鼻硬结病的临床病理分析

目的观察鼻硬结病的组织病理学和临床特点,探讨鼻硬结杆菌对宿主造成组织损伤的机理。方法以24例鼻硬结病患者的组织标本为研究对象,用HE及组织化学W-S（Warthin-Starry）染色,其中11例组织分别用CD43(T淋巴细胞)、CD20(B淋巴细胞)、CD68(巨噬细胞)、溶菌酶抗体免疫组化ABC法染色,2例进行透射电镜观察。结果肉芽肿期15例,纤维瘢痕期9例。W-S染色和电镜观察均在Mikulicz细胞内检测出大量鼻硬结杆菌,细胞外偶见。电镜下Mikulicz细胞内出现大量吞噬体,将细胞器挤到一侧,粗面内质网及溶酶体很少。在病变组织内T淋巴细胞很少,Mikulicz细胞的溶菌酶抗体表达较弱。结论鼻硬结病患者显示细胞免疫功能障碍的特点,宿主的免疫反应是导致组织损伤的主要原因。     

鼻硬结病的临床病理分析

目的 观察鼻硬结病的组织理学和临床特点，探讨鼻硬结杆菌对宿主造成组织损伤的机理。方法 以24例鼻硬结病患者的组织标本为研究对象，用HE及组织化学W－S（Wa rthin-Starry)染色，其中11例组织分别用CD43（T淋巴细胞）、CD20（B淋 巴细胞）、CD68（巨噬细胞）、溶菌酶抗体免疫组化ABC法染色，2例进行透射电镜观察。结果 肉芽肿期15例，纤维瘢痕期9例。W－S染色和电镜观察均在Mikulicz细胞内检测出大量鼻硬结杆菌，细胞外偶见。电镜下Mikulicz细胞内出现大量吞噬体，将细胞器挤到一侧，粗面内质网及溶酶体很少。在病变组织内T淋巴细胞很少，Mikulicz细胞的溶菌酶抗体表达较弱。结论 鼻硬结病患者显示细胞免疫功能障碍的特点， 的免疫反应是导致组织 损的主要原因。     

鼻腔鼻窦Rosai-Dorfman病与鼻硬结病临床病理对比分析

目的　对比分析鼻腔鼻窦Rosai-Dorfman病（Rosai-Dorfman disease,RDD）与鼻硬结病的临床病理特征。方法　回顾6例鼻腔鼻窦RDD及4例鼻硬结病临床病理资料,EnVision免疫组化二步法行S-100、CD68、IgG、IgG4染色及Warthin-Starry（W-S）特染。结果　RDD中4例伴多部位病变,鼻硬结病1例伴喉部病变;前者无鼻腔黏膜破坏,后者多伴溃疡;前者“明区”和“暗区”交错分布,后者“Mikulicz”细胞成片分布,常见中性粒细胞聚集灶;前者组织细胞内见稀薄的嗜伊红物质,伴淋巴浆细胞“伸 入”,后者“Mikulicz”细胞胞质空亮,内见细小颗粒;前者组织细胞S-100、CD68阳性,后者只CD68阳性,W-S染色见鼻硬结杆菌;二者IgG4阳性计数均值分别为26个/HPF及8个/HPF,IgG4/IgG均小于40%。结论　RDD是系统性疾病,鼻硬结病多局限于上呼吸道;组织形态学、免疫组化（S-100、CD68）及特染（W-S）有助于鉴别诊断;纤维化明显时二者需与IgG4相关性疾病鉴别。     

鼻内镜下手术联合药物治疗肉芽肿期鼻硬结病

鼻硬结病（rhinoscleroma）是由鼻硬结杆菌引起的一种慢性进行性肉芽肿性疾病。目前以抗生素治疗为主，但治疗时间较长，患者症状缓解较慢，且长期用药易产生不良反应。我们自2002年1月-2006年6月采取鼻内镜下手术联合环丙沙星治疗肉芽肿期鼻硬结病9例，取得满意效果。现报告如下。     

鼻硬结症的放射治疗（摘要）

鼻硬结症的放射治疗（摘要）杨享贤，林萍，陈海林，杨文鼻硬结症是具有低度传染性的慢性肉芽肿性疾病，放射治疗加抗生素治疗是本病的主要治疗方法。１９８０年１２月～１９９１年１０月。我院共收治鼻硬结病２５例，疗效较满意，报道如下。一、临床资料：本组病例全部经...     

