伴浆细胞样树突状细胞分化急性髓系白血病合并髓系肉瘤误诊为淋巴结炎的诊疗分析OA

Objective To summarize the clinical characteristics,diagnosis and treatment process,causes of misdiagnosis,and preventive measures of acute myeloid leukemia(AML)combined with myeloid sarcoma accompanied by plasmacytoid dendritic cell(pDC)differentiation.Methods A retrospective analysis was conducted on the clinical data of one patient with AML(M5)and pDC differentiation who was misdiagnosed as having lymphadenitis in February 2025 and had myeloid sarcoma.Results The patient presented with swelling and pain in the cervical lymph nodes for over two months,and the detection of primitive cells in the peripheral blood for 2 d.After undergoing color Doppler ultrasound examination of lymph nodes,he was misdiagnosed as having lymphadenitis and received symptomatic treatment,but his symptoms worsened.After admission,comprehensive examinations such as blood routine tests,bone marrow smear analysis and cell staining,bone marrow flow cytometry analysis,bone marrow biopsy,cervical lymph node puncture biopsy,and imaging studies were conducted.The bone marrow cell morphology analysis showed extremely active bone marrow hyperplasia,with 51％primitive monocytes and 10％immature monocytes.The bone marrow flow cytometry analysis indicated AML with pDC differentiation,the bone marrow biopsy showed AML with pDC proliferation,and the right cervical lymph node puncture biopsy revealed myeloid sarcoma.The diagnosis was AML with pDC differentiation(M5)combined with myeloid sarcoma.The misdiagnosis lasted for 3 months.Due to the fact that three courses of chemotherapy did not achieve complete remission,it was considered as refractory leukemia,with a poor prognosis.Conclusion The incidence of AML(M5)with pDC differentiation and myeloid sarcoma is low in clinical settings and is often misdiagnosed as lymphadenitis.It is crucial to understand its clinical characteristics and promptly conduct a thorough pathological biopsy to reduce and prevent misdiagnosis and mistreatment.