猫抓病性淋巴结炎的临床病理观察并文献复习

Clinicopathological observation of lymphadenitis in cat scratch disease and literature review

目的:探讨猫抓病性淋巴结炎的临床病理特征、发病机理以及诊断和鉴别诊断。方法:对猫抓病性淋巴结炎进行病理组织学观察及免疫组织化学CD20、CD3、CD68染色和组织化学W-S(Warthin-Starry)染色分析,同时复习有关文献。结果:猫抓病性淋巴结炎病变特征是微脓肿和肉芽肿形成,淋巴结早期微脓肿周围为CD20+的B淋巴细胞和CD68+的组织细胞,当典型微脓肿性肉芽肿形成时,CD68+的上皮样细胞呈放射状排列,其间夹有CD3+的T淋巴细胞;W-S染色(+)。结论:猫抓病性淋巴结炎主要病变特征是微脓肿性肉芽肿形成,可能与细菌感染所诱导的细胞免疫反应有关。将淋巴结的病理特征与临床病史结合是本病诊断的关键。本病需要与组织细胞性坏死性淋巴结炎、结核性淋巴结炎及性病淋巴肉芽肿相鉴别。

Objective To investigate the clinicopathological characteristics,pathogenesis,diagnosis and differential diagnosis of the lymphadenitis in cat scratch disease（CSD）.Method One case of lymphadenitis in CSD was studied by histopathology and immunohistochemical staining for CD20,CD3,CD68 and histochemical staining for W-S（Warthin-Starry）,together the relevant literatures were reviewed.Results The histologic features were the formation of microabscess and granuloma.The early microabscess in the lymphnodes were surrounded by B lymphocytes（CD20 ＋） and macrophages（CD68＋）.The typical microabscess granuloma were surrounded by epitheloid cells（CD68 ＋） and CD3 positive T lymphocytes.Conclusion The main feature of the lymphadenitis in CSD is the formation of granuloma with microabscess.This lesion may result from bacterial infection which induces the cell immune reaction.It is the key of the diagnosis for the lymphadenitis in CSD to connect lymphaden pathological characteristics with clinical history.The lymphadenitis in CSD need to be mainly distinguished from histiocytic necrotizing lymphadenitis and tuberculous lymphadenitis and venereal lymphogranuloma.