淋巴结Kikuchi病与结核病的病理鉴别诊断  

Pathological differential diagnosis between Kikuchi disease and tuberculosis of lymph node

作　　者：杨晶[1] 朱均[1] 张乃鑫[1] 马鸿达[1] 赵天如[1] 

机构地区：[1]天津医科大学病理学教研室、天津医科大学总医院病理科,300070

出　　处：《临床与实验病理学杂志》2008年第4期450-452,共3页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨Kikuchi病(KD)病理诊断和鉴别诊断的重要意义。方法复习31例原病理诊断KD的HE切片,并对其中的20例进行结核病相关的病原学检测。结果31例原病理诊断为KD的病例中,13例(41.94%)改诊为结核病,12例仍诊断为KD。结论淋巴结碎屑性坏死并非KD特有病变,诊断KD需先除外有明显碎屑性坏死的淋巴结结核病,后者主要表现:①碎屑性坏死虽明显,但趋于干酪样坏死;②坏死区内或同时在淋巴窦(主要边缘窦)内,组织细胞、巨噬细胞和泡沫细胞增生,并演变为上皮样细胞和趋于肉芽肿形成;③坏死灶内、外可有数量不等的中性粒细胞浸润;④抗酸杆菌/结核杆菌病原学检测阳性;⑤缺乏KD的典型临床过程。Purpose To investigate the significance of diagnosis and differential diagnosis in Kikuchi disease （KD）. Methods The HE-stained sections were collected and reviewed in 31 cases of KD being primarily diagnosed, in which an etiologic assay was conducted in 20 cases. Results In the 31 cases, the diagnosis of 13 cases（41.94% ） were changed into tuberculosis, and 12 cases were still kept diagnosis of KD. Conclusion Debris necrosis of lymph node is not the specific changes of KD. In the tuberculosis of lymph node, ① debris necrosis is obvious, but it tends to be caseous nercrosis; ② histiocytes, macrophages and foam cells are hyperplasia in the necrotic area or lymph sinus, moreover, epithelioid cells can be found and they tend to be form granuloma; ③ numbers of neutrophils infiltrate in the necrotic area ; ④ the etiologic assay of acid fast bacterium tuberculosis bacterium is positive ;⑤ typical clinical manifestation is insufficient.

关 键 词：KIKUCHI病 组织细胞性坏死性淋巴结炎 淋巴结结核病 病理诊断 

分 类 号：R551.2[医药卫生—血液循环系统疾病]