加减海藻玉壶汤治疗急性淋巴结炎的临床观察

急性淋巴结炎是一种常见病、多发病 ,在临床上较为常见。根据中医辨证 ,笔者应用加减海藻玉壶汤治疗本病 ,临床疗效满意 ,现总结如下。1　临床资料1.1　一般资料　 42例病人均来自门诊 ,年龄 6～ 5 6岁 ,平均32岁 ;病程最短 13天 ,最长 7个月。单个淋巴结肿大的 32例 ,全身多处散在性肿大的有 10例。全部经穿刺病理检查 ,诊断为淋巴结炎。多数患者出现淋巴结压痛 ,少数低热。体检时触及的淋巴结大小不等 ,质地柔韧 ,活动度可 ,表面光滑 ,与正常组织无粘连 ,排除淋巴结癌的可能。1.2　治疗方法　采取随机抽取的方法 ,将上述病例平均分成两组 …     

淋巴结穿刺和活检在组织坏死性淋巴结炎诊治中的作用——附1例病理分析

目的探讨组织细胞坏死性淋巴结炎(hostiocytic necrotizing lymphadeuitis,HNL)的临床特点及病理诊断方法。方法对1例组织坏死性淋巴结炎的多次误诊经过和两次病理检查进行对比分析,并复习相关文献。结果本例发热伴颈部淋巴结肿大患者曾先后被诊断为上呼吸道感染、颅内感染、结核,均给予相应治疗无效,分别经淋巴结穿刺和活检后,确诊为组织坏死性淋巴结炎,经糖皮质激素治疗后治愈出院。结论 HNL临床症状不典型,淋巴结活检尤其是免疫组化检测是确诊的金标准。     

颈部淋巴结结核40例临床分析

目的 探讨颈部淋巴结结核的临床特征、诊断和治疗.方法 回顾性分析40例颈部淋巴结结核患者的临床资料,男13例,女27例,年龄8～62岁(中位年龄32岁),所有患者均行胸部X线检查,其中4例做了细针穿刺病理检查,30例(包括3例穿刺阴性)做了病理活检.确诊后均接受1年以上全身抗结核治疗,其中32例接受了局部肿块切除和(或)穿刺抽脓、链霉素纱条换药.结果 颈部淋巴结结核累及双侧12例(30%),单侧28例(70%);累及一个解剖区域27例(67.5%),2个以上13例(32.5%).其中结节型24例(60%),脓肿型10例(25%),浸润型4例(10%),溃疡瘘管型2例(5%).1例细针穿刺、30例病理活检证实结核,9例伴肺结核未做肿块活检.所有患者治疗结束后颈部结核性肿块均控制.结论 颈淋巴结结核的临床表现复杂,细针穿刺活检阳性率不高,病理组织活检和胸部X线检查有助于确定颈部淋巴结结核的诊断,全身全程抗结核治疗和选择性外科手术联合治疗有助于尽快控制颈部淋巴结结核.     

淋巴结针吸细胞学检查49例

目的：总结淋巴结针吸细胞学特点以提高诊断的正确性。方法：分析经活检病理确诊、临床资料完整的淋巴结针吸细胞病例49例细胞形态特征，并分类总结。结果：49例中转移癌19例，急性淋巴结炎8例，慢性增生性淋巴结炎12例，淋巴结结核6例，淋巴瘤4例。结论：针吸细胞学技术简捷方便，取材容易，病检报告快。总结其镜下细胞特征，在结合病史、辅助检查的基础上具有重要的诊断价值。     

组织细胞坏死性淋巴结炎临床病理分析

目的：探讨组织细胞坏死性淋巴结炎（HNL）的临床病理诊断及免疫组化特征。方法：用HE染色及免疫组化对8例HNL病例进行观察、分析。结果：8例HNL主要症状为发热和颈部淋巴结肿大;组织学上表现为大小不等散在或融合的病灶,病变区以坏死为主伴散在核碎片,多种形态组织细胞增生,缺乏嗜中性粒细胞浸润。免疫组化示组织细胞表达CD68,部分散在的小淋巴细胞及增生免疫母细胞CD3、CD45RO标记大多成阳性。结论：HNL多见于青年女性,病因及发病机制不清,为淋巴结反应性增生性病变,临床病理特征复杂,易误诊。     

