。体格检查显示双手和肘部背部对称分布的红斑和紫色斑块

实验室检查显示白细胞计数为每立方毫米 16,000(参考范围,4200 至 10,200),血小板计数为每立方毫米 70,000(参考范围,145,00 至 348,000)。左肘病变的皮肤活检显示真皮血管周围淋巴细胞浸润,髓过氧化物酶、CD123、Ki67 和 CD68 染色阳性。诊断为皮肤白血病,患者被紧急转诊至肿瘤科。

骨髓活检显示ASXL1 中有15% 到 20% 的原始细胞和分子突变NRASSRSF2TET2。该患者被诊断为慢性粒单核细胞白血病并接受了干细胞移植。移植两周后,患者的皮肤变化已经消退,癌症一直在缓解。

原文:Leukemia Cutis ,Denise Barry, M.D.,  Astrid Schmieder, M.D.N Engl J Med 2021,September 30, 2021 ; 385:1316

DOI: 10.1056/NEJMicm2103771

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2081618, encodeId=ee6e208161805, content=<a href='/topic/show?id=57406e8506' target=_blank style='color:#2F92EE;'>#Eng#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6785, encryptionId=57406e8506, topicName=Eng)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3516494, createdName=spoonycyy, createdTime=Tue Nov 16 14:15:48 CST 2021, time=2021-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1198954, encodeId=16f21198954dc, content=好文章,非常谢谢梅斯医学,顶级期刊就是顶级期刊。, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Thu Mar 03 09:14:50 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1785557, encodeId=1b7b1e855573d, content=<a href='/topic/show?id=34b86e91f9' target=_blank style='color:#2F92EE;'>#Engl#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6791, encryptionId=34b86e91f9, topicName=Engl)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7eeb2500172, createdName=haouestc, createdTime=Mon May 23 07:15:48 CST 2022, time=2022-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068877, encodeId=545110688e705, content=这样也可以发新英格兰, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2822321865, createdName=DR Yao, createdTime=Wed Nov 10 08:12:52 CST 2021, time=2021-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1611308, encodeId=f51c161130842, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Fri Oct 29 09:15:48 CST 2021, time=2021-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064627, encodeId=3b8d106462e8e, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644b2182796, createdName=1207866fm50(暂无昵称), createdTime=Thu Oct 28 10:27:26 CST 2021, time=2021-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064585, encodeId=6e3910645852b, content=<a href='/topic/show?id=1991e1775c9' target=_blank style='color:#2F92EE;'>#白血病#</a>皮肤白血病,少见, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71775, encryptionId=1991e1775c9, topicName=白血病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Thu Oct 28 09:09:59 CST 2021, time=2021-10-28, status=1, ipAttribution=)]
    2021-11-16 spoonycyy
  2. [GetPortalCommentsPageByObjectIdResponse(id=2081618, encodeId=ee6e208161805, content=<a href='/topic/show?id=57406e8506' target=_blank style='color:#2F92EE;'>#Eng#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6785, encryptionId=57406e8506, topicName=Eng)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3516494, createdName=spoonycyy, createdTime=Tue Nov 16 14:15:48 CST 2021, time=2021-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1198954, encodeId=16f21198954dc, content=好文章,非常谢谢梅斯医学,顶级期刊就是顶级期刊。, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Thu Mar 03 09:14:50 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1785557, encodeId=1b7b1e855573d, content=<a href='/topic/show?id=34b86e91f9' target=_blank style='color:#2F92EE;'>#Engl#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6791, encryptionId=34b86e91f9, topicName=Engl)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7eeb2500172, createdName=haouestc, createdTime=Mon May 23 07:15:48 CST 2022, time=2022-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068877, encodeId=545110688e705, content=这样也可以发新英格兰, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2822321865, createdName=DR Yao, createdTime=Wed Nov 10 08:12:52 CST 2021, time=2021-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1611308, encodeId=f51c161130842, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Fri Oct 29 09:15:48 CST 2021, time=2021-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064627, encodeId=3b8d106462e8e, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644b2182796, createdName=1207866fm50(暂无昵称), createdTime=Thu Oct 28 10:27:26 CST 2021, time=2021-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064585, encodeId=6e3910645852b, content=<a href='/topic/show?id=1991e1775c9' target=_blank style='color:#2F92EE;'>#白血病#</a>皮肤白血病,少见, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71775, encryptionId=1991e1775c9, topicName=白血病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Thu Oct 28 09:09:59 CST 2021, time=2021-10-28, status=1, ipAttribution=)]
    2022-03-03 屋顶瞄爱赏月

