肺郎格汉斯细胞组织细胞增生症的病理诊断及鉴别诊断

Pathologic diagnosis and differential diagnosis of pulmonary Langerhans' cell histiocytosis

目的 探讨肺郎格汉斯(Langerhans)细胞组织细胞增生症诊断和鉴别诊断。方法常规HE染色及免疫组织化学链霉素抗生物素蛋白-过氧化物酶(SP)法染色观察7例肺郎格汉斯细胞组织细胞增生症的形态学及S-100、CD68、CD1a免疫组织化学表达特点并分析其临床资料。结果7例均可见明确郎格汉斯细胞性肉芽肿改变,并可见中等量炎细胞浸润、局灶间质纤维化及灶性坏死。免疫组织化学阳性检出情况分别为S-100 7/7、CD68 3/7、CD1a 5/5。结论 临床及影像学检查(X线及CT)怀疑郎格汉斯细胞组织细胞增生症患者应尽早行开胸或胸腔镜肺活组织检查,病理学确诊对肺郎格汉斯细胞组织细胞增生症的治疗和控制其发展有很重要作用,免疫组织化学S-100及CD1a染色对鉴别诊断有意义。

Objective Morphologic findings of pulmonary Langerhans' cell histiocytosis were analyzed in order to delineate diagnostic features. Methods H&E staining and immunohistochemical studies were performed on 7 cases of pulmonary Langerhans' cell histiocytosis. Results Infiltration by Langerhan's cells was obvious in all 7 cases. Inflammatory cell infiltrates, interstitial fibrosis and focal necrosis may also be seen. The cells expressed S-100 (7/7) ,CD68(3/7) ,and GD1 a (5/5). Conclusions In case there is radiologic suspicion of Langerhans' cell histiocytosis, pulmonary biopsy is strongly advised for a definitive diagnosis. S-100 and GD1 a immunostaining is also helpful in this respect.