梅毒性淋巴结炎5例病理诊断要点分析

Diagnostic analysis of five cases in syphilitic lymphadenopathy

目的 分析梅毒性淋巴结炎的临床病理特点、诊断和鉴别诊断,提高对本病的识别。方法 对5例梅毒性淋巴结炎进行归纳、分析,结合本病的临床表现、形态学特点和实验室检查结果进行诊断及鉴别诊断。结果 5例梅毒性淋巴结炎中,4例表现为腹股沟淋巴结无痛性肿大,1例表现为颈部淋巴结肿大,淋巴结直径1.8~3.5cm,平均2.6cm。组织病理学改变主要包括：1）淋巴结被膜增厚及被膜纤维化,被膜及淋巴结内可见以浆细胞为主的慢性炎细胞浸润;2）淋巴滤泡明显增生,滤泡间和副皮质区血管周围有大量浆细胞为主的炎细胞浸润;3）闭塞性血管内膜炎;4）小血管周围炎;5）上皮样组织细胞增生形成肉芽肿改变,有时可见多核巨细胞;6）淋巴结边缘窦内单核样B细胞增生;7）淋巴滤泡内外小灶性坏死。实验室检查：梅毒血清学试验均阳性。结论 梅毒性淋巴结炎有着相对特征性的组织病理学改变;因此,病理医师要对该疾病充分认识并结合病史及血清学检查明确诊断。

Objective To analyze the pathological diagnostic features and differential diagnosis of syphilitic lymphadenitis,in order to improve the understanding of the disease.Methods Five cases of syphilitic lymphadenopathy were retrospectively analyzed,the diagnosis and differential diagnosis were carried out with combining pathologic features,clinical corse and laboratory examination.Results Four cases showed inguinal lymphadenectasis and one showed cervical lymphadenectasis.All of five cases,the patients presented painless enlargement,ranged 1.8cm to 3.5cm in diameter,and the median size was 2.6cm.The histopathologic features included：1）capsular thickening and fibrosis of the lymphnode,and prominent plasma cell infiltration in the capsules and lymphaden;2）prominent follicular proliferation and perivescular infiltration of plasma cells in paracortical areas and intermediated follicular areas;3）obliterative endovasculitis;4）peripheral inflammation of small vessels;5）granulomatous changed with epithelioid histocytosis,and occasionally presented multinucleated giant cells;6）proliferation of monocytoid B lymphocytes in nodular marginal sinuses;7）focal necros inside and outside follicules.Laboratory examination：all of five cases were positive for syphilitic serologic test.Conclusion The syphilitic lymphadenopathy has histopathologic specialities,relatively,and we can definite the diagnosis if fully understanding of the disease and combined analysis of patientshistory and laboratoric examinations.