鼻和口咽梅毒的临床病理特点

目的 非性病专业临床和病理医生对鼻、口咽部梅毒误诊率较高，探讨检测活体组织内梅毒螺旋体的方法，以提高鼻、口咽部梅毒检出率。方法 以12例鼻、口咽部可疑梅毒螺旋体感染的活检黏膜为研究对象，用HE染色观察其病理学特点，用改良的Warthin-Starry(W-S)染色法检测病变组织及其渗出物涂片中的梅毒螺旋体。用性病研究实验室试验（venereal disease research laboratory,VDRL)、快速血浆反应素试验（rapid plasma reagin circle test,RPR)、荧光螺旋体抗体吸收试验（fluorescent trepnemal antibody-absorption test,FTA-ABS)、螺旋体血细胞凝集试验（trepnema pallidum hemagglutination test,TPHA)加以证实。用国家颁布的驱梅方法进行治疗。结果 W-S染色显示12例切片黏膜上皮中及6例渗出物涂片内见大量梅毒螺旋体，固有膜内螺旋体很少发现。血清学检查：11例次VDRL（ ），7例次RPR（ ），1例次FTA-ABS（ ），11例次TPHA（ ）。1例回当地治疗，未作血清学检查。11例均临床治愈，血清学检查均转阴性。结论 用病理组织化学改良的W-S染色方法，能直观地显示活检标本及渗出物涂片内梅毒螺旋体，结论临床及梅毒血清学检查，可以提高鼻及口咽部梅毒的检出率。     

鼻内镜下手术联合药物治疗肉芽肿期鼻硬结病

鼻硬结病(rhinoscleroma)是由鼻硬结杆菌引起的一种慢性、进行性肉芽肿性疾病。我们自2002年1月～2006年6月采取鼻内镜下手术联合药物治疗肉芽肿期鼻硬结病9例,取得满意效果,现报道如下。     

微波热凝加链霉素治疗鼻硬结病

鼻硬结病是一种慢性进行性肉芽肿病变 ,目前以抗生素治疗为主 ,但治疗时间较长 ,患者症状解除缓慢 ,长期用药易产生毒副作用。为探索鼻硬结病综合治疗的有效措施 ,我院 1 998年以来应用微波热凝加链霉素治疗鼻硬结病 8例 ,收到了较好效果。现报告如下。1　资料与方法1 .1 　 临床资料8例中 ,男 2例 ,女 6例 ;年龄 2 6～ 48岁 ,平均36岁。病程 5个月～ 7年 ,平均 3年 2个月。均有口服一般消炎药或外涂药膏等治疗史。主要症状为鼻塞 ,在鼻前庭、鼻中隔、下鼻甲前端 ,以及上唇等处出现结节状肿物 ,表面血管扩张 ,质硬。全部病例活组织标本均取…     

成人鼻-鼻窦郎格罕氏细胞组织细胞增生症

目的提高临床医师对成人鼻-鼻窦郎格罕氏细胞组织细胞增生症（langerhans cell histiocytosis,LCH）的认识,以便早期诊断、治疗,提高该病控制率。方法回顾南京军区南京总医院耳鼻咽喉头颈外科收治的1例成人鼻-鼻窦LCH患者的临床资料,结合相关文献对该病的临床特点、组织病理学特征、诊断、治疗及预后进行分析。结果鼻-鼻窦LCH临床表现为多发占位伴多发骨质破坏。组织学表现为密集的肉芽肿样组织细胞,同时伴有淋巴细胞和嗜酸性粒细胞浸润。免疫组化标记Langerin（＋＋＋）,CD1a（＋＋＋）,S100（＋＋＋）。本例患者手术加术后放疗后随访12个月局部无复发,无全身转移。结论成人鼻-鼻窦LCH较为罕见,诊断需要依靠详细的病理形态观察及多种免疫组化标记。治疗以手术切除为主,辅以放疗、化疗,预后与临床分级有关。     

喉硬结病的临床特点与治疗

目的探讨喉硬结病的临床特点和治疗方法。方法回顾性分析1981年5月～2002年12月收治的43例经病理证实的喉硬结病患者的临床资料和治疗方法。结果43例中声嘶43例次、呼吸困难19例次。喉部病变以萎缩期为主2例，肉芽肿期为主35例，瘢痕期为主6例。主要病变局限于声门区13例，局限于声门下区1例；累及声门上区和声门区18例，累及声门区和声门下区8例，声门上区、声门区和声门下区均受累3例。采用抗生素治疗24例，手术治疗7例，放射治疗2例。采用抗生素治疗24例中，18例治愈，另2例复发后再进行抗生素治疗治愈；24例中4例伴2度或3度喉阻塞者行预防性气管切开术。1例伴2度喉阻塞的肉芽肿期患者采用手术和抗生素结合的方法治愈。6例伴喉狭窄的瘢痕期患者通过手术成形治愈。1例采用放射治疗后4年复发，1例抗生素治疗无效的患者采用放射治疗与抗生素结合的方法治愈。结论硬结病可侵犯喉部导致发声困难和喉阻塞，抗生素治疗对多数喉硬结病患者有效，治疗后有必要进行长期随访。对喉硬结病导致瘢痕性喉狭窄的患者需手术成形。     

