组织细胞坏死性淋巴结炎52例临床病理表现

The clinical and pathological characteristics of histiocytic necrotizing lymphadenitis: analysis of 52 cases

目的探讨组织细胞坏死性淋巴结炎的临床和病理学特点。方法回顾性分析52例组织细胞坏死性淋巴结炎的临床表现、淋巴结活检病理学特点及其诊治。结果52例患者中女性41例(79%),主要表现为持续发热(100%),单发(23%)或多发(77%)淋巴结肿大(以颈部多见),多形性皮疹(35%),外周血白细胞计数降低(76%),血沉增快(100%),抗生素治疗无效(100%),小剂量肾上腺糖皮质激素治疗有效(81%)等。26例患者(50%)肝酶升高,仅7例(13%)伴流感样上呼吸道症状。淋巴结活检病理学特点为不同程度的凝固性坏死伴多种形态的组织细胞、淋巴细胞浸润,无中性粒细胞浸润。免疫组化染色示组织细胞CD68及T细胞CD3、CD45RO阳性,CD15、CD20及CD30均阴性。结论组织细胞坏死性淋巴结炎的临床表现无特异性,较易误诊,确诊主要依靠病理活检及免疫组化检查。

Objective To study the clinical manifestation and pathological features of histiocytic necrotizing lymphadenitis （Kikuchi＇s disease, KD ）. Methods 52 patients with KD were collected to analyze the clinical manifestation, pathological features of biopsy lymph nodes, diagnosis and treatment. Results 41 cases（79% ） were female of the 52 patients. The main clinical features included persistent fever（ 100% ） , single （ 23% ）/multi （ 77% ） -lymphadenopathy （ always in cervical region ） , pleomorphism erythra（ 35% ） , neutropenia （ 76% ） , elevated erythrocyte sedimentation rate （ 100% ） , insensitivity to antibiotics（ 100% ） and sensitivity to small dosage glucocorticoid （81%）. 26 cases （50%） had elevated aspartate aminotransferase and/or alanine aminotransferase, but only 7 cases （13%） had upper respiratory tract symptom like influenza. Pathological features included distinctive necrosis, loss of lymph node structure, infiltration with histiocytes and lymphocytes, absence of neutrophils. Immunohistochemical stainings showed CD68 positive for histiocytes and CD3 , CD45 RO positive for T lymphocytes. Conclusion Diagnosis of KD relies on the pathological examination and immunohistochemical staining.