梅毒性淋巴结炎1例

患者男 ,4 0岁。左腹股沟肿物伴下肢无力半月余就诊。查体发现肿块位于左腹股沟 ,3 0cm× 2 5cm× 2 0cm ,质韧 ,不活动 ,与周边组织粘连 ,轻度压痛。实验室检查 :血WBC 8× 10 3 /L ,N 0 6 9,L 0 31。胸部透视未见异常。临床考虑为淋巴瘤行肿块切除术。　　病理检查　眼观 :椭圆形肿物 1个 ,4 0cm× 2 8cm×2 4cm ,表面稍粗糙 ,灰白 ,切面灰白色 ,质地细腻 ,质脆 ,无明显出血坏死 ,包膜厚 0 2cm。镜检 :淋巴结的结构存在 ,被膜明显增厚 ,纤维细胞增生 ,并见纤维化 ,其内多量淋巴细胞、浆细胞浸润 ,血管增多 ,管壁增厚 ,有的小血…     

Kikuchi淋巴结炎病理学新进展

Ｋｉｋｕｃｈｉ淋巴结炎[1] 首先由日本Ｋｉｋｕｃｈｉ和Ｆｕｊｉｍｏｔｏ于1972年报道 ,故又称Ｋｉｋｕｃｈｉ Ｆｕｊｉｍｏｔｏ病或Ｋｉｋｕｃｈｉ病。既往称组织细胞性坏死性淋巴结炎 ,沿用至今。但有的作者认为许多病例坏死不明显 ,称Ｋｉｋｕｃｈｉ病或淋巴结炎更恰当。由于它是一种发病原因不明的自限性疾病 ,在病变区出现增生活跃细胞 ,人们对此认识不足易误诊为恶性淋巴瘤。1.临床特点 :其好发于女性青少年 ,多发生在 30岁以下。发热伴局限性淋巴结肿大 ,白细胞数降低 ,抗炎治疗不见效等[2 ] 。在Ｗｉｌｌｉａｍ等[3] 报道 75例中 ,…     

38例组织细胞性坏死性淋巴结炎组织病理学观察

对３８例组织细胞性坏死性淋巴结炎切片进行回顾性分析，其组织学表现为淋巴结局灶性受累；病变区淋巴细胞增生活跃，核分裂象易见；组织细胞增多，吞噬现象明显；淋巴细胞凋亡（ａｐｏｐｔｏｓｉｓ）及核碎片见于所有病例，１７例出现不同程度的凝固性坏死；病变区不见或偶见中性粒细胞、嗜酸性粒细胞和浆细胞。并对该病的诊断和鉴别诊断依据进行了讨论。     

肛门直肠梅毒临床病理分析

目的 探讨肛门直肠梅毒的临床病理学特点,总结经验,避免漏诊或误诊.方法 收集4例肛门直肠梅毒患者的临床及病理形态学资料,用HE染色观察直肠黏膜组织损伤的病理形态学特点,实验室梅毒螺旋体血凝测定及快速血浆反应素试验,佐证梅毒的病理诊断.结果 临床4例均误诊,实验室检查均呈梅毒螺旋体血凝测定阳性,快速血浆反应素试验阳性.1例肛周黏膜鳞状上皮呈假上皮瘤性增生,上皮内有中性粒细胞浸润、微小脓肿形成,真皮层大量浆细胞浸润伴小血管周围围管性浸润;3例直肠壁黏膜固有层内均有大量浆细胞浸润,小血管内皮细胞肿胀及梅毒性小血管炎,直肠黏膜表面溃疡,大量浆细胞、淋巴细胞、组织细胞浸润;其中1例直肠黏膜下显著慢性炎症,淋巴滤泡呈旺炙性反应性增生;1例于直肠黏膜下见多个肉芽肿性结节,偶见朗汉斯巨细胞.4例确诊后均给予青霉素静脉输注,患者痊愈出院;其中1例于半月后复发,再次给予青霉素静脉输注,痊愈出院.结论肛门直肠梅毒的组织病理学表现仅具有相对特征性,非特异性改变,临床极易误诊为肛门直肠肿物及脓肿,其最终诊断仍需结合实验室梅毒血清学检查.临床及病理医师均应提高对肛门直肠梅毒的认识,减少漏诊、误诊和误治.     