Kikuchi淋巴结炎15例临床病理分析

目的：探讨Kikuchi淋巴结炎（KD）的临床和病理特征，做好与相似病变的鉴别诊断。方法：回顾性分析15例Kikuchi淋巴结炎临床表现、淋巴结活检病理形态特点及免疫组织化学表达情况。结果：该病11例发生于女性，14例表现在颈部多发性淋巴结肿大，伴有持续性低热、高热或不规则热稽留热，有外周血白细胞降低，普通抗炎治疗效果不明显；淋巴结内不同程度的组织细胞增生、凝固性碎屑性坏死、有正常淋巴结结构保存，免疫组化染色示组织细胞CD68大片状阳性S100部分阳性，CK、CD20、CD45RO、CD30均阴性。结论：Kikuchi淋巴结炎是一自限性非肿瘤性病变，在临床表现、病理特点及免疫组化染色均有特异性，结合各方面表现能极大提高一次性正确诊断率。     

细针穿刺细胞学在体表肿大淋巴结早期诊断中的应用价值

目的探讨细针穿刺细胞学的诊断淋巴结疾病的临床应用。方法应用细针穿刺法抽吸淋巴结组织细胞成分常规制片两张,在普通光学显微镜下分析细胞结构。结果淋巴结核发病率最高有612例病例以淋巴结核45.6%,慢性淋巴结炎31%淋巴结反应增生11.3%。结论淋巴结针吸细胞病理学可做淋巴结肿大疾病早期诊断及鉴别诊断,与预后密切相关,具有简单快速低价实用、准确率高、便于推广等优点。     

乳腺、淋巴结细针穿刺细胞学150例病理分析

目的 对我院2000～2007年150例门诊住院病人用细针穿刺淋巴结50例、乳腺100例,涂片细胞学进行分析.结果 找到癌细胞40例,乳腺增生60例,慢性淋巴结炎15例.结论 细针穿刺细胞学检查具有简单、快捷、经济、创伤小、安全、痛苦小等优点,适宜作为临床第一线检查方法在基层医院推广.     

Kikuehi淋巴结炎15例临床病理分析

目的：探讨Kikuchi淋巴结炎（KD）的临床和病理特征，做好与相似病变的鉴别诊断。方法：回顾性分析15例Kikuchi淋巴结炎临床表现、淋巴结活检病理形态特点及免疫组织化学表达情况。结果：该病11例发生于女性，14例表现在颈部多发性淋巴结肿大，伴有持续性低热、高热或不规则热稽留热，有外周血白细胞降低，普通抗炎治疗效果不明显；淋巴结内不同程度的组织细胞增生、凝固性碎屑性坏死、有正常淋巴结结构保存，免疫组化染色示组织细胞CD68大片状阳性S100部分阳性，CK、CD20、CD45RO、CD30均阴性。结论：Kikuchi淋巴结炎是一自限性非肿瘤性病变，在临床表现、病理特点及免疫组化染色均有特异性，结合各方面表现能极大提高一次性正确诊断率。     

