颈部淋巴结窦组织细胞增生伴巨大淋巴结病的CT表现与鉴别诊断

目的分析颈部淋巴结窦组织细胞增生伴巨大淋巴结病(sinus histiocytosis with massive lymphadenopathy,SHML)的CT影像表现及相关临床表现,探讨该病的诊断和鉴别诊断。方法回顾性分析经临床与病理证实的7例颈部淋巴结SHML患者的临床和CT影像资料,男4例,女3例,年龄2~39岁,7例均行CT平扫及增强扫描。结果活检证实的13枚受累淋巴结的最长径范围在0.8~4.1 cm,平均2.1 cm。CT平扫密度均匀减低者10枚(76.9%),增强扫描11枚呈多环状或半环状强化(84.6%),9枚边缘清晰,4枚边界不清。结论当青少年男性颈部肿大淋巴结CT平扫密度均匀但增强呈多环或半环状强化时应想到SHML的可能,熟悉其CT表现有助于将其纳入鉴别诊断,结合临床、影像学及实验室检查有助于确诊。

颈部猫抓病性淋巴结炎23例临床病理分析

目的：探讨颈部猫抓病性淋巴结炎的临床病理特征。方法选取驻马店市中医院2011年9月至2015年9月收治的23例颈部猫抓病性淋巴结炎患者，分析其临床病理特点。结果巨检：观察淋巴结，质量呈中等显示，为轻中度肿大，有灰黄色小的坏死灶于切面检出；镜下观察：以淋巴滤泡增生为主要表现，窦扩张，结构仍存在，有中性粒细胞间质浸润，有灶性或成片化脓性坏死，周边形成有肉芽组织。23例嗜银纤维染色结果均呈阳性，微脓肿周边、淋巴窦内切片示见颗粒状、棕黑色或多形性、杆状的细菌，均为显色阳性。采用手术切除肿大淋巴结，所有患者均痊愈。结论头颈部猫抓病淋巴结炎缺乏特异性临床表现，需依据病理特点及时诊断，对症支持并配合手术治疗可取得良好预后，最大程度保障患者生存质量。

The clinical management of Level VI lymph node and neck lymph node micrometastases in follicular thyroid carcinoma

Objective： We evaluated the relationship between the clinical management of level Ⅵ lymph node and neck lymph node micrometastases in follicular thyroid carcinoma. Methods： 326 negative neck lymph nodes of 68 cases with follicular thyroid carcinoma on routine pathology were examined by keratin-19 monoclonal antibody and S-P JmmunohJsto- chemistry to confirm lymph node micrometastasis. Follow-up pathological and clinical documents were compared. Results： Forty-six neck lymph nodes showed positive micrometastasis among 326 negative neck lymph nodes including 4 lymph nodes in Level Ⅱ （4/42）, 5 lymph nodes in Level Ⅲ （5/34）, 5 lymph nodes in Level Ⅳ （5/49）, 1 lymph node in Leve Ⅳ （1/17） and 31 lymph nodes in Level Ⅳ （31/184）. Six in 14 cases with positive micrometastasis showed distant metastasis or local recurrence, but only 3 in 54 cases with negative micrometastasis indicated distant metastasis or local recurrence （P 〈 0.01）. Conclusion： The research showed that Level VI neck lymph node micrometastasis is possibly occur and closely related with local recurrence and metastasis in follicular carcinoma of thyroid.