组织细胞坏死性淋巴结炎

Histiocytic necrotizing lymphadenitis

患者女，48岁，左颈部淋巴结肿大、疼痛1周。抗炎治疗1周疗效不明显。皮肤科检查：左颈外侧乳突下方至锁骨可触及肿大的淋巴结，呈串珠状。活动度小，直径最大约2cm，触痛明显，其他部位表浅淋巴结未见明显肿大。淋巴结组织病理：多种形态的组织细胞、免疫母细胞及浆细胞样单核细胞增生，伴有程度不同的核碎片。免疫组化：病变区CD3（＋）、CD8（＋）、CD68（＋）、巨噬细胞炎症蛋白（＋）、CD20（＋）。诊断：组织细胞坏死性淋巴结炎病。

A 48-year-old female presented with a one-week history of painful and enlarged lymph nodes in the left neck. One-week systemic treatment with antibiotics resulted in no obvious improvement. Skin examination revealed palpable lymph nodes between the left lateral cervical papillae and clavicle, which appeared as a string of beads with a little mobility and obvious tendemess. The largest diameter of enlarged lymph nodes was about 2 cm. No enlarged lymph nodes were palpable in the other body sites. Histopathologically, histiocytes of various shapes, immunoblasts and plasmacytoid monoeytes markedly proliferated with different degrees of karyorrhexis. Immunohistochemistry revealed that the lesions were positive for CD3, CD8, CD68, mouse maerophage inflammatory protein, and CD20. A diagnosis of histiocytic necrotizing lymphadenitis was made.