组织细胞坏死性淋巴结炎的诊断和鉴别诊断

目的 探讨组织细胞坏死性淋巴结炎(KD)的诊断与鉴别诊断。方法 选择46例KD,5例非特异性淋巴结炎(NLD),5例非霍奇金淋巴瘤(NHL),5例霍奇金淋巴瘤(HD),5例猫抓病(CSD)和5例结核性淋巴结炎(TBL),做了组织学、免疫组织化学EnVision法观察,其中6例KD和2例NHL做了电镜观察。结果 KD可有增殖,坏死和黄色瘤样三种病理组织学图像,但其基本的组织学特点为：淋巴结边缘契形淡染病灶和副皮质区融合性淡染病灶,病灶内单核样组织细胞明显增生,出现新月体样组织细胞,凋亡细胞或核碎片增多,无或很少见中性粒细胞等。免疫组织化学标记,灶性的组织细胞CD68和MPO阳性。电镜下可见病灶内增生的单核样组织细胞、新月体样组织细胞、凋亡小体和周围散在T淋巴细胞。结论 典型的KD由于其形态变化多样,有时需与其他淋巴结病仔细鉴别。这时仔细寻找KD的形态学特点,结合组织学、免疫组织化学和电镜观察,有助于确定KD的诊断。     

肝上皮样血管内皮瘤2例临床病理分析

目的 探讨肝上皮样血管内皮瘤(hepatic epithelioid haemangioendothelioma,HEH)的临床病理特点及诊断和鉴别诊断.方法 回顾分析2例HEH的临床病理和免疫组化特征.结果 2例均为女性,年龄分别为51、55岁.临床均表现为右上腹疼痛不适,均为单发,位于肝右叶,大小分别为5 cm×4 cm×3 cm、5 cm×4 cm×4 cm.例2伴肝门淋巴结转移.光镜下肿瘤细胞呈上皮样或梭形,伴胞质内管腔,腔内可见红细胞,间质黏液透明变,瘤细胞浸润周围肝组织,例1伴钙化,脉管腔内见乳头状生长瘤细胞,似瘤栓样结构;例2淋巴结转移瘤细胞异型明显,伴局灶坏死,除淋巴结转移瘤细胞仅CD31阳性外,2例瘤组织CD31、CD34、FⅧRAg因子均为阳性,其中例2表达部分上皮标记如CK8和LCK.结论 HEH少见,易误诊为转移癌.在遇到胞质内管腔含红细胞、间质黏液玻璃样变性时应考虑HEH.     

脾脏硬化性血管瘤样结节性转化临床病理分析

目的 探讨脾脏硬化性血管瘤样结节性转化的病理形态特征、形成原因及鉴别诊断.方法 对10例脾脏硬化性血管瘤样结节性转化病例进行病理形态观察,EnVision法行免疫组织化学染色,并行网状纤维染色和PAS染色,1例行电子显微镜观察.结果 脾脏硬化性血管瘤样结节性转化有其特征性血管瘤样结节,免疫组织化学显示结节内内皮细胞异质性表达,即小叶状分布毛细血管免疫表型为CD34~+/CD31~+/CD8~-,窦岸样细胞免疫表型为CD8~+/CD31~+/CD34~-,小静脉样血管免疫表型为CD31~+/CD8~-/CD34~-,结节内梭形细胞混合表达CD31、平滑肌肌动蛋白(SMA)和CD68,结节间梭形细胞混合表达SMA和CD68.网状纤维染色显示结节轮廓和结节内血管,PAS染色显示结节周围胶原沉积物.电镜显示淋巴窦扩大,胶原丰富等特征.结论 该病是一种少见的脾脏良性病变,可能是一种反应性病变,与血管瘤出血坏死机化关系密切.尤其需要与脾脏交界性或恶性肿瘤鉴别.     

