首诊误诊为淋巴结核的25例淋巴结恶性肿瘤原因分析  

Causes of Misdiagnosis of 25 Cases of Malignant Lymph Node Tumors Misdiagnosed as Lymphoid Tuberculosis at Initial Diagnosis

作　　者：刘启梁 雷美 LIU Qi-liang;LEI Mei(Department of Pathology,Wuhan Pulmonary Hospital,Wuhan 430030,China)

机构地区：[1]武汉市肺科医院病理科

出　　处：《临床误诊误治》2020年第1期8-11,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨误诊为淋巴结核的淋巴结恶性肿瘤的临床特征及误诊原因。方法回顾性分析2016年1月—2018年12月我院收治的25例首诊误诊为淋巴结核的淋巴结恶性肿瘤患者的临床及实验室特点、诊断经过。结果所有患者均表现为淋巴结增大,可伴压痛,单一部位发病14例,多部位发病11例。15例行细针穿刺细胞学检查考虑淋巴结核,余10例因合并肺结核或结核相关检查(胸部CT、结核菌素纯蛋白衍生物试验、结核感染T细胞斑点试验、结核抗体、红细胞沉降率)结果而误诊为淋巴结核,误诊时间半个月~3年余。确诊方式:手术切除病理检查18例,淋巴结活检7例,诊断转移性鳞状细胞癌9例、非霍奇金淋巴瘤及经典型霍奇金淋巴瘤各8例。结论淋巴结核与淋巴结恶性肿瘤临床特征有重叠,仅依赖临床、实验室及穿刺细胞学检查不易鉴别,组织病理学检查是确诊金标准。Objective To investigate the clinical features of lymph node malignancies misdiagnosed as lymphoid tuberculosis and the causes of misdiagnosis.Methods The clinical and laboratory characteristics,diagnosis processes of 25 patients with malignant lymph node tumors misdiagnosed as lymphoid tuberculosis from January 2016 to December 2018 in Wuhan Pulmonary Hospital were retrospectively analyzed.Results The clinical manifestations were enlarged lymph nodes with or without pain,of which 14 cases were single site and 11 cases were multiple sites.Tuberculosis was considered in 15 cases by fine needle aspiration cytology and the remaining 10 cases were misdiagnosed as lymphoid tuberculosis due to combined pulmonary tuberculosis or because results of tuberculosis related examination(chest CT,PPD,T-SPOT,tuberculosis antibody,and erythrocyte sedimentation rate)suggested tuberculosis.The duration of misdiagnosis ranged from half a month to more than three years.As for confirmed diagnosis,surgical resection and pathological examination was performed in 18 cases and lymph node biopsy in 7 cases.Diagnosis was made in 9 cases of metastatic squamous cell carcinoma,8 cases of non-Hodgkin lymphoma and 8 cases of classical Hodgkin lymphoma.Conclusion The clinical features of lymphoid tuberculosis and malignant lymph node tumors overlap and it is difficult to differentiate them only by clinical and laboratory examination,and fine needle aspiration cytology.Histopathological examination is the gold standard of diagnosis.

关 键 词：淋巴结核 淋巴瘤 转移癌 误诊 组织病理学检查 

分 类 号：R733.4[医药卫生—肿瘤]