梅毒性淋巴结炎8例临床病理分析

目的 分析梅毒性淋巴结炎的临床病理学表现,探讨该病相对特征性的组织病理改变.方法 对8例梅毒性淋巴结炎的临床资料和组织学形态进行回顾性分析,采用与临床实验室检查相结合的方法对其进行诊断和鉴别诊断.结果 腹股沟淋巴结无痛性肿大5例,胸壁1例,颌下1例,腋下1例,淋巴结直径1.8~4.0cm,平均3.1cm.组织病理基本病变是,①闭塞性血管内膜炎;②血管周浆细胞、淋巴细胞浸润;③被膜及淋巴结周围组织以浆细胞为主的慢性炎细胞浸润和纤维化,导致被膜显著增厚是梅毒性淋巴结炎相对特征性的组织学表现.淋巴滤泡增生,滤泡间和副皮质区血管周围有大量淋巴细胞与浆细胞浸润,上皮样组织细胞增生伴有肉芽肿改变;散在小灶性坏死是诊断的参考性指标.结论 梅毒性淋巴结炎的组织病理表现仅具有相对特征性,非特异性改变多种多样,极易误诊为非特异性慢性淋巴结炎、淋巴结反应性增生或者淋巴结结核等病变,其最终诊断仍需结合梅毒血清实验室检查.     

高频超声引导下粗针穿刺活检诊断颈部及锁骨上窝淋巴结病变的应用价值

目的 探讨高频超声引导下粗针穿刺活检（CNB）诊断颈部及锁骨上窝淋巴结病变的应用价值。方法 选取2020年2月—2021年8月青海省人民医院收治的145例颈部及锁骨上窝淋巴结病变患者（145枚淋巴结）作为研究对象。统计临床淋巴结病变诊断结果。对比不同颈部及锁骨上窝淋巴结病变患者病理诊断结果。对比高频超声引导下CNB与病理诊断结果。并以病理诊断结果作为金标准，分析高频超声引导CNB对颈部及锁骨上窝淋巴结病变的诊断效能。结果 ≥ 45岁患者淋巴结恶性率高于< 45岁患者（P <0.05）。不同性别、淋巴结纵横比患者淋巴结恶性率比较，差异无统计学意义（P >0.05）。高频超声引导下CNB诊断结果为恶性病变100例（肿瘤淋巴结转移71例，淋巴瘤24例，淋巴结反应性增生1例，淋巴结结核4例），良性病变45例（肿瘤淋巴结转移1例，淋巴瘤1例，淋巴结反应性增生32例，淋巴结结核11例），病理诊断结果为恶性病变97例（肿瘤淋巴结转移72例，淋巴瘤25例），良性病变48例（淋巴结反应性增生33例，淋巴结结核15例）。高频超声引导下CNB对颈部及锁骨上窝淋巴结病变诊断的敏感性、特异性和准确率分别为97.94%（95% CI：0.477，0.878）、89.58%（95% CI：0.650，0.834）和95.17%（95% CI：0.610，0.785）。结论 高频超声引导下CNB诊断颈部及锁骨上窝淋巴结病变的效能较高，可作为临床诊断颈部及锁骨上窝淋巴结病变的首选方法。     

颈部淋巴结结核的CT诊断

目的分析颈部淋巴结结核的CT表现,探讨诊断价值及鉴别诊断。方法回顾分析15例颈部淋巴结核的MSCT表现。全部病例均经病理证实。其中男2例,女13例。年龄13-66岁。结果颈部淋巴结结核好发于胸锁乳突肌周围。根据增强扫描强化方式不同可以反映病理改变的不同。结论 MSCT在颈部淋巴结结核的诊断有着重要价值,增强扫描可以反映病理改变。     

