临床酷似淋巴瘤的组织细胞性坏死性淋巴结炎65例临床病理分析  

A Clinicopathologic Analysis of 65 Cases of Histiocytic Necrotizing Lymphadenitis Which Can be Easily Misdiagnosed as Lyphoma

作　　者：杨映红[1] 郑宇辉[1] 黄建平[1] 杨涛[2] 陈华[2] 

机构地区：[1]福建医科大学附属协和医院病理科,福州市350001 [2]福建医科大学公共卫生学院

出　　处：《中国肿瘤临床》2011年第8期455-458,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨临床上酷似淋巴瘤的组织细胞性坏死性淋巴结炎(HNL)的临床病理特点、鉴别诊断和EBER原位杂交特征。方法:回顾性分析65例HNL淋巴结活检标本的HE切片、免疫组织化学SP法检测病灶内细胞的免疫表型和EBER原位杂交检测。结果:本组男性31例(47.7%)、女性34例(52.3%),男女比例为1:1.1;年龄20岁以下18例(27.7%)、20岁以上26例(40.0%)、30岁以上13例(20.0%),20～30岁之间病例较多。病程为30d的病例最多,有15例(23.1%)、其次为7d 7例(10.8%)。发热20例(30.8%)、无发热45例(69-2%)。淋巴结最大直径1.5～3.0 cm48例(73.9%)。镜检淋巴结结构完整56例(86.2%)、部分完整7例(10.8%)、结构完全破坏者2例(3.1%)。淋巴结单个大的坏死灶1例(1.5%)、多灶性坏死灶62例(95.4%)、出现坏死灶融合呈大片坏死者33例(50.8%)。淋巴结中组织病理学三个阶段特点:增殖期、坏死期和黄色瘤期,三种不同病理特征,可同时出现在同一淋巴结中。淋巴结免疫组织化学染色显示大量CD68阳性细胞。EBER指标,阳性14例(21.5%)、阴性51例(78.5%)。经Logistic回归分析,性别、发热、EBER与各指标间的关系P>0.05,无统计学意义。多元线性回归分析,淋巴结结构与坏死期细胞百分比之间存在关联,回归方程:Y=0.012+0.008X,其中Y为结构,X为坏死期细胞百分比。说明坏死期细胞百分比越多,结构完整性越低,结构越不完整。用Logistic回归分析,皮质多灶性坏死与其余各指标之间的关系,P>0.05,无统计学意义。同样,皮质融合性坏死与其余各指标之间的相关性不明显(P>0.05),病理组织学各阶段变化经统计学处理结果:增殖期、坏死期细胞百分比与皮质融合坏死灶、坏死边缘灶转化淋巴细胞之间都存在关联。黄色瘤期百分比与皮质坏死灶、年龄之间存在关联。结论:HNL诊断性条件,即所谓三个组织学特点,必须与淋巴瘤、结核相鉴别。Objective： To study the clinicopathologic features of 65 histiocytie necrotizing lymphadenitis （ HNL ） cases and to explore the differentiatial diagnosis between HNL and lyphoma. Methods： A total of 65 HNL cases with routine section of lymph node biopsies, immunophenotypes detected by immunohistochemistry s-p methods and results of EBER in situ hybridization were retrospectively analyzed. Results： There were 31 males （ 47.7% ） and 34 females （ 52.3% ） and the ratio of male to female was 1：1.1. Eighteen cases （ 27.7% ） were younger than 20 years, 26 cases （40.0%） were between 20 and 30 years, and 13 cases （ 20.0% ） were older than 30 years. Twenty cases （ 30.8% ） had fever. The size of lymph node of 48 cases （ 73.9% ） was 1.5cm to 3,0cm. Microscopy showed that the structure of lymph nodes was intact in 56 cases （ 86.2% ）, partially destroyed in 7 cases （10.8%）, and completely destroyed in 2 cases （ 3.1% ）. One case had a large necrosis lesion （ 1.53% ）. Sixty-two cases （ 95.4% ） had multiple necrosis lesions and 33 cases （50,08%） showed fusion necrosis lesions. The 3 phases of pathologic characteristics （ proliferative, necrotizing and xanthomatous ） were observed simultaneously in the same lymph node. Immunohistochemistry showed a large number of CD68 positive cells in the lymph nodes. EBER showed 14 positive cases （ 21.5% ） and 51 negative cases （ 78,5% ）. Stepwise logistic analysis showed no relationship of sex, fever, and EBER with other parameters （ P 〉 0.05 ）. Multiple linear regression analysis showed a correlation between the structure of lymph node and the percentage of cells in necrosis phase （ Y = 0.012 ＋ 0.008X, Y indicates the structure of lymph node, Xindicates the percentage of cells in necrosis phase ）. No relationship was found between multiple necrosis lesions of the cortex and other parameters （ P 〉 0,05 ）. No relationship was found between the fusion necrosis lesions of the cortex and other parameters

关 键 词：组织细胞性坏死性淋巴结炎 免疫组织化学 EBER原位杂交 

分 类 号：R551.2[医药卫生—血液循环系统疾病]