脾脏硬化性血管瘤样结节性转化3例病理分析

目的 探讨脾脏硬化性血管瘤样结节性转化(sclerosing angiomatoid nodular transformation,SANT)的病理形态特征、诊断及鉴别诊断.方法 对3例脾脏SANT进行病理形态观察,免疫组化染色采用EnVision法,并对临床资料和术后随访情况进行分析讨论.结果 脾脏SANT具有特征性血管瘤样结节.病理学检查:(1)眼观病灶呈灰白色结节,边界清楚.(2)镜下见有其特征性血管瘤样结节.免疫组化显示结节内内皮细胞异质性表达,即小叶状分布毛细血管免疫表型为CD34、CD31均(+),CD8(-),窦岸样细胞免疫表型为CD34(-),CD31、CD8均(+);小静脉样血管免疫表型为CD34、CD8均(-),CD31(+);结节内梭形细胞混合表达CD31、SMA和CD68;结节间梭形细胞混合表达SMA和CD68.结节周围梭形细胞呈vimentin、SMA阳性反应,desmin和NSE均(-).术后随访,患者病变均复发和转移.结论 该病是一种罕见的脾脏良性病变,可能是一种增生性病变,与血管瘤出血坏死机化关系密切.需要与脾脏交界性或恶性肿瘤鉴别,鉴别诊断依靠病理组织学形态和免疫组化.     

脾脏硬化性血管瘤样结节性转化的临床病理特征

目的 探讨脾脏硬化性血管瘤样结节性转化(sclerosing angiomatoid nodular transformation,SANT)的临床病理特征、诊断和发生机制.方法 对5例脾脏SANT进行常规HE及免疫组化(SP法)观察并结合文献进行讨论.结果 眼观病变呈单发或多发性结节,边界清楚,切面斑彩状.显微镜下特征性的表现是多发性血管瘤样结节形成,其周围被增生的纤维组织包绕.结节中央为裂隙样、不规则形或略扩张的血管腔,内衬肿胀的内皮细胞.血管腔隙之间为梭形细胞和卵圆形细胞.结节周围的纤维化组织中有淋巴细胞、浆细胞和组织细胞浸润.免疫组化显示结节内毛细血管内皮细胞CD34和CD31(+),CD8(-);窦内皮细胞CD8和CD31(+),CD34(-);结节内的小静脉CD31(+),CD34和CD8(-);结节周围梭形细胞vimentin、SMA(+),desmin(-);其内的炎细胞CD68(+).其中1例伴发腹腔多发性钙化性纤维性肿瘤.结论 脾脏SANT是一种少见的特殊的脾脏血管病变,有其特征性的临床病理特征,可以伴发腹腔多发性钙化性纤维性肿瘤,预后良好,应注意与脾脏其他类型肿瘤及瘤样病变鉴别.     

皮肤结核临床观察分析

目的 提高对皮肤结核病诊断的警惕和认识能力.方法 对112例皮肤结核的临床特点、辅助检查、病理组织学检查.结果 皮肤结核临床表现多样,不典型,极易误诊为其它皮肤病,最后行组织病理检查、病原学检查、PPD试验或诊断性抗结核治疗确定诊断.结论 皮肤结核病程长,组织病理检查、病原学检查、PPD试验或诊断性抗结核治疗对结核病的诊断有极大帮助.     

进行性转化生发中心样滤泡T细胞淋巴瘤14例临床病理学分析

目的探讨进行性转化生发中心样滤泡T细胞淋巴瘤(PTGC样FTCL)的临床病理学特征。方法收集首都医科大学附属北京友谊医院病理科2017年1月至2022年1月14例PTGC样FTCL, 分析其临床特征、病理形态、免疫表型及EB病毒感染状态。对10例行T细胞受体基因检测, 对8例行免疫球蛋白(Ig)基因克隆性检测。结果 (1)患者男性10例, 女性4例, 男女比为5∶2, 发病年龄32～70岁, 中位年龄61岁, 起病时均有淋巴结肿大, 按Ann Arbor系统分期, Ⅰ～Ⅱ期7例, Ⅲ～Ⅳ期7例, 有B症状者7例, 脾肿大者4例, 伴皮疹及皮肤瘙痒者2例。10例获得原单位病理报告, 3例诊断为小B细胞淋巴瘤, 3例诊断为经典霍奇金淋巴瘤, 2例诊断为不除外血管免疫母细胞性T细胞淋巴瘤(AITL), 1例诊断为EB病毒相关淋巴组织增生性病变, 1例诊断为外周T细胞淋巴瘤(PTCL)伴多量B细胞反应。(2)形态学显示由形态成熟的小淋巴细胞构成的深染大结节, 结节内可见散在及灶状分布的异型瘤细胞, 胞质淡染或透明。2例在深染结节内见增生的生发中心。5例在结节内还见到散在霍奇金(HRS)样大细胞...     

