多发性嗜酸性淋巴肉芽肿1例及文献回顾

报道1例多发性嗜酸性淋巴肉芽肿病例,并复习该病的相关国内外文献。多发性嗜酸性淋巴肉芽肿发病率低,且病因至今未明。临床上常表现为头颈部淋巴结肿大、嗜酸性粒细胞及Ig E增高。病理学上表现为淋巴组织增生并形成淋巴滤泡,生发中心极性存在,血管周围及滤泡间大量的嗜酸性粒细胞浸润。放疗、药物治疗及手术切除均可达良好疗效,但易复发。     

嗜酸性淋巴肉芽肿

嗜酸性淋巴肉芽肿是一种病因不明的、多累及头颈部浅表淋巴结和软组织的慢性肉芽肿痛变。病理学上表现为淋巴滤泡形成或滤泡样结构增生，存在生发中心。外周血中嗜酸性粒细胞增多。该病变组织对放疗极为敏感，此外，还可采用化疗、手术等方法。虽然本病预后良好，但容易复发，早期患者的确诊较困难，应引起口腔颌面外科医生的高度重视。     

颜面部多发性复发性嗜酸性粒细胞增生性淋巴肉芽肿1例及文献复习

嗜酸性粒细胞增生性淋巴肉芽肿又称木村病（Kimura disease,KD）,发病率低,病因不明,其确诊依靠组织病理学检查,镜下有显著生发中心的淋巴组织增生及淋巴滤泡形成,嗜酸性粒细胞在淋巴结内灶性聚集,形成嗜酸性微脓肿。临床上对于头颈部无痛性皮下肿物及局部淋巴结肿大的患者,尤其是伴外周血嗜酸性粒细胞及血清IgE增高者,应考虑KD可能,手术和放疗可取得一定疗效,但复发率较高。笔者报道颜面部多发性复发性KD1例。     

嗜酸性淋巴肉芽肿

嗜酸性淋巴肉芽肿是一种病因不明的、多累及头颈部浅表淋巴结和软组织的慢性肉芽肿病变。病理学上表现为淋巴滤泡形成或滤泡样结构增生,存在生发中心。外周血中嗜酸性粒细胞增多。该病变组织对放疗极为敏感,此外,还可采用化疗、手术等方法。虽然本病预后良好,但容易复发,早期患者的确诊较困难,应引起口腔颌面外科医生的高度重视。     

Kimura病的病理学分析

目的:探讨Kimura病(Kimura’s disease,KD)的临床病理学特点,提高对该病的认识及诊断。方法:分析和观察7例KD的临床资料、病理组织学表现及免疫组织化学特征。结果:7例KD患者均为男性,发病年龄21～73岁,主要表现为头颈部皮下或大唾液腺的无痛性肿块,组织学上以淋巴组织增生为主,可见淋巴滤泡形成,生发中心扩大,滤泡间见血管增生,大量嗜酸性粒细胞浸润。免疫组织化学显示KD中的淋巴滤泡表达B细胞抗原,滤泡间的淋巴细胞多表达T细胞标记。结论:KD是一种少见的淋巴组织增生性疾病,需与部分富含淋巴组织的肿瘤鉴别,组织病理学及免疫组化对其诊断具有重要意义。     

颌面部嗜酸性淋巴肉芽肿的临床特点与诊断

目的 分析颌面部嗜酸性淋巴肉芽肿的临床特点。方法 对 34例颌面部嗜酸性淋巴肉芽肿临床资料,分别从患者性别、发病年龄、病理、临床表现、实验室检查、穿刺细胞学涂片检查、误诊及治疗等方面进行回顾性分析。结果 34例颌面部嗜酸性淋巴肉芽肿患者,男性多见(男:女=11.3:1),平均发病年龄37.4岁,5年以下病程占73.5％,好发于腮腺区(41.9％)。主要表现为局部软组织结节样包块,60％患者嗜酸性粒细胞计数超过正常范围,误诊率达90％。结论 对于中青年患者,颌面部无明显压痛的软组织包块,伴包块区皮肤瘙痒和色素沉着,外周血嗜酸性粒细胞计数大于0.05,应首先考虑嗜酸性淋巴肉芽肿。     

