组织细胞坏死性淋巴结炎13例临床和病理分析

Clinical characteristics and pathology in 13 patients with Kikuchi's lymphadenitis

目的通过对13例组织细胞坏死性淋巴结炎(HNL)患者的临床和病例资料进行总结分析,以探讨其临床和病理特点。方法回顾性分析1997年6月～2006年12月住院治疗的13例HNL患者的临床及病理资料。结果所有患者均有发热和颈部淋巴结大,大多数患者白细胞减少、淋巴细胞比率增高、血沉增快,9例EBV-DNA阳性。初诊时7例误诊为淋巴瘤,4例误诊为淋巴结核,1例误诊为败血症。淋巴结活检HE染色可见典型的病理学改变。12例患者应用疗程为2～6个月的肾上腺皮质激素治疗,疗效显著,未复发。1例应用肾上腺皮质激素2周治愈,但6年后复发。结论该病临床表现缺乏特异性,易误诊,确诊需进行淋巴结活检,CD标志免疫组化为关键依据,可用于排除T、B淋巴瘤,其病因可能与EB病毒感染有关,早期长疗程的激素治疗可能有助于减少复发。

Objective . To investigate and analyze the clinical features and pathology in patients with histiocyfic necrofizing lymphadenitis（HNL） or Kikuchi＇s lymphadenifis, Methods 13 patients with HNL from Tongji hospital hospitalized between the years of 1997 to 2006 were enrolled for study. The clinical data were collected based upon the hospitalized records. HE staining and immunohistochemistry staining of the CD molecule markers including CD3, CD45 RO, CD20cy, CD79α of the biopsy samples of lymph nodes were performed. Results All patients had fever and swelling of lymph node on neck. Major laboratory findings included the leukocyte reduction, the increasing of lymphocyte proportion within the whole blood, swiftness of ESR in serum and positive EBV-DNA. Initially, 7 patients were diagnosed as lymphoma, 4 patients as tuberculous lymphadenitis and 1 as sepsis. The final diagnosis of HNL in the present report was confirmed by biopsy investigation of the pathology and lymphocyte CD markers. Subsequently the patients were treated with glucocorticoid for 2 weeks to 6 months. Up to now, 12 of the patients improved significantly after treatment without reoccurrence of the disease during follow-up observation time. 1 patient with treatment time of 2 weeks relapsed 6 years later, the patient was cured after receiving longer period treatment for 6 months. Conclusion The clinical situation manifestation in HNL lacks specifity and can be easily misdiagnosed. Histopathological investigation of enlarged lymph nodes contributed greatly to the final diagnoses of HNL. HNL might be related to infecting EB virus. Early and sufficient administration of glucocorticoid is closely related to the effectiveness of treatment and disease outcome.