鼻、咽喉黏膜早期梅毒的病理诊断与鉴别诊断

目的探讨鼻咽部梅毒病变及病原特点,总结诊断上的经验。方法回顾性总结北京同仁医院1996年6月-2005年9月耳鼻咽喉科门诊25例患者的病理资料,用HE染色观察黏膜梅毒组织损伤的病理形态学特点,用改良的W-S染色和免疫组织化学ABC法以梅毒螺旋体（treponema pallidum,TP）多克隆抗体标记,观察侵袭到组织内TP的形态特点及侵袭规律;快速血浆反应素环状卡片试验和TP血凝试验佐证早期梅毒的病理诊断。结果25例血清学检查均为快速血浆反应素环状卡片试验阳性（1：8～128）、TP血凝试验阳性。20例黏膜被覆鳞状上皮内有中性粒细胞浸润、微小脓肿形成,25例固有膜内均有大量浆细胞浸润,小血管内皮细胞肿胀及梅毒性小血管炎。14例扁桃体黏膜表面溃疡,大量浆细胞、淋巴细胞、组织细胞浸润,其中1例扁桃体见各种转化淋巴细胞增殖。1例喉黏膜伴鳞状上皮假瘤样增生。改良的W-S染色发现20例黏膜微脓肿中及鳞状上皮间TP,5例小血管周围见TP,14例扁桃体溃疡面见大量TP,6例渗出物涂片内均见大量TP。4例用免疫组织化学方法在鳞状上皮内见TP。结论鼻、咽喉部早期梅毒有一定的病理形态学特点,改良的W-S染色显示TP是诊断黏膜梅毒的关键性方法。     

过敏性肺炎的临床病理学诊断

过敏性肺炎(hypersensitivity pneumonitis, HP)也称外源性过敏性肺泡炎(extrinsic allergic alveolitis,EAA),是指各种致敏源吸入后引发机体免疫介导的呼吸系统疾病.根据临床过程分为急性、亚急性和慢性HP,并具有不同的临床、影像和病理学特征.由于作为肺间质病变诊断的主要方法--开胸肺活检在国内尚不普及,病理医师难有机会对HP有充分的认识,本文通过对HP的介绍,意在提高病理医师对该疾病的认识,及时作出准确诊断,帮助临床治疗.     

猫抓病性淋巴结炎的临床病理分析

目的：探讨猫抓病性淋巴结炎的诊断和鉴别诊断要点,方法：应用免疫组化S－P法对26例猫抓病性淋巴结炎分别标记CD20、CD3、CD68;15例进行Warthin-Starry银染色,结果：早期微脓生肉芽肿21例,其病变特征是微脓肿和肉芽肿形成。淋巴结早期微脓肿周围为CD20＋的B淋巴细胞和CD68＋组织细胞,当典型微脓肿性肉芽肿形成时,CD68＋的类皮细胞呈放射状排列,其间夹有CD3＋T淋巴细胞;15例中12例Warthin-Starry染色（＋）。结论：猫抓病灶性淋巴结炎的主要特征是微脓肿性肉芽肿形成,免疫组化标记有助于识别病变中反应增生的细胞成分,本病可能与细菌感染所诱导的细胞免疫反应有关。     

新生儿期先天性梅毒28例临床诊断和治疗

本科自１９９６年７月至９７年６月共收治新生儿期先天性梅毒２８例，男２３例，女５例；早产儿１２例，足月儿１６例，小于胎龄儿７例，适于胎龄儿２１例。出生体重≤１５００ｇ３例，１５００２５００ｇ１２例，２５００４０００ｇ１３例，出生窒息１２例。好转治愈出院１９例，死亡４例，自动出院５例。诊断标准：父或母均有明确梅毒感染史，母亲ＴＰＨＡ或ＲＰＲ＋ＴＰＨＡ试验阳性，患儿ＴＰＨＡ和ＲＰＲ试验均为阳性。临床表现为多脏器受损。治疗：青霉素５万单位／ｋｇ，每８１２小时静注１次，共１０１４天。     

皮病性淋巴结炎4例临床病理分析

目的探讨皮病性淋巴结炎(dermatopathic lymphadenitis,DL)的临床病理特征、诊断、鉴别诊断、治疗及预后。方法收集4例DL的临床病理资料,分析其临床病理特征和免疫表型,并复习相关文献。结果镜下副皮质区内见多个淡染的结节形成,沿被膜下散在分布,含色素细胞。免疫组化标记CD3、CD43、CD1α、CD68、CD163、S-100蛋白示多个T结节形成,其内混杂大量组织细胞、指突状树突细胞(interdigitatingdendritic cell,IDC)、Langerhans细胞(Langerhans cell,LC);CD21、CD20示滤泡挤压、萎缩,生发中心BCL-2阴性;髓索内浆细胞增生明显,κ及λ染色提示为多克隆,浆细胞CD138、MUM1均阳性;其他标记Melan A、SMA、CD34、CD56、HMB-45均阴性。结论DL罕见,无特殊性临床表现,易漏诊,病理形态学结合免疫表型可明确诊断。     

