Castleman并发Hodgkin病1例报道及文献复习

Hodgkin's disease with coexistent Castleman-like histologic features: a case report and literature review

目的：探讨以Castleman病组织学特征为主要表现的Hodgkin病的病理学特点及两者之间的关系。方法：对1例以Castleman病组织学特征为主要表现的Hodgkin病进行了光镜、免疫组织化学及原位分子杂交的观察。结果：淋巴结组织内淋巴滤泡明显增生．淋巴滤泡生发中心大小正常或较小，部分滤泡中心网状细胞增生，小淋巴细胞围绕滤泡呈套状排列似洋葱皮样结构，滤泡间及副皮质区见有明显增生的血管，部分血管壁增厚并有透明样变，滤泡之间及副皮质区见有较多的Hodgkin细胞及Reed-Stenberg细胞，CD15、CD30免疫组化染色阳性。结论：诊断为Castlemani病但不久又复发的患者，除仔细复查第一次活检切片并重新活检外，还应做免疫组织化学或原位分子杂交检测病毒DNA，有助于对Hodgkin细胞及Reed－Sternberg细胞识别，提高Hodgkin病的正确诊断，避免再次出现漏诊。

Purpose To investigate histopathologic characteristic of Hodgkin's disease presenting with thehistological features of Castleman's disease. Methods A case of Hodgkin's disease presenting with the histologi-cal features of Castleman's disease was evaluated by light microscopy, immunohistochemical staining and in situhybridization. Results The biopsy specimen revealed essentially intact nodal architecture with expansion of theinterfollicular areas and reactive follicular hyperplasia. The lymphoid follicles contained normal or small germinalcenters. A few germinal centers were surrounded by concentric layers of small lymphocytes, so-called onion-skinlayers. Vascular proliferations were present in the interfollicular areas. Many of which showed hyalization. Nu-merous Reed-Sternberg cells and mononuclear variants were interpersed and were present at the periphery of thefollicles and an admixture of eosinophils, lymphocytes, plasmacytes. These cells reacted with CD15 antibody andshowed weak reactlvity with CD30 antibody. The Reed-Sternberg and mononuclear variant cells showed negativereactions for CD45, CD43, and CD68 antibodys. Virus DNA was detected by in situ hybrldlzation. Conlusion Apersistent or recurrent Castleman's disease requires a careful review of the initial diagnosis, with appropriate im-munohistochemistry or detection of Epstein-Barr virus DNA by in situ hybridization and a second biopsy, in or-der to exclude the possibility of an unrecognized neoplasm.