Clinicopathologic analysis of rhinoscleroma]

OBJECTIVE: To investigate the clinicopathologic characteristics and reason of tissue injury caused by klebsiella rhinoscleromatis(KR) infection. METHODS: Twenty-four cases of rhinoscleromas in the nasal and pharyngeal region in this hospital from March 1983 to March 1998 were studied retrospectively. Warthin-Starry (W-S) stain was used in all cases and CD43, CD20, CD68, Lysozyme mark were observed in eleven specimens by ABC immunochemical method. Two cases were studied further with transmission electron microscopy. RESULTS: A great number of KR were found in Mikulicz cells and were confirmed further in the phagosomes in cytoplasm of Mikulicz cells, where a small number of endoplasmic reticulums and lysozymes was squeezed to the side of cells. A few of T-lymphocytes was found within the granuloma. CONCLUSION: Cellular immunity function of the patient with rhinoscleroma was depressed and the response to immunization of host which regards to KR was the major cause of tissue injury.     

鼻腔、鼻窦髓外浆细胞瘤的诊断与治疗(12例报告及文献分析)

目的 探讨鼻腔、鼻窦髓外浆细胞瘤的临床特点与患者预后,以提高对该病的诊断与治疗水平。方法 收集2000年1月～2010年11月住院确诊的12例鼻腔、鼻窦浆细胞瘤患者的病历及随访资料,就临床表现、诊断、治疗及预后进行回顾性分析。结果12例患者中,男9例,女3例,男女比3∶1; 35～61岁,平均49.6岁。12例患者均经手术治疗,病理确诊为髓外浆细胞瘤,术后放疗 10 例,术后放、化疗1 例。免疫组化染色排除多发性骨髓瘤,结果 显示CD38均为阳性,CD79a阳性5例,CD20、CD56及CyclD1均为阴性。随访1～59个月,平均随访（53±8）个月。术后1年6月及3年各失访1例,术后1年6月局部复发伴重症感染死亡1例,1例术后2 年3月转化为多发性骨髓瘤,再行化疗,术后4年死亡。结论 鼻腔、鼻窦髓外浆细胞瘤好发于中年男性,诊断主要依靠病理检查,手术+放疗预后较好,部分可转化为多发性骨髓瘤。     

喉罩辅助改良气管切开术在重症OSAHS多平面手术治疗中的应用

目的：探讨喉罩辅助改良气管切开术在重症阻塞性睡眠呼吸暂停低通气综合征（OSAHS）多平面手术中的应用价值。方法回顾性分析我科近5年在喉罩辅助改良气管切开术条件下对重症OSAHS实施同期行多平面手术的21例患者临床资料。首先经口插入喉罩行全麻,继行横切口改良气管切开术,术毕拔出喉罩,通过气管造口插管维持全麻,再完成多平面OSAHS手术。结果本组患者术毕均未进ICU复苏而直接返回普通病房,无明显手术相关并发症;气管套管拔管时间为7～30天。随诊6个月,手术效果满意。结论喉罩辅助改良气管切开术易行而并发症少,切口瘢痕不明显,为同期行多平面手术治疗重症OSAHS的患者提供了安全保障。     

Clinicopathological features of Epstein-Barr virus-associated nasal T/NK cell lymphomas in southern Japan

OBJECTIVE: Nasal T/natural killer cell lymphomas (NTCL) are highly prevalent among Oriental populations. However the characteristic immunophenotype of NTCL is still controversial and it can be difficult to make a firm histologic diagnosis of malignancy. Therefore, 14 cases of NTCL in patients from southern Japan were evaluated for clinicopathological features and immunophenotypic status. Furthermore, the genetic variations in the latent membrane protein 1 (LMP-1) gene of Epstein-Barr virus (EBV)-related NTCL were evaluated. METHODS: Biopsy specimens were fixed in formalin and embedded in paraffin before examination using in situ hybridization for EBV-encoded RNA-1 (EBER-1) as well as immunohistochemical staining for CD3, CD3epsilon, CD4, CD8, CD43, CD45RA, and CD45RO. To detect genetic variations, single-strand conformation polymorphism (SSCP) analysis and DNA sequencing were applied. RESULTS: Clinically, 14 cases were divided into two groups. The first group consisting of eight patients showed good prognosis. The other group consisting of six patients showed poor prognosis. The vast majority of neoplastic cells in NTCL were EBER-1 positive. These cells did not express CD4, CD8, or CD45RA, but often expressed CD43 and CD45RO. In addition, they were negative for CD3 when stained with a mouse monoclonal antibody but stained for CD3epsilon when a rabbit polyclonal was used. The 3'-terminal of LMP-1 gene of seven cases were amplified and all of them have 30 base pair (bp) deletion. CONCLUSION: NTCL are a heterogeneous mix of cell types although EBV-associated NTCL in patients from southern Japan appear to originate from natural killer cells rather than T cells, and also prognosis is variable and not always poor. The ability to make a firm diagnosis can be enhanced through the combined use of in situ hybridization and immunohistochemistry. High prevalence of the 30-bp deletions of the LMP-1 gene in EBV-related NTCL may also reflect the prevalence of the deletion variant in the normal population in Japan.     

