肺玻璃样变性肉芽肿临床病理分析

Clinicopathologic analysis of a pulmonary hyalinizing granuloma case with literature review

目的探讨肺玻璃样变性肉芽肿的临床病理特征。方法报道1例肺玻璃样变性肉芽肿病例的临床及病理特点,并复习文献探讨其诊断及鉴别诊断。结果肺玻璃样变性肉芽肿病理学表现由大片玻璃样变性的厚的胶原带组成,呈漩涡状、束状排列,胶原带之间见较多淋巴浆细胞浸润;中心区及边缘区见淋巴滤泡结构。免疫组化CD99、Bcl-2、ALK阴性,IgG4/IgG阳性浆细胞之比>40%。Masson三色染色显示为胶原纤维阳性;刚果红染色阴性。结论病理检查是肺玻璃样变性肉芽肿确诊的关键。其发病机制与免疫反应有关,可能为IgG4相关性疾病谱的一种。

Objective To analyze the clincopathologic characteristics of a pulmonary hyalinizing granuloma （PHG） cases. Methods A pulmonary hyalinizing granuloma case was analyzed based upon clinical and pathological findings, and discussed in differential diagnosis with review of the literature. Results Histologically, PHG was composed of bundles of dense thick lamellar hyalinizing tissue aligned in whorls and streams accompanied by some plasma cells, lymphocytes among the collagen bundles. Germinal centers were seen at the peripheral and the centrie area of the lesion. Immunohistoehemieally, The test results of CD99,Bcl-2 and ALK in PHG eases were negative and the ratio of IgG4/IgG positive plasma cells was over 40%. Masson trichrome showed positive blue staining for eollagenous fiber and Congo red stain was negative for amyloid. Conclusion Pathological analysis is essential for diagnosis of PHG. The pathogenesis of PHG is associated with exaggerate immunoreaction, which might be one of IgG4-related diseases.