组织细胞坏死性淋巴结炎20例临床病理分析

Histiocytic necrotizing lymphadenitis:a clinicopathological analysis of 20 cases

目的 探讨组织细胞坏死性淋巴结炎 (HNL)的临床病理学特点。方法 回顾性分析 2 0例HNL的临床资料 ,应用光镜观察其形态改变 ,并应用SP法检测细胞表型和用TUNEL法检测凋亡情况。结果 2 0例中女性 13例 ,平均年龄 2 6岁。 16例颈部淋巴结肿大 ,半数有发热 ,2例有皮疹。外周血白细胞计数正常或偏低 ;血细胞沉降率增快。在活跃的反应性增生淋巴结病变的背景下 ,出现程度不同的凝固性坏死 ,伴有多种形态的组织细胞增生 ,细胞内外见大量碎片。病变区及周围有免疫母细胞及浆样单核细胞增生 ,无中性粒细胞浸润。组织细胞CD6 8和Lyso(+) ,淋巴细胞CD3和CD4 5RO(+) ,CD15、CD30和CD5 6 (- )。滤泡生发中心及散在淋巴细胞CD2 0 (+)。凋亡细胞及碎片TUNEL强 (+)。结论 HNL为淋巴结反应性增生的特殊表现。临床多见于年轻女性 ,常为单侧颈部淋巴结肿大 ,伴发热。临床病理特征复杂 ,易误诊。

Objective To study the clinical and pathological features of 20 cases of histiocytic necrotizing lymphadenitis (HNL) Methods The clinical and histopathologic features of 20 cases HNL were analyzed Immunophenotyping and detection of apoptotic DNA fragments were performed using SP and TUNEL methods respectively Results There were 13 female and 7 male, with age ranged from 12～43 years (mean 26 years) Sixteen patients developed cervical lymph node swelling with fever Laboratory examination showed increase in erythrocyte sedimentation, and decrease in total white blood cells The lymphnode biopsy revealed necrosis, loss of lymphnode structure with many histiocytes and absence of granulomatous reaction Many plasmacytoid monocytes and large lymphoid cells (immunoblasts) existed Immunophenotyping revealed CD3 and CD45RO positive for lymphocytes, CD68 for histiocytes and no expression of CD15,CD30,CD56,and CD20 in follicle center cells and scattered lymphocytes Conclusions HNL predominantly affects young women, who present with solitary or multiple cervical lymphadenopathy accompanied by fever Laboratory examinations show normal or nonspecific results The affected lymph node showed the typical histology of HNL: irregular shaped necrotic foci with histiocytes engulfing apoptotic bodies intermingled with plasmacytoid monocytes and immunoblasts without neutrophils HNL is often mistaken for malignant lymphoma A background of reactive lymphadenopathy, prominent karyorrhexis and pathy nodal involvement in the form of non expansive patchs are the important points of differential diagnosis.