儿童肾脏上皮样血管平滑肌脂肪瘤病理特点

目的 探讨儿童肾脏上皮样血管平滑肌脂肪瘤(epithelioid angiomyolipoma,EAML)免疫标记的表达特点及其对临床病理诊断、鉴别诊断和预后的意义.方法 对1例肾脏EAML临床资料进行复习,进行光镜观察和免疫组化染色,并随访.结果 光镜下肿瘤由典型性的上皮样细胞组成,细胞核有异型性,核分裂象可见,有坏死和出血;淋巴结内未见上皮样肿瘤细胞累及.免疫标记:瘤细胞vimentin、SMA、HMB-45、Melan-A、CD68均阳性;而CK(AE1/AE3)、EMA、S-100、CD10、CD34、CD117、ER、PR、Ki-67和p53均为阴性.患者手术后状态良好,无肿瘤局部复发和转移征象.结论 肿瘤以上皮样细胞增生特征为主,临床表现和组织学表现易与肾脏肿瘤及其他肿瘤相混,寻找经典血管平滑肌脂肪瘤的结构和肿瘤细胞表达HMB-45和SMA对诊断和鉴别诊断至关重要.而细胞的不典型性、核分裂、出血和坏死可能只表明肿瘤的恶性潜能;淋巴结受累、肾静脉瘤栓均不是恶性的诊断依据;远处转移才是恶性的证据.Ki-67和p53对患者的预后可能有指示意义.     

颈部淋巴结黏液表皮样癌

目的 探讨颈部淋巴结黏液表皮样癌的临床病理特点及鉴别诊断.方法 对1例颈部淋巴结黏液表皮样癌的临床病理特点进行分析并复习文献.结果 患者3次入院手术病理检查组织形态有较大变化.第一次活检标本镜下见淋巴结包膜完整,结内肿瘤组织主要由3种细胞构成:黏液细胞、中间型细胞及表皮样细胞,并可见较多含黏液的囊腔结构.第二次见肿瘤仍位于淋巴结内,主要由表皮样细胞构成,偶见分泌黏液的细胞,含黏液的囊腔结构几乎全部消失.第三次活检标本见横纹肌内浸润的癌细胞巢主要由表皮样细胞构成.随访2年,未见其他部位肿瘤.结论 (1)颈部淋巴结可能会发生原发性的涎腺黏液表皮样癌.(2)颈部淋巴结的黏液表皮样癌可反复复发并发生结外浸润.(3)随着病变进展和(或)复发,黏液表皮样癌的分化程度会逐渐降低,组织病理学形态会发生相应改变.     

