反射式共聚焦显微镜观察儿童朗格汉斯细胞组织细胞增生症14例  

Reflectance confocal microscopy imaging of pediatric Langerhans cell histiocytosis lesions： 14 case reports

作　　者：苏海辉[1] 陈立新[1] 宫泽琨[1] 管志伟[1] 王蓟[1] 王莹[1] 廉佳[1] 冯晓燕[1] 郝良辰 苑世萍[1] 王晓艳[1] 段志华[1] 

机构地区：[1]天津市儿童医院皮肤科,300074

出　　处：《中华皮肤科杂志》2015年第10期710-712,共3页Chinese Journal of Dermatology

基　　金：天津市卫生系统引进应用新技术填补空白项目（2014057）

摘　　要：目的探讨儿童朗格汉斯细胞组织细胞增生症（LCH）在反射式共聚焦激光扫描显微镜（RCM）下的特征，使RCM辅助早期诊断儿童LCH成为可能。方法14例LCH患儿常规行RCM检查，依据RCM图像确定病理取材部位，对比RCM图像和组织病理检查结果。所有病例均经组织病理及免疫组化检查结果确诊。结果14例LCH患儿的RCM图像显示，表皮结构紊乱，正常蜂窝状结构消失，海绵水肿，可见中度折光的炎症细胞浸润，有时表皮浅层甚至在角质层出现了低折光的空洞样、火山口样外观；正常环状的真皮乳头结构模糊或消失，见较多散在的中度折光的炎症细胞浸润；真皮层出现大量明亮的树突状细胞，聚集成团，大小不等，形态不一，折光性强；真皮乳头层至网状层可见中度折光的炎症细胞浸润，部分见圆形或线状迂曲扩张的血管。同部位病理取材，行组织病理、免疫组化S100、CD1a染色，证实明亮的树突状细胞为活化的朗格汉斯细胞，RCM图像与组织病理、免疫组化病理像对比，结果具有较好的一致性。结论RCM无创检测有助于LCH病理活检定位，提高组织病理诊断LCH的准确率。Objective To assess the reflectance confocal microscopic features of pediatric Langerhans cell histioeytosis （LCH）, and to evaluate the performance of RCM in the early diagnosis of pediatric LCH. Methods RCM was routinely performed to image lesions in 14 children with LCH before biopsy. Then, biopsy and histopathological examination were carried out at the sites determined according to RCM images. A comparison was conducted between the confocal microscopic and pathological findings. All the 14 cases were finally diagnosed based on histopathological and immunohistochemical examination results. Results RCM imaging in these patients showed that the epidermal structure was disorganized with spongiosis, infiltration of moderately refractive inflammatory cells and disappearance of normal honeycomb structures, slightly refractive cavernous or crateriform appearance was observed sometimes in the superficial epidermis and even stratum corneum; normal dermal papillary rings were obscure or absent with infiltration of multiple scattered moderately refractive inflammatory cells; plenty of bright hyper-refraetive dendritic cells, which varied in size and shape, gathered into clusters in the dermis; moderately refractive inflammatory cells infiltrated the papillary and reticular dermis with the tangling and dilation of blood vessels giving a spherical or linear appearance in some regions. Histopathological examination and immunohistochemical staining for S100 and CDla both demonstrated that the bright dendritic cells were activated Langerhans cells. RCM images were highly consistent with histopathological and immunohistochemieal findings in these patients. Conclusion RCM, a non-invasive examination method, can facilitate the determination of biopsy sites, and promote the accuracy of pathological diagnosis of LCH.

关 键 词：组织细胞增多症 郎格尔汉斯细胞 病理学 诊断 皮肤疾病 儿童 反射式共聚焦显微镜 

分 类 号：R725.9[医药卫生—儿科]