粗针穿刺确诊马尔尼菲篮状菌感染性淋巴结炎的临床病理分析  

Clinicopathological Characteristics of Lymphadenitis Caused by Talaromyces marneffei Diagnosed by Core Needle Biopsy

作　　者：杨金玲 仇以利 王婉玲 朱焱[2] 蔡雪玉[3] 刘江福[4] 张宏图 陈一峰[1] YANG Jinling;QIU Yili;WANG Wanling;ZHU Yan;CAI Xueyu;LIU Jiangfu;ZHANG Hongtu;CHEN Yifeng(Department of Pathology,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian 362000,China;Department of Laboratory,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian 362000,China;Medical Record Department,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian 362000,China;Department of Infectious Diseases,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian 362000,China;Department of Pathology,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,CAMS and PUMC,Beijing 100021,China)

机构地区：[1]福建医科大学附属泉州第一医院病理科,福建泉州362000 [2]福建医科大学附属泉州第一医院检验科,福建泉州362000 [3]福建医科大学附属泉州第一医院病案室,福建泉州362000 [4]福建医科大学附属泉州第一医院感染科,福建泉州362000 [5]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院,北京协和医学院肿瘤医院病理科,北京100021

出　　处：《中国医学科学院学报》2022年第3期440-445,共6页Acta Academiae Medicinae Sinicae

摘　　要：目的分析马尔尼菲篮状菌(TM)感染性淋巴结炎的临床病理特点。方法回顾性分析15例TM感染性淋巴结炎的临床资料、病理形态特点、病原体检查、治疗情况等。结果15例TM感染性淋巴结炎中,男14例,女1例,年龄26~67岁,平均(49.1±11.87)岁,包括13例艾滋病和2例糖尿病患者,伴有颈部、锁骨上、腋窝、腹股沟等部位浅表淋巴结肿大。粗针穿刺的条索状淋巴结组织,其结构全部或部分被炎性病变所取代,8例显微镜下形态以吞噬病原体的组织细胞弥漫性浸润为主;5例以广泛凝固性坏死为主伴散在少量病原体及核碎屑;2例以成纤维细胞小结节状增生,形成肉芽肿结构的改变为主,多核巨细胞少、散在分布。病原体大小、形态较一致,呈圆形、椭圆形或腊肠状,团聚成簇,如桑葚样,淀粉酶消化后过碘酸希夫及六胺银染色可见包含横隔的菌体结构。15例患者血液、肺泡灌洗液、痰液或者淋巴结抽出液真菌培养均查见TM生长。临床及时抗真菌治疗,15例患者病情好转后出院。结论TM感染性淋巴结炎往往是全身侵袭性TM病晚期阶段的突出表现之一,容易被临床误诊,通过淋巴结粗针穿刺活检及早明确诊断,以免延误治疗,从而提高治愈率。Objective To analyze the clinicopathological characteristics of lymphadenitis caused by Talaromyces marneffei(TM).Methods The clinical data,pathological features,pathogen examination,and treatment of 15 cases of TM-caused lymphadenitis were analyzed retrospectively.Results The 15 cases included 14 males and 1 females,who were aged 26-67 years,with an average age of(49.1±11.87)years.The 15 cases,including 13 cases of acquired immunodeficiency syndrome and 2 cases of diabetes mellitus,were accompanied by superficial lymph node enlargement in the neck and supraclavicular,axillary,and inguinal regions.The structure of cord-like lymph node tissue punctured by thick needle was completely or partially replaced by inflammatory lesions.Under microscope,8 cases showed mainly diffuse infiltration of phagocytes with pathogens;5 cases presented mainly extensive coagulation necrosis with a small amount of pathogens and nuclear debris;2 cases were characterized by small nodular hyperplasia of fibroblasts,formation of granulomatous structure,and scattered distribution of a few multinucleated giant cells.The pathogens were relatively consistent in size and shape,which were round,oval or sausage-shaped and clustered like mulberry.Diastase periodic acid-Schiff staining and hexamine silver staining highlighted the bacterial structure with transverse septum.TM growth was detected in the blood,alveolar lavage fluid,sputum or lymph node extract fungal culture of the 15 patients.Owing to the adequate antifungal treatment in time,these 15 patients were discharged after their conditions were improved.Conclusion Lymphadenitis is one of the major manifestations of the systemic invasion of TM at the late stage,which is tended to be misdiagnosed.Through core needle biopsy of lymph node,it can be diagnosed as soon as possible to avoid delayed treatment and improve the cure rate.

关 键 词：马尔尼菲篮状菌 获得性免疫缺陷综合征 淋巴结 病理学 影像诊断 实验室检查 

分 类 号：R365[医药卫生—病理学]