消化道癌引流淋巴结结节病样反应的临床病理特征及鉴别诊断  

Clinicopathological features and differential diagnosis of digestive tract carcinomas complicating sarcoid reactions in draining lymph nodes

作　　者：朱皓皞[1] 熊晓平[1] 杜丽英[1] 熊敦勇[1] 寇辉[1] 

机构地区：[1]解放军第九四医院病理科,江西南昌330002

出　　处：《现代医药卫生》2011年第20期3058-3060,F0003,共4页Journal of Modern Medicine & Health

摘　　要：目的:观察消化道癌引流淋巴结结节病样反应的临床病理特征及鉴别诊断要点,避免误诊误治。方法:搜集2例食管癌、2例胃癌及4例结直肠癌伴引流区淋巴结结节病样反应共8例,同时分析其原发癌组织学特点,淋巴结均行抗酸染色及免疫组织化学染色,结合随访结果进行预后分析。结果:8例消化道癌引流区淋巴结出现结节病样反应中,患者既往无结核、结节病病史,光镜下显示淋巴结结构破坏,代之大小不等、境界清楚的结节状病灶,中央无干酪样坏死,抗酸染色阴性,免疫组化染色显示CD68及溶菌酶阳性表达,CK及CEA均阴性表达。结论:癌引流区淋巴结结节病样反应可能为机体对肿瘤细胞或其坏死产物的一种免疫反应,伴淋巴结结节病样反应且无淋巴结癌转移的患者预后较好。Objective：To research clinicopathological features and differential diagnosis of digestive tract carcinomas complicating sarcoid reactions in draining lymph nodes, so as to avoid making misdiagnosis and mistreatment.Methods ： 8 cases of digestive tract carcinomas complicating sareoid reactions in draining lymph nodes were collected,including 2 cases of esophageal carcinoma,2 cases of gastric carcinoma,3 cases of colon carcinoma and 1 case rectum carcinoma.Meanwhile ,the histological features of primary carcinoma were analyzed and all lymph nodes were performed acid-fast staining,PAS staining and immunohistochemical staining. Combined with the followup results,the prognosis analysis was conduced.Results：Among 8 cases, no case had the tuberculous or nodular disease history.Histologically,lymph nodes＇ structure were damaged and replaced by clear-cut nodular focus in different sizes.No caseous necrosis was observed in lymph nodes.Acid-fast staining and PAS staining were negative,immunohistochemical staining indicated positive for CD68 and lysozyme and negative for CK or CEA.Conclusion：Sarcoid reaction in draining lymph nodes may be a kind of immunoreaction against tumor cells or their sphacelus.The patients with complicating sarcoid reactions without lymph node metastasis could have better prognosis.

关 键 词：淋巴结 结节病样反应 癌 病理学 鉴别诊断 

分 类 号：R36[医药卫生—病理学]