梅毒性淋巴结炎8例临床病理分析

CLINICALPATHOLOGICAL ANALYSIS OF SYPHILITIC LYMPHADENITIS :8 CASES REPORT

目的分析梅毒性淋巴结炎的临床病理学表现,探讨该病相对特征性的组织病理改变。方法对8例梅毒性淋巴结炎的临床资料和组织学形态进行回顾性分析,采用与临床实验室检查相结合的方法对其进行诊断和鉴别诊断。结果腹股沟淋巴结无痛性肿大5例,胸壁1例,颌下1例,腋下1例,淋巴结直径1.8～4.0cm,平均3.1cm。组织病理基本病变是,①闭塞性血管内膜炎;②血管周浆细胞、淋巴细胞浸润;③被膜及淋巴结周围组织以浆细胞为主的慢性炎细胞浸润和纤维化,导致被膜显著增厚是梅毒性淋巴结炎相对特征性的组织学表现。淋巴滤泡增生,滤泡间和副皮质区血管周围有大量淋巴细胞与浆细胞浸润,上皮样组织细胞增生伴有肉芽肿改变;散在小灶性坏死是诊断的参考性指标。结论梅毒性淋巴结炎的组织病理表现仅具有相对特征性,非特异性改变多种多样,极易误诊为非特异性慢性淋巴结炎、淋巴结反应性增生或者淋巴结结核等病变,其最终诊断仍需结合梅毒血清实验室检查。

Objective To investigate the clinicopathological characteristics of syphilitic lymphadenitis. Methods The clinical data and pathological features were retrospectively analyzed in 8 cases of syphilitic lymphadenitis with review of the literature. The diagnosis and differential diagnosis were made by combination with laboratory examination. Results The patients presented as painless lymphadenopathy, 5 cases in groin, 1 cases in chest wall, 1 case in submaxilla, 1case in axillary fossa. The lymph node were 1.8 -4.0cm in diameter （median 3. lcm）. Microcopically, there are obliterative vasculitis, perivascular infiltration of plasma cell and lymphocyte, capsular and pericapsular inflammation and extensive fibrosis resulting in predominant capsular thickening, diffuse plasma cell infiltration, proliferation of blood vessels with endothelium swelling and inflammatory infiltration of their wall （phlebitis and endarteritis ）, follicular hyperplasia and interfollicular and paracortical perivascular lymphocyte and plasma cell infiltration . Rarely, noncaseating granulomas, abscesses and scattered focal necrosis are present. Conclusion The pathological changes of syphilitic lymphadenitis were mostly nonspecific, and should be distinguished with other nonspecific lymphadenitis, reactive node proliferation and tubercalosis of lymph node, and its final diagnosis should be made by combination with laboratory detection of serumal treponema pallidum.