皮病性淋巴结病临床病理研究及文献复习

Clinicopathological study and the literature review of dermatopathic lymphadenopathy

目的:复习文献对皮病性淋巴结病(dermatopathic lymphadenopathy,DPL)的病理形态特点、组织发生、诊断和鉴别诊断、治疗及预后等做一初步探讨。方法:利用4例DPL患者的淋巴结标本,采用常规石蜡切片,HE染色。另对石蜡切片采用En Vision免疫组化二步法染色。结果:淋巴结皮质及髓质结构尚存,淋巴滤泡变小,呈压迫萎缩状态,副皮质区极度扩张,被膜下淋巴窦及髓窦开放、组织细胞增生,增生的组织细胞胞质内和细胞间有黑色素颗粒沉积。被膜下淋巴窦和副皮质区有结节状分布的淡染区,其内可见胞质丰富的大细胞,细胞胞界不清、胞质空亮,核细长、扭曲、分叶状,染色质细腻,有的可见核沟。副皮质区内可见一定数量的嗜酸性粒细胞、浆细胞浸润和免疫母细胞增生。免疫组化示淡染区内胞质丰富的大细胞表达S100(+)、CD1α(+)、CD4(+)、Ki67(约5%+),而HMB45、CD8、CD163、CD23、CD68、Bcl-6、CD20、CD3、CD10、CD21、CD30、CXCL13、CD35及PD-1均为阴性。结论:DPL较为少见,易误诊为转移性恶性黑色素瘤或T细胞淋巴瘤,病理诊断需结合病史及临床表现。

Objective：To review the literature and explore the pathology morphological features,histogenesis,diagnosis and differential diagnosis,therapy and prognosis of the dermatopathic lymphadenopathy （DPL）.Methods：Four cases of DPL were studied by using of paraffin slice,HE staining,immunohischemistrical method（EnVision method）.Results：The cortex and medulla of lymph node were present,which follicles were compressed smaller and atrophic,and of which paracortical zones were extremly expansed.The subcapsular and medullary sinuses were open,the histocyte in which are hyperplasia.There are many black pigment depositions in the cytoplasm and intercellular areas.Large cells which had bright cytoplasm,indistinct boundary,slender,twisted and lobulated nucleus,fine chromatin,some visible nuclear groove could be seen in subcapsular sinus and paracortical zone.A certain number of Eosinophils,plasma cells and hyperplastic immune cell could aslo be seen in paracortical areas.By immunochemistry stain,the tumor cells expressed S100（＋ ＋ ＋）,CD1α（＋ ＋ ＋）,CD4（＋ ＋ ＋） and Ki67 （5％ ＋）.Conelusion：DPL is rare and easily misdiagnosed as metastatic malignant melanoma or T cell lymphoma.Pathological diagnosis requires a combination of case history and clinical manifestations.