酷似淋巴瘤的淋巴结组织细胞增生性病变的诊断与鉴别诊断

Histiocytosis in lymph node similar to lymphoma and its diagnosis and differential diagnosis

目的分析淋巴结组织细胞增生症的临床病理特点及诊断与鉴别诊断。方法对1例以组织细胞增生为主要特点的淋巴结病变进行光镜观察、免疫组化染色、基因重排检测,并结合国内10余家医院的会诊结果和文献进行讨论。结果患者女性,43岁。左颈部淋巴结无痛性肿大1月余。光镜下窦组织细胞显著增生伴上皮样细胞团聚和散在少量霍奇金样细胞,该细胞CD68、Lys、α1AT(+),S-100、CD1α、CD3、CD30、CD15、ALK、MTB、EBV(-),无Ig与TCR基因重排。结论由于淋巴结中增生的霍奇金样细胞有EBV感染,并呈CD68(+),S-100、CD1a和CD30(-),无Ig和TCR基因重排,是否属感染相关的组织细胞增生值得考虑。

Objective To present and analyze the clinicopathologic features of histiocytesis in lymph node and its differential diagnosis. Methods One doubtful case of cervical lymphadenopathy with histiocytosis was studied by light microscopy, immunohistochemistry and polymemse chain reaction for Ig and TCR gene rearrangment. Results The patient was a 43-year-old woman with the cervical lymphadenopathy involved multiple lymph nodes. Histologically, the lesion was characterized by sinus histiocytosis and sparsely distributed epithelioid or Hodgkin＇ s-like cells in lymphocytic background. The lesions were positive for CD68, Lys, α1but negative for S-100,CD1α, CD3, CD30, CDI5, ALK, MTB, EBV,without Ig and TCR gene rearrangement that often occur in lymphoma and some Hodgkin＇s lymphoma. Conclusions The consultant diagnoses by several pathologists include Hodgkin＇ s and non-Hodgkin＇s lymphoma, true malignant histiocytesis, and sinu histiocytoses. Due to the lack of the typical immunophenotypes of any disease mentioned above, presence of EBV irfection and absence of Ig and TCR gene renerearrangement, the infection-associated reactive histiocytesis caused by some microorganism pathogens is proposed and follow-up is necessary.