原发性鼻腔非霍奇金淋巴瘤的免疫表型及其与EB病毒的关系

目的:探讨原发性鼻腔非霍奇金淋巴瘤(NHL)的免疫表型特征及其与EB病毒(EBV)感染的关系。方法:采用免疫组织化学方法检测29例鼻腔NHLCD45RO、CD3ε、CD56、CD20、TIA-1、GranzymeB,确定肿瘤细胞免疫表型以及EBV潜伏膜蛋白(LMP-1);采用原位杂交技术检测EBV编码的RNA(EBER1/2)。结果:CD45RO阳性29例(100.00%),CD3ε、TIA-1及GranzymeB阳性19例(65.52%),CD56阳性17例(58.62%),CD20均阴性;EBER1/2阳性23例(79.31%),LMP-1阳性14例(48.28%)。EBER1/2和LMP-1表达阳性率在外周T细胞淋巴瘤和NK/T细胞淋巴瘤中的差异均无统计学意义(均P>0.05)。结论:鼻腔NHL以NK/T细胞淋巴瘤为多见,EBV感染与鼻腔NHL关系密切,但EBV感染率与鼻腔NHL免疫表型无关,EBV感染在鼻腔NHL的发生、发展中可能起重要作用。     

Expressions of NeuroD and GAP43 as diagnostic markers for olfactory neuroblastoma

ObjectiveOlfactory neuroblastoma (ONB) is often difficult to pathologically distinguish from other small round cell tumors (SRCTs) arising in the nasal cavities. Although there are several diagnostic markers used for differential diagnosis of ONB, these molecules are also expressed in various neuronal derived tumors. Here, we examined the expression of NeuroD, GAP43, and olfactory marker protein (OMP) in ONB and non-ONB SRCT to determine their utility in the differential diagnosis of ONB.MethodsTwenty-six patients diagnosed with and treated for ONB at Kobe University Hospital between 1997 and 2017 with formalin-fixed, paraffin-embedded biopsy or surgical resection specimens were included. The expressions of NeuroD, GAP43, and OMP were immunohistochemically examined in these 26 ONB specimens and specimens from 13 SRCTs arising in the nasal cavities for reference.ResultsAmong the 26 ONB samples, focal, patchy, and marked staining for NeuroD was observed in 4, 3, and 9 samples, respectively. Focal, patchy, and marked GAP43 staining was observed in 5, 3, and 11 samples, respectively. Consequently, marked positive staining for either NeuroD or GAP43 was observed in 54% (14/26) of ONBs. Among the 13 SRCTs, marked staining for NeuroD was observed in two small cell carcinomas, one undifferentiated carcinoma, and one neuroendocrine carcinoma, whereas marked positive staining for GAP43 was observed only in one undifferentiated carcinoma. No specimen in this study exhibited OMP staining.ConclusionsOur results suggest possible roles of GAP43 immunostaining in the differential diagnosis of ONB.     

Investigation of the nasal T/NK cell lymphomas in 14 cases]

OBJECTIVE: To study the biologic behavior, pathologic features as well as clinic manifestations of the nasal T/NK cell lymphomas, and to provide experiences for the diagnosis and treatment of the tumor. METHODS: Specimens of 23 cases lethal midline granulomas (LMG) were examined: (1) HE stain for immunohistochemical staining for TIA-1, CD43, CD20, CD3 epsilon, CD56 and in situ hybridization for EBV encoded small nuclear RNA(EBER1/2, Y017, DAK0). (2) The cases histories were reviewed. RESULTS: (1) 14 cases were confirmed by histological features. In the 14 cases, tumor cells expressed TIA-1, CD56, CD3 epsilon, CD43, EBER1/2 positive. (2) Among them 8 cases (57%) showed special clinic features of LMG, Nasopharynx, pharynx and laryngeal involvement were found in other 6 cases. One case revealed lymphoid leukemia. In other 2 cases, gastrointestinal tract were involved. Hemophagocytic syndrome (HPS) complication happened in 1 case. CONCLUSION: The tumor cells of nasal T/NK cell lymphomas expressed TIA-1, CD56, CD43, CD3 epsilon may suggest it originates from NK cell. The high association with EBV may suggest in situ hybridization. 57% patients showed that the special clinic features of the LMG, and gastrointestinal tract, bone marrow, peripheral blood were involved in some cases. One case complicated with hemophagocytic syndrome (HPS).