猫抓病性淋巴结炎38例临床病理分析

A clinicopathological study of 38 cases of lymphadenitis in cat scratch disease

目的 :探讨猫抓病性淋巴结炎的病理诊断、鉴别诊断及病因。方法 :应用免疫组织化学ABC法对 3 8例猫抓病性淋巴结炎标本分别标记CD2 0、CD45RO、Mac3 87;每例均作PAS反应、吉姆萨染色、Gram染色、六胺银及抗酸染色和Warthin starry染色。结果 :早期星形脓肿改变 9例 ,脓肿周围为B淋巴细胞 (CD2 0 +)和组织细胞(Mac3 87+) ;肉芽肿改变 2 9例 ,组织细胞源性类上皮细胞 (Mac3 87+)呈放射状排列 ,其间散在分布T淋巴细胞(CD45RO+)。 3 8例中 ,2 9例Warthin starry染色阳性 ,PAS反应、吉姆萨染色、Gram染色、六胺银及抗酸染色均为阴性。结论 :猫抓病性淋巴结炎的病理特征为星形脓肿和肉芽肿形成。免疫组织化学可识别增生的细胞类型 ,结合PAS反应、吉姆萨染色、Gram染色、六胺银及抗酸染色等 。

Objective:To study the pathologic diagnosis, differential diagnosis and the etiology of lymphadenitis in cat scratch disease.Method:Expression of CD20,CD45RO and Mac387 were evaluated immunohistochemically (ABC method). Each case was done by PAS, Giemsa,Gram, Grocott methenamine stain (GMS), fast anti-acid stain and Warthin-starry stain.Result:Nine cases of star-like abscess in early stage and 29 cases of granuloma in late period were found. The early star-like abscess were surrounded by B-lymphocytes (CD 20 +) and macrophages (Mac387 +). The granuloma were surrounded by epithelioid cells (Mac387 +) and T-lymphocytes (CD45RO +).Conclusion:The typical change of the lymphadenitis of cat scratch disease the formation of star-like abscess and granuloma. The immunohistochemical makers are helpful to distinguish the proliferative cell types. Combined with PAS, Giemsa, Gram, GMS, fast anti-acid stain, it was useful to differential diagnosis.