组织细胞坏死性淋巴结炎25例临床及病理特征分析

Analysis on the clinical and pathological features of histiocytic necrotizing lymphadenitis in 25 cases

目的:探讨组织细胞坏死性淋巴结炎患者的临床及病理特征。方法:回顾性分析2012年6月~2016年5月在皖南医学院弋矶山医院住院的25名组织细胞坏死性淋巴结炎患者的病历资料。结果:25例患者中女性17例(68%),平均年龄为(28.2±11.3)岁。发热者16例(64%);24例(96%)为颈部淋巴结受累及,淋巴结触痛者16例(64%)。白细胞为(3.6±1.7)× 10~9/L;血沉为(34.4±12.3)mm/h。病理示组织细胞反应性增生,凝固性坏死,但不伴有中性粒细胞浸润。免疫组化示泡沫样组织细胞CD68(+)以及残存生发中心B淋巴细胞CD20(+)。结论:组织细胞坏死性淋巴炎以青年女性更为多见;多伴发热;颈部淋巴结肿大最常见,多伴触痛;可见白细胞降低及血沉增快;特征性的病理学改变有助于明确诊断。

Objective ：To investigate the clinical and pathological features of histiocytic neerotizing lymphadenitis.Methods：The clinical data were retrospectively analyzed in 25 cases of histiocytie necrotizing lymphadenitis treated in our hospital form June 2012 to May 2016.Results：In the 25 patients, 17 were female （68%） , with an average age of （28.2±11.3） years.Symptom of fever was observed in 16 cases （64%）.Cervical lymph node involvement was found in 24 cases （96%） , and lymph mode tenderness occurred in 16 （64%）.Average white blood cell and erythrocyte sedimentation rate（ESR） were （ 3.6±1.7 ）× 10^9/L and （ 34.4±12.3） ram/h, respectively.Histopathological examination indicated reactive proliferation of cells and coagulation necrosis without neutrophil infiltration.lmmunohistochemistry showed CD68 （＋） expression in foamy-like histocytes and CD20 （＋） of B lymphocyte in residual germinal center.Conclusion：Histioeytic necrotizing lymphadenitis more occurs in young females, and is characterized by fever, enlarged cervical lymph node with tenderness as well as decreased leukopenia and accelerated ESR in most cases.Characteristic pathologic changes may contribute to definite diagnosis.