Kikuchi淋巴结炎60例病理形态变化规律及鉴别诊断  

Pathological characteristics and differential diagnosis of histiocytic necrotizing lymphadenitis

作　　者：贺莉[1] 林汉良[2] 胡维维[3] 韩西群[1] 宋兰英[1] 蒋会勇[1] 李海军[1] 沈丽佳[1] 朱梅刚[1] 赵彤[1] 

机构地区：[1]南方医科大学附属南方医院病理科,广州510515 [2]中山大学基础医学院病理学教研室,广州510000 [3]佛山市第一人民医院病理科,广东佛山528000

出　　处：《诊断病理学杂志》2004年第5期295-297,I077,共4页Chinese Journal of Diagnostic Pathology

基　　金：广东省科技计划项目 (B3 0 10 1);广州市科技计划项目(2 0 0 2Z3 E40 61)

摘　　要：目的　探讨Kikuchi淋巴结炎病理形态变化规律及与非霍奇金淋巴瘤 (包括NK T细胞淋巴瘤 )、不典型分枝杆菌结核、猫抓病鉴别的诊断。方法　应用组织病理学、免疫组化、结核杆菌DNA、巢式聚合酶链反应 (N PCR)技术观察 6 0例Kikuchi淋巴结炎活检标本的病理形态学特征。结果　Kikuchi淋巴结炎 95 %的病例同时可见增生(PT)、坏死 (NT)及黄色瘤 (XT) 3型改变 ,其中PT为主占 5 6 % ,NT占 39% ,XT占 5 % ;受损区域可见到组织细胞、巨噬细胞、浆样单核细胞、免疫母细胞、小淋巴细胞 5种类型细胞 ;组织细胞每例可见 ,常共同表达CD6 8、MAC387及髓过氧化物酶 (MPO) 3种抗原 ;PT期抗体Ki 6 7强 (+) ,NT灶内细胞FAS(+) ;PCR检测发现 10 6 0 (16 7% )结核杆菌阳性 ,在 10例阳性中仅有 6例抗BCG(antimycobacteriumbovis) (+)。结论　Kikuchi淋巴结炎病变特征复杂 ,以组织细胞为主体的多细胞组成 ,以凋亡坏死为主 ,存在PT→NT→XT病变发展规律 ;Objective To investigate the characteristics of pathological morphology and differential diagnosis of histiocytic necrotizing lymphadenitis (HNL) and its distinction with other cervical lymphadenopathy, such as non-Hodgkin lymphoma, atypical Mycobacterium tuberculosis and cat scratch disease. Methods A total of 60 cases of HNL with formalin-fixed and paraffin-embedded biopsy speciments were collected and analyzed by histopathology, immunohistochemistry and nested PCR analysis. Results Three types of pathologic characteristics, including proliferative type (PT), necrotizing type (NT) and xanthomatous type (XT) were histologically identified in 95% cases of NHL. The proportions of PT, NT and XT were 56%, 39%, and 5% respectively. The lymph node lesions comprised histiocytes, phagocytes, plasmacytoid monocytes, immunoblasts and small lymphocytes. Histiocytes were observed in all the cases and the histiocytes generally co-expressed CD68, Mac387 and MPO antigens. In PT, Ki-67 expression was strongly positive. FAS expression was detected mainly in the necrotizing lesions. 10 of 60 NHLs were identified positive for Mycobacterium tuberculosis by nested-PCR, but only 6 of 10 nested-PCR positive Mycobacterium tuberculosis were observed positive for BCG antibody. Conclusion The histologic changes of Kikuchi's disease are complex and variable. The lesions compose of histocytes, and are also associated with other cells. Apoptosis is its major necrotic pattern. There may exist a developmental tendency in HNL lesions from PT to NT and at last XT. Immunohistochemistry and PCR can be very helpful for the diagnosis and differential diagnosis of Kikuchi's disease.

关 键 词：KIKUCHI淋巴结炎 病理形态 组织细胞 结核杆菌 鉴别诊断 坏死 阳性 PCR) DNA CD68 

分 类 号：R551[医药卫生—血液循环系统疾病] R632.6[医药卫生—内科学]