组织细胞坏死性淋巴结炎的诊断和鉴别诊断  

The diagnosis and differential diagnosis of histiocytic necrotizing lymphadenitis. A study of histology,immunohistochemistry and electron microscopy

作　　者：肖家诚[1] 金晓龙[1] 陆建波[1] 

机构地区：[1]上海第二医科大学瑞金医院病理科,200025

出　　处：《中华病理学杂志》2003年第6期525-529,共5页Chinese Journal of Pathology

摘　　要：目的　探讨组织细胞坏死性淋巴结炎 (KD)的诊断与鉴别诊断。方法　选择 4 6例KD ,5例非特异性淋巴结炎 (NLD) ,5例非霍奇金淋巴瘤 (NHL) ,5例霍奇金淋巴瘤 (HD) ,5例猫抓病 (CSD)和5例结核性淋巴结炎 (TBL) ,做了组织学 免疫组织化学EnVision法观察 ,其中 6例KD和 2例NHL做了电镜观察。结果　KD可有增殖 ,坏死和黄色瘤样三种病理组织学图像 ,但其基本的组织学特点为 :淋巴结边缘契形淡染病灶和副皮质区融合性淡染病灶 ,病灶内单核样组织细胞明显增生 ,出现新月体样组织细胞 ,凋亡细胞或核碎片增多 ,无或很少见中性粒细胞等。免疫组织化学标记 ,灶性的组织细胞CD6 8和MPO阳性。电镜下可见病灶内增生的单核样组织细胞 新月体样组织细胞 凋亡小体和周围散在T淋巴细胞。结论　典型的KD由于其形态变化多样 ,有时需与其他淋巴结病仔细鉴别。这时仔细寻找KD的形态学特点 ,结合组织学 免疫组织化学和电镜观察 ,有助于确定KD的诊断。Objective To study the diagnosis and differential diagnosis of histiocytic necrotizing lymphadenitis (Kikuchi disease, KD). Methods Histologic analysis and immunohistochemical study (EnVision method) was carried out in 46 cases of KD, 5 cases of nonspecific lymphadenitis (NLD), 5 cases of non-Hodgkin's lymphoma (NHL), 5 cases of Hodgkin's lymphoma (HD),5 cases of cat-scratch disease (CSD) and 5 cases of tuberculous lymphadenitis (TBL). Electron microscopy was also performed in 6 cases of KD and 2 cases of NHL. Results Three histologic (proliferative, necrotizing and xanthomatous) patterns were noted in KD. In any of these patterns, there were some basic histologic findings: a wedge-shaped pale area at the edge of the lymph node or paracortical nodules associated with an increase in apoptotic cells or karyorrhectic debris, crescentic histiocytes, proliferative mononuclear histiocytes and absence of or very scanty neutrophils. Immunohistochemical study demonstrated focal occurrence of histiocytes expressing both CD68 and MPO. Electron microscopy confirmed the presence of apoptotic bodies, proliferative mononuclear histiocytes, crescentic histiocytes and dispersed T cells in the lesional areas. Conclusions In general, there should not be much difficulty in differentiating KD from other types of lymphadenopathy. Sometimes, problems arise mainly because of the diversity of KD histology. Correct diagnosis can be made if one pays attention to the described characteristic morphology, peculiar immunophenotype of the histiocytes and possibly ultrastructural features.

关 键 词：组织细胞坏死性淋巴结炎 鉴别诊断 免疫组织化学 电镜检查 超微结构 

分 类 号：R551.2[医药卫生—血液循环系统疾病]