SARS尸检组织的病理变化和超微结构观察

目的 研究严重急性呼吸综合征(SARS)尸检组织的临床病理和超微结构特征。方法 对1例SARS死亡患者做即刻肺穿刺和12h后尸检,进行病理形态和超微结构的观察;用Macchiavello法做病毒包涵体染色;并对淋巴结、脾脏、结肠、小肠及骨髓组织行CD20、CD45RO(UCHL-1)、CD4、CD8、CD68、CD34免疫组织化学标记。结果 SARS肺的主要病变为急性弥漫性全小叶性间质性炎,可见肺泡腔内透明膜形成和增生及脱落的肺泡上皮,偶见胞质内病毒包涵体样结构,病毒包涵体染色阳性,肺内小血管增生、扩张,呈血管炎性改变。淋巴结、脾脏结构破坏,淋巴滤泡消失,脾小体萎缩,淋巴细胞明显减少,组织细胞增生;结肠、小肠孤立和集合淋巴结淋巴滤泡消失;骨髓增生减低,巨核细胞增多。免疫组织化学染色：淋巴结、脾脏B细胞CD20弥漫散在阳性,CD45RO(UCHL-1)散在阳性,CD4辅助T细胞显著减少,CD8毒性T细胞稍增加,CD4／CD8比例明显小于0．5。电镜观察：肺泡内的单核巨噬细胞、肺泡上皮胞质内可见病毒样颗粒,大小80～160nm,有光晕或花环状包膜。结论 肺部明显急性弥漫性全小叶性间质性炎,肺泡腔透明膜形成,肺外淋巴造血系统明显损害,尤T细胞明显;内脏器官出血、坏死和血管炎改变等为急性SARS的形态特征;肺内所见病毒样颗粒可能为新型冠状病毒,推测其为此次SARS流行的主要病原体。     

Histopathology of human lymph node tularemia caused by Francisella tularensis var palaearctica

Histopathology of tularemia, caused by type-B strain, tuberculosis, and sarcoidosis were compared in lymph node biopsy specimens from ten patients with tularemia, 26 with tuberculosis, and 14 with sarcoidosis. In very early tularemia there were only reactive changes without necrosis. Abscess necrosis with or without epithelioid cell reaction was observed during the second week and caseous necrosis during the fourth week. Argyrophil fibers were absent from necrotic lesions in tularemia, but, often, also in tuberculosis. In most cases of tularemia and in half the cases of tuberculosis, the inflammatory process extended beyond the capsule of the lymph node. In some cases, tularemia could not be histologically differentiated from tuberculosis, but tularemia was always differentiated from sarcoidosis. Our series of lymph node tularemia seems to represent a milder disease than those cases published earlier. Tularemia should be considered in the differential diagnosis with tuberculosis, toxoplasmosis, and cat-scratch disease.     

儿童川崎病临床特征分析

目的:分析并比较典型川崎病(KD)与不典型川崎病(IKD)的临床特征。方法:回顾性分析2017-01-01—2017-12-31武汉大学人民医院儿科收治的69例患儿的临床资料,将其分为IKD组(n=25)和KD组(n=44),比较两组患儿的临床特征。结果:两组患儿发热发生率均为100%,IKD组持续发热时间、确诊时间及临床治愈时间均明显高于KD组(P<0.05或P<0.01);两组患儿皮疹、颈淋巴结肿大、口唇皲裂及杨梅舌发生率差异无统计学意义(P>0.05);IKD组手足硬性水肿发生率低于KD组(P<0.05);IKD组肛周脱皮、卡疤红肿、冠状动脉损伤发生率均高于KD组(P<0.05)。结论:IKD具有发热时间久,早期不易确诊,冠状动脉损伤发生率高的特点,影响患儿预后,需早期识别诊断。     

Histiocytic necrotizing lymphadenitis diagnosed by conventional cytology and liquid based cytology

Histiocytic necrotizing lymphadenitis (HNL; Kikuchi-Fujimoto disease) is a rare benign disorder. The diagnosis of HNL is established on recognizing the characteristic histologic findings from biopsy of the enlarged lymph nodes. Though diagnosis of HNL by fine-needle aspiration (FNA) was reported, the characteristic fine-needle aspiration cytologic features with conventional cytology and a liquid based cytology test (LCT) have not been well documented. In this study, 42 cases of suspicious necrotic lymph nodes were subjected to cytology and biopsy diagnosis. The lymph nodes were aspirated using a 10 mL disposable syringe with the percutaneous ultrasound guided. Samples were used for conventional cytology and LCT. Among 42 cases of suspicious necrotic lymph nodes, 37 of cases were histologically confirmed as HNL; 3 of cases were hyperplasia of lymphoid tissue; 1 case was tuberculosis of lymph node, and 1 case was classical Hodgkin lymphoma (nodular sclerosis type). 31 out of 37 (83.8%) cases of HNL were diagnosed by conventional cytology, 33 out of 37 (89.2%) were diagnosed by LCT. Our results indicate that no significant difference on accuracy rate between conventional cytology and LCT, but LCT has its advantages in the diagnosis of HNL.     

