细针吸取细胞学在HIV感染者体表肿大淋巴结和肿块诊断中的应用

Diagnostic application and value of the fine needle aspiration cytology in HIV positive patients with lymphadenopathy and superficial mass

目的探讨细针吸取细胞学(fine needle aspiration cytology,FNA)对HIV感染者体表肿大淋巴结和肿块诊断的应用价值。方法采用"友谊式"细针穿刺器,对72例HIV感染者进行FNA检查。获得组织用于制备涂片或细胞块,进行HE染色、抗酸染色、六胺银染色、PAS染色,特殊病例进行细菌培养、免疫组织化学染色和PCR检测。结果在72例HIV感染者中,穿刺淋巴结65例(90.3%)和体表肿物7例(9.7%)。淋巴结病例包括:结核30例(42%),非结核分支杆菌感染5例(7%)、HIV相关性反应性增生14例(19%)、淋巴瘤7例(10%)、化脓性淋巴结炎5例(7%)、隐球菌感染2例(3%)和马尔尼菲青霉菌感染2例(3%)。体表肿块包括:皮肤及软组织4例(5.6%)、乳腺2例(2.8%)和甲状腺1例(1.4%),其中恶性肿瘤2例,分别为乳腺淋巴瘤和甲状腺乳头状癌。诊断后多数感染治疗有效。结论对于HIV感染者进行FNA操作安全、容易执行,诊断可靠、用时较短。取材充分即能够明确多数淋巴结肿大和体表肿块的病因。在本组研究中患者年龄多是20～40岁的男性,结核感染是淋巴结肿大最常见的病因,高级别的恶性淋巴瘤是最多见的恶性肿瘤。

Purpose To study the diagnostic value of fine needle aspiration cytology（FNA） in AIDS patients with lymphadenopathy and superficial mass.Methods 72 cases HIV positve patients with superficial masses were done by fine needle aspiration,samples were obtained by Youyi Type FNA aspirators,specimens were prepared into cell smears,HE staining and special staining such as Acid-fast,Grocott-Gomori,PAS were stained and cell blocks were made if required.Bacterial culture,immunohistochemistry and PCR assay were used for specific diseases.Results Among 72 cases of HIV patients,there were 65 paracentesis lymph node（90.3%） and 7 superficial masses（9.7%）.These patients with lymphadenopathy included 30 cases of tuberculosis,5 cases of MAC,14 cases of reactive lymphadenitis,7 cases of lymphoma,5 cases of suppurative lymphadenitis,2 case of Cryptococcus,2 cases of Penicillium marneffei.Superficial masses were located at skin and soft tissues（4 cases）,breast（2 cases） and thyroid（1 case） which there were 2 cases of malignant tumour including 1 breast lymphoma and 1 thyroid papillary carcinoma.Conclusions FNA is one simple and effective diagnostic method for those HIV positive patients with lymphadenopathy,which is important valuable in determining pathogen for HIV positve patients with lymphadenopathy.The tuberculosis is the most common cause of lymphadenopathy in our study.