皮肤伴巨大淋巴结病性窦组织细胞增生症临床病理观察  

Clinical pathological study on skin with massive lymphadenopathy sinus histiocytosis

作　　者：乔海国 张昶[2] 庄一林 

机构地区：[1]涟水县人民医院病理科,江苏淮安223400 [2]南京医科大学附属淮安市一院病理科,江苏淮安223001

出　　处：《临床和实验医学杂志》2012年第2期86-88,共3页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨完全局限于皮肤的伴巨大淋巴结病性窦组织细胞增生症的临床病理特点及鉴别诊断。方法对1例皮肤病变进行常规病理检查,伊红染色(HE)及免疫组化(S-100,CD68,Lys,Mac387,CD31,CD1a,ⅩⅢa因子和CD34)染色,光镜观察,分析其病理学特征、免疫表型及鉴别诊断。结果组织学上病变主要在皮肤真皮层,低倍镜下见深蓝染区域与淡粉染区域相间(重要诊断提示性背景病变);在炎症背景中有纤维分割;细胞组成见大量的单核或多核的组织细胞及散在的淋巴细胞、浆细胞、中性粒细胞等浸润,同时巨噬性组织细胞内可见吞噬的小淋巴细胞。免疫组化显示巨噬性组织细胞S-100强(+),CD68和Lys(+),Mac387(+),CD31(+),不表达CD1a、ⅩⅢa因子和CD34。病理诊断:皮肤伴巨大淋巴结病性窦组织细胞增生症。术后随访5年,无局部复发或远处转移。结论完全局限于皮肤的伴巨大淋巴结病性窦组织细胞增生症是很少见的非肿瘤性疾病,临床行为属于良性/潜在恶性,易被误诊为淋巴网织系统恶性肿瘤。明确诊断主要依靠其独特的组织病理学,并辅以免疫组化标记。Objective To study a ease of entirely confined to skin with massive lymphadenopathy sinus histioeytosis, and review of literatures, and to discuss its clinical pathologic features and differential diagnosis. Methods Routine pathological examination, H E staining and im- munohistoehernieal staining （ S - 100, CD68, Lys, Mac387, CD31, CDla, X Ilia and CD34） and light microscopic observation were carried out in cutaneous lesion of a patient, and its pathological features, immunophenotype and differential diagnosis were studied and analyzed. Results Histologically the lesions were mainly in dennis layer of skin, at low magnification, blue stained area and light pink area were alternately arranged （ important diagnostic tips of background lesions） ; in an inflammatory background with fiber cells segmentation ; large number of monocytes or rnul- tinueleated cells and scattered lymphoeytes, plasma cells, neutrophil infiltration, and maerophage tissue cells can be seen in phagoeytosis of small lymphoeytes. Immunohistoehemieal examination showed maerophagie tissue cells with S - 100 strong（ ＋ ） , CD68 and Lys（ ＋ ）, Mac387 （ ＋ ） and CD31 （ ＋ ）, but CDla, X Ilia and CD34 were not expressed. The pathological diagnosis：skin with massive lymphadenopathy sinus histioeytn- sis. Postoperative follow - up for 5 years, no local recurrence or distant metastasis had been seen. Conclusion Massive lymphadenopathy sinus histioeytosis entirely confined to skin is a rare non - neoplastic disease, its clinical behavior is benign with malignant potential, and it is easily to be misdiagnosed as malignant tumor of lymphoretieular system. Definitive diagnosis mainly depends on its distinctive histopathologieal features supplemented by immunohistochemical staining.

关 键 词：皮肤 伴巨大淋巴结病性窦组织细胞增生症 免疫组化 鉴别诊断 

分 类 号：R55[医药卫生—血液循环系统疾病]