Rapid diagnosis of tuberculous lymphadenitis by amplification of mycobacterial DNA]

In patients with cervical lymph node swelling, prompt differential diagnosis of tuberculosis leads to an appropriate treatment. A method based on DNA amplification and hybridization for the rapid detection of Mycobacterium tuberculosis was used for demonstrating its specific DNA in cervical lymph nodes biopsied from seven patients. The DNA specific for Mycobacterium tuberculosis was detected in 5 patients. Four of them were histologically diagnosed as tuberculous lymphadenitis. In another case with necrotizing lesions but without granulomatous reactions, culture method subsequently revealed a positive result. In other 2 cases, the diagnosis of tuberculosis was promptly excluded by both this method and conventional methods (histologic diagnosis/direct microscopy). The rapid detection of Mycobacterium tuberculosis by amplification of mycobacterial DNA is helpful particularly in differential diagnosis of cervical lymphadenopathy.     

Lymph-node tuberculosis in patients infected or not with HIV: general characteristics, clinical presentation, microbiological diagnosis and treatment

Lymph node tuberculosis is the most frequent form of extrapulmonary tuberculosis, especially in immunocompromised patients. We have studied patients with proven lymph node tuberculosis in the Department of Infectious Diseases at Pitié-Salpêtrière Hospital, Paris, between January 1997 and January 2002. Clinical presentation, microbiological diagnosis and treatment were analyzed in 13 HIV infected and 19 non-HIV infected patients. A risk factor for tuberculosis was present in all cases (HIV infection, immigration, life in community, poverty, past history of tuberculosis and IVDU). The median duration between the onset of symptoms and diagnosis was longer for HIV infected (2 months) compared with non-HIV infected patients (1 month). At the time of the diagnosis, general symptoms were present in >50% of patients of both groups. In HIV infected patients, abdominal lymph node involvement was more frequent (P < 0.05). All the non-HIV infected and 85% of HIV infected patients had peripheral adenopathies. A pulmonary tuberculosis was noted in more than half of the cases (53% non-HIV and 69% HIV patients). Inflammatory parameters and liver function tests were frequently abnormal in both groups. Hyponatremia was more frequent in HIV patients (P < 0.05). TB skin testing was more frequently positive and phlyctenular in non-HIV infected patients (P < 0.05). In this study, direct examination of the needle aspirate from infected lymph nodes was rarely positive; cultures were more frequently positive after biopsy compared to needle-aspiration. The median duration of treatment was 9 months for the two groups (6-24 months). Three HIV infected patients were infected by mycobacteria resistant to at least one antibiotic (isoniazid, 1; rifampicin, 1; isoniazid, streptomycin, etambutool, 1). All the patients recovered.     

Pulmonary Langerhans cell histiocytosis with cervical lymph node involvement,and coexistence with pulmonary tuberculosis and right pneumothorax: a case report and review of literature

We report an uncommon 22-year-old male Pulmonary Langerhans Cell Histiocytosis (PLCH) case which co-existed with pulmonary tuberculosis (TB). Unlike the common PLCH cases, this PLCH case has cervical lymph node involvement and right pneumothorax. The diagnosis was established by the imaging of lung and the biopsies of the lung and left neck lymph node. Imaging of the chest showed characteristic small nodules and thin-walled cysts and right pneumothorax. The LCH cells in the lung and left neck lymph node were characterized by large convoluted nuclei with cerebriform indentations of the nuclear envelope and longitudinal grooves. The nuclei contained small eosinophilic nucleoli and moderate amount cytoplasm. Immunohistochemically, the histiocytoid cells were positive for Langerin, CD1a and S-100. Acid-fast bacilli were found in sputum and lung biopsy tissue. To the best of our knowledge, this is the first case of PLCH with cervical lymph node involvement, and coexisted with pulmonary tuberculosis, right pneumothorax. A contribution of this case and review three of the five cases of PLCH with extrapulmonary involvement to lymph nodes resolved spontaneously after smoking cessation constitute a novel addition that it is inappropriate to regard pulmonary/nodal LCH as multi-organ or disseminated disease, and the treatment methods are the same whether the PLCH patient with lymph node involvement or not.     

