- 期刊
Treatment of Large Solitary Primary Cutaneous Anaplastic Large-Cell Lymphoma-A Case Report and Literature Review
單一巨大原發性皮膚間變性大細胞淋巴瘤的治療－個案報告及文獻探討
摘要
Background: Primary cutaneous anaplastic large-cell lymphoma (PC-ALCL) may present as solitary or clustered enlarged skin lesions, which may cause a huge defect after tumor incision. The reconstruction of a complicated soft tissue defect at the upper back requires a more rigorous consideration at multiple levels, such as the size and location of the lesion, surrounding tissue quality, and patient compliance. Aim and Objectives: Herein, a case of primary cutaneous anaplastic large-cell lymphoma at the upper back was presented, and the course of diagnosis, evaluation, and surgical treatment was described. Three rhomboid cutaneous flaps combined with negative pressure wound therapy (NPWT) were used to resurface the skin and soft defect. Materials and Methods: A 58-year-ole male without any systemic diseases had a small skin mass at the right upper back. This progressed rapidly into a large ulcerative tumor (8 cm × 7 cm) in four months. He was diagnosed with primary cutaneous anaplastic large-cell lymphoma based on skin biopsy. A series of examination was done to confirm if there is only a solitary lesion at his upper posterior trunk. After excising the tumor, three rhomboid cutaneous flaps with negative pressure wound therapy were used to reconstruct the skin defect and promote wound healing. Result: The patient was discharged 12 days after the operation, and there was no wound infection, hematoma, or seroma formation. Only minimal skin necrosis at the tip of the rhomboid flaps was observed. During a long-term follow-up, the wound healed without wound dehiscence or scar contracture. Positron emission tomography-computed tomography (PET/CT) scan was arranged every six months, and no recurrence or relapse was noted after the 2.5-year follow-up. Conclusion: PC-ALCL often presents as a solitary or grouped enlarging nodule with ulceration. It also has a good prognosis. A proper evaluation and differential diagnosis are very important for an appropriate treatment protocol. Three rhomboid cutaneous flaps aid upper back reconstruction, given less operating time without sacrificing muscles. NPWT can effectively help in wound healing by decreasing fluid accumulation, surgical site infection, and tension in the suture wound.
並列摘要
背景：原發性皮膚間變性大細胞淋巴瘤主要臨床表現為單一或整群，且快速增長的皮膚結節。若是單一腫瘤，治療可以考慮手術切除，但可能造成巨大的皮膚或軟組織的缺損。若複雜的軟組織缺損在上背部，如何重建就需要多方面的謹慎考量以求獲得更好的預後，例如病灶的位置及大小、鄰近軟組織的狀態、及病人的順應性。目的及目標：我們介紹了一例上背部的原發性皮膚間變性大細胞淋巴瘤，並描述了他的診斷、評估和手術治療過程。我們利用三重菱形皮瓣來重建上背部皮膚和軟缺損及運用負壓傷口治療來輔助以傷口癒合。材料及方法：一位本身無任何慢性病的58歲男性起初時發現右上背部有小腫塊，但在4個月內進展為一個長為8公分、寬為7公分的潰瘍性腫瘤。經過皮膚切片後，確診為原發性皮膚間變性大細胞淋巴瘤。我們安排了一系列相關檢查後，確認病人身上只有上背部的一個單獨的病灶。在安排廣泛性腫瘤切除後，我們使用三重菱形皮瓣及負壓傷口治療重建他的缺損並促進傷口癒合。結果：病患於術後第12天患者出院，住院期間沒有傷口感染、血腫、血清腫形成，而皮瓣尖端僅有零星的皮膚局部壞死。在長期的追蹤時也發現所有傷口均癒合良好，沒有傷口裂開或瘢痕攣縮的情況發生。我們也安排每六個月一次的正子電腦斷層掃描檢查，至今並沒有發現腫瘤復發的情況。結論：原發性皮膚間變性大細胞淋巴瘤（PC-ALCL）通常有良好的預後，其主要臨床表現常為單一或群聚性的潰瘍性結節。此疾病在相關的評估和鑑別診斷特別的重要，因為可能會需要不同的治療方法。三重菱形皮瓣是上背部重建的一個很好的選擇；因為手術時間更短且不需要犧牲肌肉。此外，使用負壓傷口治療可以減少積液、手術部位感染和縫合傷口的張力，從而更有效地幫助傷口癒合。