传染性单核细胞增生症淋巴结病病理诊断与鉴别诊断  

Lymphadenopathy of infectious mononucleosis:the diagnosis and differential diagnosis

作　　者：张慧芝[1] 宋钰[2] 王朝夫[1] 孙娟娟[1] 蔡旭[1] 

机构地区：[1]复旦大学附属肿瘤医院病理科、复旦大学上海医学院肿瘤学系,上海200032 [2]四川省巴中市中心医院病理科,四川巴中636000

出　　处：《临床与实验病理学杂志》2011年第5期503-505,共3页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨传染性单核细胞增生症淋巴结病的病理形态学特点及诊断与鉴别诊断要点。方法收集3例传染性单核细胞增生症淋巴结病(均为会诊病例:1例原单位诊断为间变性大细胞淋巴瘤,1例诊断为经典型霍奇金淋巴瘤,另1例未能定性),观察和分析其临床、病理组织学和免疫表型,并对病变淋巴结做EB病毒原位杂交检测。结果 3例患者中男性2例,女性1例,平均年龄15岁,平均病程16天;3例患者均表现为颈部淋巴结肿大,1例伴有低热及咽部疼痛。术后均未予特殊治疗,随访时间分别为5、9、18个月,无1例复发。镜检、免疫表型及EBV检测:淋巴结基本结构不同程度破坏,滤泡外免疫母细胞样大细胞增生,其大多数CD3、CD45RO、CD43、CD30均(+),CD15、EMA和ALK1(-),3例EBER均(+)。结论传染性单核细胞增生症淋巴结病的副皮质区有较多免疫母细胞增生,易过诊,但其临床特征、病理特点和免疫表型与大细胞淋巴瘤不同;结合EBV检测有助于其诊断。Purpose To discuss the pathological features of lymphadenopathy of infectious mononucleosis（LIM） and the key points of the diagnosis and differential diagnosis.Methods Three cases of LIM were studied by HE staining,immunohistochemical techniques and in situ hybridization for Epstein-Barr virus（EBV）.All the three cases were followed up.Results The average age was 15 years old.The average suffering duration was 16 days.The involved lymph nodes of the three cases were all located in the cervix,and one of them had a low fever and sore throat.The EBV antibody in serum was positive for all the three cases.Microscopically,the normal architecture of the involved lymph nodes was partially destroyed,interfollicular and paracortical areas were infiltrated by numerous large lymphoid cells.Immunohistochemically,the large lymphoid cells in the three cases were positive for CD3,CD45RO,CD43,and CD30,but negative for CD15,EMA and ALK1.The large lymphoid cells in the three cases were positive for EBER by in situ hybridization.The three cases have been followed up for 5,9,18 months respectively,and none of them recurred.Conclusions LIM may present with numerous large lymphoid cells in the interfollicular and paracortical areas of involved lymph nodes,and likely mistaken for some large cell lymphomas.However,its clinical characteristic,morphology and immunophenotype are different from lymphomas.The detection of EBV by in situ hybridization may contribute to LIM.

关 键 词：淋巴结病 传染性单核细胞增生症 鉴别诊断 

分 类 号：R447[医药卫生—诊断学] R733[医药卫生—临床医学]