Kikuchi's Disease in Children: Clinical Manifestations and Imaging Features

Previously published studies on Kikuchi disease (KD) have frequently addressed the computed tomography (CT) findings in the adult population, however, only a few studies have been reported for the pediatric age group. The purpose of this study is to analyze the clinical characteristics and imaging features of KD in children. Fifteen children (2-14 yr) who had a neck CT and pathology diagnosis of KD were included in this study. Clinical features, including the duration of lymphadenopathy and fever, prognosis, and laboratory values, were evaluated. We analyzed the sites, size, and lymph node pattern as seen on their CT scans. The median duration of fever was 10 days. Fourteen patients experienced improvement in their condition, although four of these patients experienced recurrent episodes of KD. All patients had affected cervical nodes at level V. Perinodal infiltrates were observed in the affected cervical nodes in 14 cases (93%), and non-enhancing necrosis was also noted within the affected cervical nodes in 10 cases (63%). In conclusion, the combination of imaging findings in conjunction with clinical findings of KD may help to determine whether or not to perform pathology analysis and follow-up studies.     

Fine-needle aspiration in the management of peripheral lymphadenopathy in a developing country.

Fine-needle aspiration (FNA) is a simple, cheap, and well-tolerated procedure that is well-established as a method of definitive diagnosis of palpable masses. This review reports the role of FNA in the investigation of peripheral lymphadenopathy as an alternative to expensive surgical excision biopsy in developing countries, where there are limited funds and facilities. All lymph node aspirates done in the FNA clinic at the Department of Pathology, University College Hospital, Ibadan, between 1995-1997 were reviewed. The aspirates were obtained using 21- or 22-gauge needle with a 5- or 10-ml disposable plastic syringe, smeared on standard microscopic slides and stained with Giemsa and/or Papanicolou stains. The most common diagnosis was reactive change/nonspecific inflammation, constituting 33.4%; tuberculosis and metastatic lesions made up 25. 7% and 22.4%, respectively, while lymphoma constituted 16.9% of cases. The commonly aspirated nodes were cervical. Tuberculosis was the most frequent diagnosis in these nodes and was the most commonly diagnosed infective condition, particularly in those under age 20 years. The sensitivity and specificity of lymph node FNA in the diagnosis of tuberculosis were 79.5% and 100%, respectively. The overall accuracy rate of lymph node aspiration was 89.5%. Our study showed that FNA is a simple, cost-effective procedure which offers a reliable method of diagnosis in distinguishing reactive lymphadenopathy, tuberculosis, and malignant conditions. Diagn. Cytopathol. 1999;21:159-162.     

Immunological marker patterns in granulomatous lymph node lesions

The distribution of various types of lymphocytes and macrophages was studied in 19 cases with granulomatous lymph node lesions using 14 monoclonal antibodies. Cases of sarcoidosis, tuberculosis and atypical mycobacteriosis all showed well demarcated granulomas devoid of B-lymphocytes and natural killer cells. In these cases, T-helper: T-suppressor cell ratios were greater than 2 and poor preservation of the normal lymphoid tissue outside the granulomas was seen. In contrast, cases of non-specific lymphadenitis showed less well-demarcated granulomas always containing B-lymphocytes and natural killer cells, with a T-helper:T-suppressor cell ratio less than 1 and good preservation of the normal lymphoid tissue outside the granulomas. Immunological marker studies may be helpful in the differential diagnosis of granulomatous lymph node lesions, as well as in the study of the pathogenesis of such lesions.