皮病性淋巴结炎20例临床病理分析

Clinicopathological analysis of dermatopathic lymphadenitis:a study of 20 cases

目的探讨皮病性淋巴结炎(dermatopathic lymphadenitis,DL)的临床病理学特征。方法回顾性分析2014~2021年中山大学附属第三医院病理科存档的20例DL的临床病理学及免疫表型特征、影像学表现、实验室检查结果等。采用免疫组化SP法对DL进行检测,并复习相关文献。结果20例DL患者中,男性9例,女性11例,年龄6~84岁,中位年龄34岁。临床表现为皮疹、瘙痒、发热、关节痛、淋巴结无痛性肿大。镜检:淋巴结结构保存,副皮质区扩大,可见形状不规则的淡染区,其内可见树突状细胞、小~中等大小的淋巴细胞及组织细胞,部分组织细胞胞质内可见色素颗粒沉积,另可见少量嗜酸性粒细胞、浆细胞及免疫母细胞散在分布。免疫表型:树突状细胞S-100、CD1a阳性,组织细胞CD68阳性,淋巴细胞大部分CD3阳性,小部分CD20阳性,生发中心BCL-2阴性,CD21、CD23显示淋巴滤泡内的滤泡树突状细胞网结构保存。结论DL是一种良性病变,临床表现易与淋巴瘤混淆,淋巴结活检是确诊手段。

Purpose To investigate the clinical and pathological features of dermatopathic lymphadenitis(DL).Methods The clinicopathological and immunophenotypic features,imaging manifestations,and laboratory findings of 20 cases of DL archived in the Department of Pathology,Third Affiliated Hospital of Sun Yat-sen University from 2014 to 2021 were retrospectively analyzed.The immunohistochemical SP method was used to detect DL and to review the relevant literature.Results Among the 20 DL patients,there were 9 males and 11 females,aging from 6 to 84 years,with a median age of 34 years.Clinical manifestations included erythra,pruritus,fever,arthralgia,and painless swelling of lymph nodes.All lymph nodes showed paracortical areas expanded by dendritic cells,lymphocytes,macrophages and melanophages.Eosinophils,plasma cells,and immunoblasts were scatteredly distributed.Immunohistochemical analysis showed that dendritic cells were S-100 and CD1a positive,mixed with CD68 positive histocytes.Most of the lymphocytes in the paracortical areas were CD3 positive,with a small number positive of CD20.The germinal center was negative for BCL-2.CD21 and CD23 showed preserved follicular dendritic cell structure in lymphatic follicles.Conclusion DL is a benign lesion that is easily confused with lymphoma clinically and the correct diagnosis depends on lymph node biopsy at present.