Evaluation of fine needle aspiration cytology (FNAC) of lymph node in Mymensingh

Fine needle aspiration cytology (FNAC) is widely accepted as the accurate, sensitive, specific and cost-effective procedure in the diagnosis of lymphadenopathy. The purpose of the study was to evaluate the results of FNAC of lymph nodes in our institutions comparing with results of histopathology. We performed 117 FNAC of lymph node in a period between November 2001 to April 2002, of which, histological results were available in 81 (69.23%). Cervical lymph nodes were 102 (87.18%) and axillary lymph nodes were 15 (12.82%). Male to female ratio of the patients was 1:0.65. Patients' age ranged from 3-80 years with a median age of 23 years. FNAC diagnosis was found to be as follows: granulomatous inflammation 46 (40.35%), reactive hyperplasia 31 (27.19%), metastatic carcinoma 20 (17.54%), Non-Hodgkin's lymphoma 6(5.26%), tubercular lymphadenitis 4(3.51%), acute non-specific lymphadenitis 3(2.63%), Hodgkin's lymphoma 3(2.63%) and chronic non-specific lymphadenitis 1(0.88%). Out of 81 cases of FNAC 71(87.65%) were consisted with histopathological diagnosis of granulomatous lymphadenitis. In the malignancy of lymph node sensitivity and specificity of FNAC were 82.76% and 97.92%, respectively. So, the investigators reasonably conclude that before resort to surgical intervention FNAC may be a helpful procedure in the diagnosis of both neoplastic and non-neoplastic lesion of lymph nodes.     

颈部淋巴结肿大180例临床病理分析

目的：探讨颈部淋巴结肿大的病因,以指导临床诊断与治疗.方法：对2008年1月至2013年4月以颈部淋巴结肿大为首发症状并行病理活检的颈部淋巴结肿大患者180例临床病理资料进行回顾性分析.结果：180例患者中,恶性淋巴结肿大96例（53.33％）,其中主要为转移癌39例（40.62％）和非霍奇金淋巴瘤40例（41.67％）,不明原因转移癌8例（20.51％）;良性淋巴结肿大84例（46.67％）,其中主要为非特异性淋巴结炎32例（38.09％）和淋巴结结核34例（40.48％）.结论：颈部恶性淋巴结肿大以转移癌和非霍奇金淋巴瘤最为常见;良性淋巴结肿大以非特异性淋巴结炎与淋巴结结核较为常见.对不明原因颈部淋巴结肿大的病例,应及时行淋巴结活检以明确诊断.     

端粒酶活性检测在浅表淋巴结转移癌诊断中的价值

目的探讨浅表淋巴结细针穿刺活检（FNAB）标本中端粒酶活性检测在浅表淋巴结转移癌诊断中的应用价值。方法在超声引导下穿刺抽取浅表淋巴结组织FNAB标本,分别进行细胞学病理检查和端粒酶活性检测,以术后石蜡病理切片结果为最终标准,对以上两者结果进行对照分析。结果在40例浅表淋巴结转移癌中,FNAB的正确诊断率为45%（18/40）,端粒酶活性阳性率为77.5%（31/40）,两者相比差异有显著性（P〈0.05）,在22例浅表淋巴结转移癌被FNAB诊断为“可疑阳性”、“取材不够”及“淋巴结炎”者中17例显示端粒酶活性,阳性率为77.3%（17/22）,两者联合诊断率可提高至87.5%。结论端粒酶活性检测是FNAB很好的辅助诊断方法,两者联合应用可有效提高FNAB标本的阳性诊断率。     

组织细胞坏死性淋巴结炎35例临床病理及免疫表型分析

目的探讨组织细胞坏死性淋巴结炎的临床和病理学特点。方法回顾性分析35例组织细胞坏死性淋巴结炎的临床资料。结果 35例患者主要表现为单发或多发淋巴结肿大,并有持续性发热,淋巴结活检可见不同程度的凝固性坏死伴多种形态的组织细胞、淋巴细胞浸润,免疫组化染色显示组织细胞及T细胞较多,很少见到B细胞。结论组织细胞坏死性淋巴结炎临床表现无特异性,显微镜下淋巴结结构破坏,常见凝固性坏死,细胞异型性较大,容易误诊为淋巴瘤、结核,必须认真阅片,结合病史,避免误诊。     

Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management

Tuberculosis is one of the biggest health challenges the world is facing. In this study the clinical pattern of patients with cervical lymphadenitis, who presented to the ear, nose, and throat outpatient department of the Government Medical College Hospital, Chandigarh, India between June 1997 and May 1998 is recorded. Tuberculosis accounted for 60 out of 94 cases of cervical lymph node enlargement. The commonest age group affected was 11-20 years. Constitutional symptoms were not present in most of the patients. Multiple matted nodes were seen in 23 patients but a single discrete node was seen in 18 patients. Upper deep jugular nodes were the most commonly affected lymph nodes. Discharging sinus and abscess formation were uncommon. Fine needle aspiration cytology yielded a positive diagnosis in 52 out of 56 patients. Chest lesions on radiography were evident in 16% of the patients. Mantoux test was positive and was more than 15 mm in most of the patients. This study shows that the classical picture of "scrofula" is no longer seen nowadays and can probably be explained by the earlier presentation of the disease. All the patients were treated with short course daily chemotherapy for six months. Surgery was not required in the majority of patients except in four cases where excision biopsy was performed. Patients with abscess formation were managed with wide bore needle aspiration only. With a minimum six month period of follow up, no patient was found to have a recurrence of local or systemic disease. This study emphasises the role of fine needle aspiration cytology in diagnosis and confirms the efficacy of six months short course chemotherapy.     

Tubercular lymphadenitis - diagnostic evaluation

Tuberculosis is one the commonest disease affecting peripheral lymph node and cervical tubercular lymphadenitis are frequently encountered in Otolaryngological practice. Three hundred fifty six (356) cases of Fine Needle Aspiration for Cytology (FNAC) positive tubercular lymphadenitis were studied from January 2006 to December 2008. FNAC positive but histopathologically negative cases were excluded from the study. Among 356 cases of FNAC positive cervical lymphadenopathy 300 cases (84.27%) were confirmed tuberculosis on histopathological examination. Remaining 50 cases (15.73%) were diagnosed as nontubercular lymphadenitis where nonspecific lymphadenitis was the commonest finding 34(9.55%) followed by metastatic carcinoma 7(1.97%), lymphoma 6(1.08%), Kikuchiz's disease 6(1.08%), Kala-Azar 2(0.56%) & Leukemia 1(0.28%). Most of the patients presented with only multiple lymph node swelling with other symptoms, such as fever 18(5.06%), pain (15.7%), tenderness 53(14.88%), weight loss 29(8.14%), anorexia 33(9.26%). Following observations are evident from this study: i) Disease is comparatively common between 12-35 years ii) Multiple matted/discrete lymph nodes are the earliest presentation iii) Multiple lymph node is the most consistent finding for clinical diagnosis. iv) Very few patients have constitutional symptoms v) Suppuration with or without abscess formation although confirms the diagnosis even then certainty is very essential. Though the evidence of cervical tuberculosis was thought to be decreasing in developing countries the real picture seems to be different. Random survey among the whole population was not done in any country rather hospital based laboratory research was made.     

E-cadherin、FAK在声门上型喉癌组织中的表达及其与颈淋巴结隐性转移的相关性

目的探讨E-cadherin、FAK的表达在声门上型喉癌早期淋巴结转移诊治中的价值。方法采用免疫组化法检测30例声门上型喉癌患者活检组织中E-cadherin、FAK的表达情况,并结合肿瘤分化程度及局部肿瘤分期选择性进行颈淋巴结清扫治疗,然后分析E-cadherin、FAK的表达与淋巴结转移的相关性。结果cN1-3患者18例,术后淋巴结转移15例,无转移3例。cN0患者12例,其中6例E-cadherin低表达、FAK中高表达,且分化程度为中或低分化,行双侧选择性淋巴结清扫术（Ⅱ～Ⅳ区）,后经病理检查证实3例有淋巴结转移。所有患者均随访1．5年,未行淋巴结清扫的6例cN0患者中1例发生同侧淋巴结转移,行淋巴结清扫的6例cN0患者均未见淋巴结转移。结论声门上型喉癌转移与否与E-cadherin、FAK的表达相关,利用肿瘤组织分化程度、原发肿瘤分期及E-cadherin、FAK的检测可指导声门上型喉癌选择性进行颈淋巴结清扫治疗。