    好文章,非常谢谢梅斯医学,顶级期刊就是顶级期刊。

    0

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    2022-05-23 haouestc
  4. [GetPortalCommentsPageByObjectIdResponse(id=2081618, encodeId=ee6e208161805, content=<a href='/topic/show?id=57406e8506' target=_blank style='color:#2F92EE;'>#Eng#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6785, encryptionId=57406e8506, topicName=Eng)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3516494, createdName=spoonycyy, createdTime=Tue Nov 16 14:15:48 CST 2021, time=2021-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1198954, encodeId=16f21198954dc, content=好文章,非常谢谢梅斯医学,顶级期刊就是顶级期刊。, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Thu Mar 03 09:14:50 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1785557, encodeId=1b7b1e855573d, content=<a href='/topic/show?id=34b86e91f9' target=_blank style='color:#2F92EE;'>#Engl#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6791, encryptionId=34b86e91f9, topicName=Engl)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7eeb2500172, createdName=haouestc, createdTime=Mon May 23 07:15:48 CST 2022, time=2022-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068877, encodeId=545110688e705, content=这样也可以发新英格兰, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2822321865, createdName=DR Yao, createdTime=Wed Nov 10 08:12:52 CST 2021, time=2021-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1611308, encodeId=f51c161130842, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Fri Oct 29 09:15:48 CST 2021, time=2021-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064627, encodeId=3b8d106462e8e, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644b2182796, createdName=1207866fm50(暂无昵称), createdTime=Thu Oct 28 10:27:26 CST 2021, time=2021-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064585, encodeId=6e3910645852b, content=<a href='/topic/show?id=1991e1775c9' target=_blank style='color:#2F92EE;'>#白血病#</a>皮肤白血病,少见, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71775, encryptionId=1991e1775c9, topicName=白血病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Thu Oct 28 09:09:59 CST 2021, time=2021-10-28, status=1, ipAttribution=)]
    2021-11-10 DR Yao

    这样也可以发新英格兰

    0

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  6. [GetPortalCommentsPageByObjectIdResponse(id=2081618, encodeId=ee6e208161805, content=<a href='/topic/show?id=57406e8506' target=_blank style='color:#2F92EE;'>#Eng#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6785, encryptionId=57406e8506, topicName=Eng)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3516494, createdName=spoonycyy, createdTime=Tue Nov 16 14:15:48 CST 2021, time=2021-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1198954, encodeId=16f21198954dc, content=好文章,非常谢谢梅斯医学,顶级期刊就是顶级期刊。, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Thu Mar 03 09:14:50 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1785557, encodeId=1b7b1e855573d, content=<a href='/topic/show?id=34b86e91f9' target=_blank style='color:#2F92EE;'>#Engl#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6791, encryptionId=34b86e91f9, topicName=Engl)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7eeb2500172, createdName=haouestc, createdTime=Mon May 23 07:15:48 CST 2022, time=2022-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068877, encodeId=545110688e705, content=这样也可以发新英格兰, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2822321865, createdName=DR Yao, createdTime=Wed Nov 10 08:12:52 CST 2021, time=2021-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1611308, encodeId=f51c161130842, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Fri Oct 29 09:15:48 CST 2021, time=2021-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064627, encodeId=3b8d106462e8e, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=644b2182796, createdName=1207866fm50(暂无昵称), createdTime=Thu Oct 28 10:27:26 CST 2021, time=2021-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064585, encodeId=6e3910645852b, content=<a href='/topic/show?id=1991e1775c9' target=_blank style='color:#2F92EE;'>#白血病#</a>皮肤白血病,少见, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71775, encryptionId=1991e1775c9, topicName=白血病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Thu Oct 28 09:09:59 CST 2021, time=2021-10-28, status=1, ipAttribution=)]
    2021-10-28 1207866fm50(暂无昵称)

    谢谢分享

    0

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    2021-10-28 医者仁者

    #白血病#皮肤白血病,少见

    0

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