嗜酸性淋巴肉芽肿四例误诊报告

嗜酸性淋巴肉芽肿四例误诊报告湖北医科大学口腔医学院·口腔医院（邮４３００７０）江波，赵怡芳嗜酸性淋巴肉芽肿亦称嗜伊红细胞增生性淋巴肉芽肿，是一种好发于颌面部软组织和淋巴结的肉芽肿性疾病，临床上易误诊为肿瘤等病奕。现就我科４例误诊病例报告如下，并对有关...     

颌面部嗜酸性淋巴肉芽肿的临床病理特点与诊断

目的：探讨嗜酸性淋巴肉芽肿（Eosinophilic Limphoid Grannuloma,ELG）的临床和病理特点,以利于正确诊治。方法：对我院10年间收治的经组织学确诊的14例ELG的临床资料、发病年龄、病理表现、实验室检查等进行回顾性分析。结果：14例ELG患者在临床上主要表现为腮腺区和颌下区无痛性软组织包块。组织学上表现为大量的嗜酸性粒细胞浸润、淋巴组织增生和滤泡形成、不同程度的纤维化、血管增生反应。结论：ELG是一种具有特殊临床和病理表现的慢性炎症性疾病,应与表现为头颈部肿块的其他疾病相鉴别,组织病理学对于诊断具有十分重要的意义。     

嗜酸性淋巴肉芽肿临床病理分析及电镜观察

对８例嗜酸性淋巴肉芽肿进行临床病理分析及电镜观察。结果表明，其病理特征有：１大量不典型增生的血管内皮细胞。２大量嗜酸性粒细胞及淋巴细胞浸润。３淋巴滤泡形成。电镜下，不公观察到血管内皮细胞及嗜酸性粒细胞的变化而且发现许多肥大细胞脱颗粒及一种类似含有大量扩张粗面内质网的浆细胞。患者经放疗后，放疗区标本不典型，毛细血管内皮细胞转化为正常，嗜酸性粒细胞消失，淋巴细胞量显著减少。     

颌面部淋巴结反应性增生的临床与病理研究

目的 分析颌面部淋巴结反应性增生的临床和病理学表现,以期为治疗提供参考.方法 对32例术后病理诊断为淋巴结反应性增生的住院患者进行临床表现、组织形态学和免疫组织化学分析.结果 32例患者的组织形态学分别表现为淋巴滤泡增生、边缘区淋巴增生、副皮质区淋巴增生和很少的混合性增生.免疫组织化学表现:23例(72%)为以CD20...     

颌面部嗜酸性淋巴肉芽肿15例临床病理分析

目的:探讨嗜酸性淋巴肉芽肿临床和病理特征,以利于正确诊治.方法:对我院19年来治疗的15例颌面部嗜酸性淋巴肉芽肿患者的临床资料进行分析.结果:5例术前正确诊断者中4例都有嗜酸细胞增高,1例有病理诊断;误诊以多形性腺瘤最多见,达6例.结论:末梢血嗜酸粒细胞增高对诊断本病有较高的参考价值,确诊靠病理检查,皮肤瘙痒则有一定参考作用;单靠临床检查易误诊.     

Benign lymphoid hyperplasia of the palate: report of two cases and immunohistochemical profile

Two cases of benign lymphoid hyperplasia (BLH) of the palate are reported. The histologic appearances are those of a benign or reactive lymphoid aggregate and correlate well with other published accounts of this lesion. Using a battery of antileukocyte antibodies suitable for formalin-fixed tissue, analysis of the antigenic profile of oral BLH has been performed. The results indicate its benign nature: the germinal centres show tingible-body macrophages and polyclonal light chain restriction, the mantle zones are composed of both mature and immature B-cells, and the extramantle zones contain both B- and T-lymphocytes, plasma cells, macrophages, polymorphonuclear leukocytes and eosinophils. The histologic and immunohistochemical features are those of benign rather than malignant proliferation of lymphocytes. This is in agreement with published accounts of long-term follow-up, which have found no correlation between BLH in the mouth with either malignant association or malignant transformation.     

