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病例报告患者女性,27岁,住院号0414054。因反复发热、面色苍白、全身骨痛半年,左耳下肿块5月,明显增大2月,于1991年4月27日入院。患者于1990年8月出现左下领角肿痛,伴低热,’在当地医院经X线拍片诊为“左下领角骨髓炎”行“切除术”。术后2个月,局部仍轻度肿痛,且出现全身骨痛、发热、面色苍白,间伴牙酿出血。遂行骨髓穿刺,结果:原粒十早幼粒细胞占72%,确诊为“急性粒细胞性白血病(MZa),用HOAP(高三尖杉醋碱、阿糖胞普、长春新碱、强的松)方案化疗2疗程,发热、骨痛、左下领肿胀消失,贫血改善,复查骨髓完全缓解(CR)。然后用HOAP方案巩固4个疗程。至1991年1月起左耳下出现一无痛性肿物,近2月增大明显妥门诊以“左耳下淋巴结肿大待查”收入院。体检:皮肤无黄染及出血点。左耳下们及4厘米又4‘厘米淋巴结,质较硬,表面光滑,无触痛,与基底粘连,余浅表淋巴结未触及。左下领可见手术疤痕。胸骨无压痛,心肺正常。肝脾肋下未触及。神经系统检查(一)o 实验室检查:血红蛋白工21克/升,红细胞3。gx10’叮升。白细胞4浦x 10叮升,中性0.57,嗜酸0.03,淋巴。.40。血小板127 xl。,/升,肝功能正常。左下领部X线正侧位片:左下领骨术后缺失,周围软组织肿胀。骨髓检查报告:复习原骨髓片,结合病史,符合急性粒细胞性白血病化疗后CR骨髓象。左颈部淋巴结活检病理报告为白血病细胞浸润。
Case report Female patient, 27 years old, hospital number 0414054. Due to repeated fever, pale, systemic pain for six months, left ear mass in May, significantly increased in February, was admitted to April 27, 1991. In August 1990, the patient developed a left lower extremity swelling and pain with fever. He was referred to a “left lower collar osteomyelitis” by a radiograph at a local hospital for “resection.” 2 months after surgery, the local still mild swelling and pain, and the emergence of body pain, fever, pale, with bleeding teeth. Bone marrow aspiration was performed and the results showed that prokaryocyte ten promyelocytic cells accounted for 72%, diagnosed as “acute myeloid leukemia (MZa), with HOAP (homoharringtonine, avastatin, vincristine, prednisone ) Chemotherapy 2 courses of treatment, fever, bone pain, left lower collar swelling disappeared, anemia improved, review of bone marrow complete remission (CR) and then use HOAP regimen to consolidate four courses until January 1991 from the left ear appeared a painless Mass, nearly 2 months increased obviously outpatient to ”left ear lymph node enlargement awaiting investigation" income hospital Physical examination: no yellow skin and bleed point of the left ear and 4 cm and 4 cm cm lymph node, quality Hard, smooth surface, no tenderness, adhesion with the basement, superficial lymph nodes not touched. Left lower collar can be seen surgical scars .Sternal no tenderness, normal heart and lung .Not accessible to the liver and spleen .Nervous system examination (a) o laboratory examination : Hemoglobin 21 g / l, erythrocyte 3.gx10 ’jumped white blood cells 4 xu x 10 jelly, neutral 0.57, eosinophilic 0.03, lymphatic .. 40, platelet 127 xl, / liter, normal liver function. Collar X-ray is a lateral film: the left lower extremity after surgery, the surrounding soft tissue swelling .Bone marrow examination report: Review of the original bone marrow , In conjunction with the history, in line with acute myelogenous leukemia chemotherapy bone marrow CR left cervical lymph node biopsy reports infiltration of leukemic cells.