组织细胞性坏死性淋巴结炎30例临床病理分析

A Clinicopathologic Analysis of 30 Cases of Histiocytic Necrotizing Lymphadenitis

目的 探讨组织细胞性坏死性淋巴结炎 (HNL)的临床病理特征。方法 回顾性分析 30例 HNL患者淋巴活检标本的 HE切片 ,并用免疫组化 S- P法检测细胞表型。结果 所有病例在淋巴结活检之前均未能明确诊断 ,组织学上表现为大小不等散在或融合的病灶 ,病变区以坏死为主伴散在核碎片 ,多种形态组织细胞增生 ,缺乏粒细胞浸润。免疫组化示淋巴细胞表达 CD3、CD45 RO、L CA、κ和 λ,不表达 CD15、CD2 0和 CD30 ;组织细胞表达 CD6 8和 MAC387,部分细胞表达 CD30。结论 HNL的确诊有赖于组织病理学。含有多量核碎片坏死灶的形成是 HNL 的主要病理学特征。免疫组化检测有助于鉴别诊断。

Objective To investigate clinicopathological characteristics of histiocytic necrotizing lymphadenitis.Methods HE sections of lymph node biopsies of 30 patients with HNL were analyzed retrospectively and their cell phenotypes were examined by immunohistochemistry S-P method.Results All cases could not be diagnosed before lymph node biopsy.Histologically there were scattered or syncretic leisions with different size.Necrosis accompanied by scattered neucleolus debris, proliferated pleomorphic histiocytes,scarce granuloctes infiltration were characteristics of the focuses.It was revealed by immunohistochemistry that CD3,CD45RO,LCA,κ,λ were positive while CD15,CD20,CD30 negative in lymphocytes,and CD68,Mac87 were positive for all histiocytes and CD30 positive for only part of them.Conclusions Histiocytic necrotizing lymphadenitis could be diagnosed by histopathology.Formation of necrosis focus with abundant karyorrhectic debris is main pathologic features of histiocytic necrotizing lymphadenitis.Immunohistochemistry was helpful for differential diagnosis.