A case of Kimura's disease of the hard palate

A 33-year-old man presented with Kimura's disease of the hard palate. Serological examination showed no elevation in the number of eosinophils or in IgE level, but histological examination revealed well-developed lymph follicles with increased numbers of eosinophils. In addition, immunohistochemical examination revealed that the IgE concentrations were shown in the lymphoid follicles with germinal centers, a finding typical of Kimura's disease. The patient underwent surgical resection followed by treatment with non-steroidal anti-inflammatory drugs (NSAIDs). Throughout the 2-year follow-up period, the patient's condition has remained satisfactory.     

口腔颌面部炎症性肌纤维母细胞瘤8例临床分析

目的:探讨炎症性肌纤维母细胞瘤(IMT)在口腔颌面部的临床表现及治疗方法。方法:回顾总结2007—2011年期间诊治的8例颌面部IMT患者,分析其临床资料及治疗方法。结果:口腔颌面部炎症性肌纤维母细胞瘤肉眼观均为实性肿物,呈浸润性生长,与周围软组织黏连,无明显包膜。肿瘤镜检主要有梭形细胞型和黏液血管型2种组织学形态。除1例术后失访外,其余患者随访1～3a,情况稳定,未见局部复发或远处转移。结论:IMT是一种少见的间叶性肿瘤,多见于儿童和青壮年,罕见于头颈部,具有局部侵袭性和复发等低度恶性或交界瘤特点,远处转移少见;手术切除是口腔颌面部IMT首选的治疗方法。     

Follicular dendritic cells confirm lymphoid organization in the minor salivary glands of primary Sjögren’s syndrome

Background: Sjögren’s syndrome (SS) is an autoimmune chronic inflammatory disorder affecting the salivary and lacrimal glands. The aim of this study was to explore immunophenotypic features of chronic inflammatory reactions in the minor salivary glands in patients with primary SS (pSS). Methods: Formalin‐fixed, paraffin‐embedded labial minor salivary gland tissue sections from randomly selected patients with pSS (n = 60) were investigated for the expression of CD21, CD23, CD35 and IgD by immunohistochemistry. Results: Based on the distribution and staining pattern of CD21, CD23, CD35 and IgD in lymphoid aggregates, several stages of chronic inflammatory reactions were observed. In 12/60 (20%) patients, lymphoid infiltrates with germinal centre (GC)‐like features such as extensive networks of CD21‐, CD23‐ and CD35‐positive cells were observed in the minor salivary gland tissue. Smaller networks and /or focal infiltrates with scattered CD21⁺, CD23⁺ and CD35⁺ cells were observed in the remaining 48/60 (80 %) cases. When dividing patients according to the presence (GC+) or the absence (GC?) of GC in the minor salivary glands, the mean focus score was significantly higher in the GC+ patients (P < 0.05). Double staining of the minor salivary glands revealed focal infiltrates with follicular dentritic cell networks and B cells resembling normal GCs in tonsillar tissue. Conclusion: A particular cellular profile was demonstrated in a sub‐group of patients with pSS and could be linked to serological aberrations. These findings warrant further prospective studies.     

