组织细胞性坏死性淋巴结炎41例临床及病理分析

Histiocytic necrotizing lymphadenitis: a clinicopathological analysis of 41 cases

目的探讨组织细胞性坏死性淋巴结炎(HNL)的临床及病理特点。方法回顾性分析41例HNL的临床病理资料及免疫组织化学表型。结果41例中女性23例,平均年龄21岁。37例颈部淋巴结肿大,半数有发热,2例有皮疹。33例外周血白细胞计数正常,8例减低;血细胞沉降率增快。2例分别在1个月和5年后患系统性红斑狼疮(SLE)。病理形态见在活跃的反应性增生淋巴结病变的背景下,出现程度不同的凝固性坏死,伴有多种形态的组织细胞增生,细胞内外见大量碎片。病变区及周围有免疫母细胞及浆样单核细胞增生,无中性粒细胞浸润。组织细胞CD68(+),淋巴细胞CD3和CD45RO(+)。结论HNL为淋巴结反应性增生的特殊表现,多见于年轻女性,常为单侧颈部淋巴结肿大伴发热,与SLE等诸多疾病相关,易误诊为恶性淋巴瘤,需引起警惕。

Objective To study the clinicopathologic features of 41 cases of histiocytie.necrotizing lymphadenitis （HNL）. Methods The elinieopatologie and immunohistoehemieal features of 41 cases of HNL were analyzed. Results The ratio of female/male was 23/18 ,with age ranging from 6 to 46 years （mean 21 years）. Thirty seven patients developed cervical lymph node swelling. Laboratory examination showed increasing in erythrocyte sedimentation rate and leukopenia. The lymphnode biopsy revealed necrosis,loss of lymphnode structure with many histiocytcs and absence of granulomatous reaction. Abundant plasmacytoid monocytes and large lymphoid cells （immunobalsts） existed. Immunophenotyping revealed CD3 and CD45RO positive for lymphocytes,CD68 for histiocytes. Conclusion HNL predominantly affects young women, who present with solitary or multiple cervical lymphadenopathy.accompanied by fever. HNL is ofiern mistaken for malignant lymphoma histologically. Clinically, it may be associated with systemic lupus erythematosus （SLE） and many other autoimmune diseases and the early recognition of this disease helps in avoiding unnecessary investigations and treatment.