组织细胞性坏死性淋巴结炎病理组织学分析

Histopathological analysis of histiocytic necrotizing lymphadenitis

目的探讨组织细胞性坏死性淋巴结炎(HNL)的临床病理特征。方法复习36例HNL淋巴结活检标本的HE切片,并用免疫组化SP法检测病灶内细胞的免疫表型。结果HNL组织学上副皮质区,尤其是滤泡间区有散在大小不等或融合病灶,由多种形态的组织细胞、转化的淋巴细胞和凋亡碎屑构成,缺乏中性粒细胞、浆细胞和/或嗜酸性粒细胞反应。部分淋巴细胞表达CD45RO,组织细胞表达CD68,残留的生发中心细胞表达CD20。结论HNL形态学上显示由多种组织细胞、转化T淋巴细胞及凋亡碎片组成的病灶,不见中性粒细胞浸润。应与恶性淋巴瘤、淋巴结的非肿瘤性病变鉴别。

Objective To describe clinicopathological features of 36 cases of hisfiocytic necrotizing lymphadenitis（HNL）. Methods 36 cases HNL with routine lymph node biopsies were reviewed and their immunophenotyping were performed using immunohistochemical S-P methods. Results Histologically HNL had variable-sized discrete or confluent nodules in the paracortex, expecially in the interfollicular area, which were composed of proliferative pleomorphic hisfiocytes, transformed lymphocytes, and karyorrbectic debris, no reaction of the neutrophils, plasma cells and/or eosinophils. Immunohistochemistry revealed CD45RO ＋ for transformed lymphocytes, CD68 ＋ for histiocytes, and CD20 ＋ for lymphocytes in the residual reactive germinal centers. Conclusions Morphologically, the presence of pleomorphic histiocytes, transformed T cells and karyorrhectic debris and the absence of granular cells infiltration support the diagnosis of HNL. The differential diagnosis of HNL includes malignant lymphoma and non-neoplastic lesions of the lymph node.