口腔颌面部Ewing肉瘤/原始神经外胚层瘤的临床病理学研究

目的提高对口腔颌面部Ewing肉瘤／原始神经外胚层瘤（Ewing肉瘤／PNET）的临床病理特征的认识，减少误诊。方法收集四川大学华西口腔医学院病理科1970年1月至2004年12月临床病理诊断符合Ewing肉瘤／PNET的病例共15例，年龄1～49岁，平均14．5岁，主要表现为肿胀，影像学可见骨质破坏。结合文献对其组织学特征进行分析，并行免疫组化LSAB法染色，抗体为CD99（12E7）、波形蛋白、神经冗特异性烯醇化酶（NSE）、S-100、突触素（Syn）、CD45（LCA）及结蛋白。结果①组织学特征：肿瘤主要由密集的小细胞组成，弥漫分布，纤维性条索将其分隔成不规则片块状，可见菊形团样结构，部分细胞含糖原。②免疫组化标记：所选7例CD99及波形蛋白均阳性，CD45、结蛋白均阴性；S-100阳性4例，NSE阳性3例，Syn阳性1例，2例对NSE、S-100、Syn均为阴性。结论口腔颌面部Ewing肉瘤／PNET极为少见，多为青少年，免疫组化可辅助诊断，p30／32^MIC2高水平表达对确诊有价值。     

Gingival inflammatory response induced by chemical retraction agents in beagle dogs

PURPOSE: The aim of this in vivo study on dogs was to investigate and compare the inflammatory potential of four different retraction agents on the gingival connective tissue. MATERIALS AND METHODS: All procedures on eight beagle dogs were performed under general anesthesia: taking oral hygiene measures, placing retraction cords medicated with four chemical agents into the gingival sulci, and taking tissue biopsies. The specimens were evaluated after a 10-minute exposure to chemical agents. The inflammatory response of the connective tissue underlying the sulcular and junctional epithelium triggered by retraction agents was assessed quantitatively. Microscopic images of tissue specimens were morphometrically analyzed using a computer-assisted morphometric method. RESULTS: The most intense inflammatory response in the connective tissue underlying the sulcular epithelium was triggered by astringent retraction agents--Racestyptine in specimens taken after 1 day and 1 week and Rastringent after 1 day (P < .05). Tetrahydrozoline-sympathomimetic vasoconstrictor (Visine) was found to have the lowest inflammatory potential. Retraction chemicals produced no significant effects on the connective tissue subjacent to the junctional epithelium. The ratio of the connective tissue area to that of the inflammatory infiltrate showed that 25% aluminum chloride (Racestyptine) was the most aggressive and tetrahydrozoline the least aggressive retraction agent used. CONCLUSION: All the retraction chemicals tested increased the infiltration with inflammatory cells in gingival connective tissue.     

头颈部嗜酸性淋巴肉芽肿14例临床分析

目的 探讨头颈部嗜酸性淋巴肉芽肿（ELG）的临床特点,以提高临床诊治水平。方法 回顾性分析中山大学孙逸仙纪念医院口腔颌面外科2003 - 2012年14例头颈部ELG的临床资料,分别从研究对象的发病年龄、性别、发病部位、实验室检查、病理、临床表现、治疗及预后等方面进行总结。结果 所有病例均经病理检查确诊。治疗后随访时间为1 ~ 13个月,其中1例经肿块切除术,术后5个月复发;1例经药物治疗,治疗后4个月复发。其余12例患者预后良好,随访期间未出现病情进展或复发。结论 ELG常表现为一种无痛的软组织病变,好发于男性,多见于中青年人,好发部位为腮腺区、颈部等。主要依靠病理确诊,最佳治疗方案是手术切除结合适当剂量的放疗。     

口腔黏膜增殖性天疱疮的组织病理学特征

目的 研究口腔黏膜慢性增殖性天疱疮的临床组织病理学特征。方法 对7例口腔黏膜慢性增殖性天疱疮患者的临床表现及病理学切片进行分析。结果 7例患者中5例女性，2例男性，平均52．7岁。病程3个月-10年。口腔黏膜表现为斑块状或疣状增生，伴有广泛的水肿、糜烂及渗出，可有结痂形成。5例患者伴有增生性皮肤改变。组织病理学观察显示：病变区上皮增生，钉突延长；上皮内形成深棘层细胞间或棘层与基底层间的裂隙或疱，邻近裂隙的上皮中可见细胞间水肿；上皮内及上皮下有嗜酸性细胞浸润并可在上皮内形成嗜酸性微脓肿；固有层存在炎症性变化。结论 口腔黏膜慢性增殖性天疱疮的上述病理变化特点对于该病的病理学诊断具有重要意义。