颈部巨淋巴结增生临床分析

Clinical analysis on giant lymph node hyperplasia on neck

目的提高对颈部巨淋巴结增生（Castleman病）的诊断水平。方法回顾性分析曾经误诊的10例巨淋巴结增生的临床资料，分析临床诊断和鉴别诊断的经验和教训。结果10例颈部巨淋巴结增生患者，男3例，女7例；按Frizzera分类标准分为局灶性8例（其中透明血管型6例，混合型2例），多中心性2例（其中浆细胞型1例，混合型1例）。临床以无痛性颈淋巴结肿大为特征，多中心性2例伴有全身症状和（或）多脏器受累等特征。10例患者均为误诊后接受淋巴结切除术后病理检查确诊。随访4—17年10例患者均健康生存，其中1例多中心性浆细胞型患者术后2年复发，再次接受淋巴结手术切除术和化疗后4年未再复发。结论颈部巨淋巴结增生临床少见，易于误诊，应采用淋巴结切除活检术病理检查确定诊断，注意与颈淋巴结结核、颈淋巴结炎、结节病、肉芽肿等鉴别。如无系统功能严重受累，首选手术切除。

Objective To improve the diagnosis and management level of giant lymph node hyperplasia （Castleman＇s disease）. Methods To retrospective analyze 10 misdiagnosed cases with Castlemen＇s disease in order to give some suggestions for clinical diagnosis and differential diagnosis. Results Ten patients with neck giant lymph node hyperplasia underwent surgical treatment after misdiagnosis. There were 8 localized Castleman＇s disease constituted of 6 cases with hyaline vascular type and 2 cases with mixture type and 2 muhicentric Castleman＇s disease constituted of 1 cases with plasma cell type and 1 cases with mixture type were classified according to the criteria described by Frizzera. Ten eases were diagnosed by secondary operation after misdiagnosis and were clinically characterized by painless neck lymphadeneetasis, 2 cases with multicentrie Castleman＇s disease accompanied with aspecific systemic symptom and（or） multi-system damage. Ten cases survived for 4 - 17 years during follow-up periods in which 1 case with plasma cell type, multicentrie Castlemen＇s disease was recurrent 2 years later and underwent lymphadeneetomy and chemotherapy and have no local recurrence so far. Conclusions Castlemen＇s disease on neck is seldom seen and liable to misdiagnose. The diagnosis of Castlemen＇s disease is based on its histopathological characteristics by lymph node resection biopsy. It should be considered in the differential diagnosis with lymph node tuberculosis, lymphadenitis, sarcoidosis and granuloma. Operation is the first choice for patient with localized type and multicentric type without serious involvement of multiple system functions.