结核性淋巴结炎的针吸细胞学特点及漏诊原因分析

Missed diagnosis and fine needle aspiration cytological features of tuberculous lymphadenitis

目的分析颈颌部淋巴结结核针吸涂片细胞学特点及漏诊原因。方法HE染色及抗酸染色 ,利用光镜观察淋巴结结核针吸涂片的细胞成分及形态。结果小淋巴细胞及单核细胞为淋巴结结核针吸涂片之背景细胞 ,干酪样坏死物为坏死型淋巴结结核的主要成分 ,而上皮样细胞及朗汉斯巨细胞则较难见到 ;抗酸染色诊断结核漏诊率高。结论随着结核治疗的进展 ,变异的结核菌及其所致非典型性结核病变增多 ,其针吸涂片细胞学特点也随之改变。临床应结合聚合酶链反应技术、改良抗酸染色或免疫组织化学染色 ,以提高结核菌的阳性检出率。

Objective To investigate the cytological characteristics of tuberculous adenitis in neck and jaw with needle aspiration smear and to explore the causes for missed diagnosis. Methods Having been processed with HE staining and acid-fast staining, smears were observed with light microscopy to sum up the cytological characteristics of tuberculous lymph adenitis.Results Light microscopy revealed: small lymphocyte and monocytes made up of the background on the smear;caseous necrosis was found the dominating component of tuberculous adenitis;epithelioid cells and Langerhans giant cells were not frequently found;acid-fast bacillus could not be found in all the smears. Conclusion As the treatment of tuberculosis developed, the variant acid-fast bacillus and atypical tuberculosis were becoming increasingly common. The cytological characteristics on smear were also changing. Routine acid-fast staining would result in missed diagnosis. In clinical practice, PCR, improved acid-fast staining technique or immunohistochemistry should be combined in order to enhance the detection of Bcillus tuberculosis.