猫抓病性淋巴结炎的病理诊断与鉴别诊断——附38例报告

Pathological and differential diagnosis of cat-scratch-disease lymphadenitis: a report of 38 cases

目的加深对猫抓病性淋巴结炎的认识,提高其诊断水平。方法对38例猫抓病性淋巴结炎作回顾性临床病理分析,并作Warthin-Starry银染色。结果发病年龄:4～56岁,平均20.8岁;发病部位:上肢及腋窝淋巴结16例42.1%)、下肢及腹股沟淋巴结13例(34.2%)、颈部淋巴结9例(23.7%);发病季节:28例(73.7%)发生于6～10月份(夏秋季)、10例(26.3%),发生于其它月份;组织学特点:淋巴结皮髓质内肉芽肿形成,部分肉芽肿中微脓肿形成;Warthin-Starry银色染色:38例中有33例(86.8%)阳性。结论本病常有一定好发部位及高发季节性,并常有猫抓史或与猫密切接触史。将淋巴结形态学特点与临床病史结合,是提高本病诊断水平的关键。

Objective To recognize cat-scratch-disease lymphadenitis(CSDL),and raise the diagnositic level of CSDL. Methods Thirty-eight cases of CSDL were reviewed clinicopathologically,and Warthin-Starry staining was employed. Results 38 cases of cat scratch disease lymphadenitis,aged 4～56 years(median age 20.8)were collected.The leisions were found in the lymphadens of pectoral limbs and axillae in 16(42.1%),pelvic limbs and inguina in 13(34.2%),neck in 9(23.7%).Season of onset was in summer and autumn in 28(73.7%) (June～Oct),in other month in 10(26.3%).Histologically,granuloma were found in the cortex and medullae of lymphadens with microabscess in some granuloma. 33 cases(86.8%) were Warthin-Stary positive. Conclusion CSDL is usually found in summer and autumn,and usually with a history of cat-scratching or close cat-touching. It is the key of the diagnosis for CSDL to connect lymphaden pathological changes with clinical history.