Clinical and pathologic diagnosis and different diagnosis of syphilis cervical lymphadenitis

Purpose: To study the clinical pathologic characteristics and differential diagnosis of syphilitic cervical lymphadenitis, and to improve the rate of its diagnosis and treatment. Methods: Retrospectively analyzed the clinical history, Trepone pallidum-ELISA (TP-ELISA), rapid plasma regain test (RPR) and routine pathological examination of the patient diagnosed as syphilis lymphadenitis. And review related literatures. Results: The main clinical presentation was multiple palpable cervical lymph nodes. The multiple nodes were hard, fixed, and the major diameter of the larger one was 2 cm. The main pathological changes included: the capsule was significantly thickened; reactive hyperplasia of lymphoid follicular with sky star phenomenon; occlusive endovasculitis; perivascular inflammation; the proliferation of epithelioid histiocytes can form granulomas with few multinucleated giant cells; few necrosis. TP-ELISA and RPR were positive. Conclusions: The pathological changes of syphilitic lymphadenitis have a variety of performance with relatively specific and suggestive alterations which requires a combination of clinical history and laboratory test before the diagnosis, and the clinicians can reduce misdiagnosis and missed diagnosis of the disease by increasing vigilance of it.     

Diagnostic pitfalls in pathological diagnosis of infectious disease: patients with syphilitic lymphadenitis often present with inconspicuous history of infection

Retrospective study was applied to 16 cases of syphilitic lymphadenitis to elucidate the pathological diagnostic features. The typical morphology of syphilitic lymphadenitis includes: (i) well preserved or partially destroyed lymph node structure; (ii) reactive hyperplasia of lymph follicles with broadened germinal centers in the cortex and medulla of the lymph node; (iii) thickened fibrotic lymph node capsules with infiltration of plasma cells; and (iv) phlebitis and endarteritis in varying degree. Additional morphology includes: (i) focal histiocytes with ingested debris; (ii) noncaseating granuloma with epithelioid histiocytes and disperse giant cells; and (iii) hyperplastic centroblast and occasionally isolated mononuclear Reed‐Sternberg cell‐like giant cells. Treponema pallidum was identified in 15 of the 16 cases by immunohistochemical staining. The histopathological diagnosis of syphilitic lymphadenitis poses difficulty in differentiation from other infectious or neoplastic lymphadenopathies. The newly established Treponema pallidum antibody is sensitive to identification of Treponema pallidum in formalin fixed paraffin embedded tissue.     

脑猪囊尾蚴病的临床病理诊断

目的：探讨脑猪囊尾蚴病的临床病理特点及诊断方法。方法：复习12例脑猪囊尾蚴病的病理切片、病史及临床资料。结果：男女发病性别比3：1，平均年龄22岁。临床以癫痫发作为主要症状9例，颅内高压2例，痴呆1例。5例见到猪囊尾蚴，7例虫体崩解的陈旧性病变均找到形态不一的石灰小体。结论：脑猪囊尾蚴病以青年男性多见，癫痫发作为主要症状。病理诊断除找到囊尾蚴外，组织中散在的石灰小体是陈旧性病变的重要诊断依据。     

乳腺皮脂腺样癌临床病理诊断

目的探讨乳腺皮脂腺样癌的临床病理学特征及其诊断和鉴别诊断要点。方法对1例乳腺皮脂腺样癌进行光镜观察和免疫组化标记。结果癌组织由两型细胞构成：一型为未分化细胞,较基底细胞胞质丰富;另一型为较分化细胞,胞界清楚,胞体宽大,胞质丰富,有小空泡,两型细胞均可见1～3个小红核仁。癌细胞排列成不规则小叶,各小叶中两型细胞的数目和分布不一,部分似皮脂腺小叶结构。可见癌组织与残存小叶内导管上皮移行结构,部分区域伴鳞化。结论皮脂腺样癌为罕见的特殊类型乳腺癌,可能源自小叶内导管上皮皮脂腺化生。确诊须符合下列标准：①肿物位于乳腺实质内;②具备皮脂腺分化特点及恶性特征;③可见癌组织与乳腺导管上皮移行结构。     

组织细胞性坏死性淋巴结炎

目的：总结10例组织细胞性坏死性淋巴结炎（HNL）的临床病理特征。方法：复查10例淋巴结活检标本的HE切片;分别用S－P法和TUNEL法检测细胞免疫表型和凋亡。结果：5例曾被诊断为非霍奇金淋巴瘤。组织学上副皮质区,尤其滤泡间区有各种大小散在或融合病灶,由多种形态的组织细胞、转化淋巴细胞以及凋亡碎片组成,缺乏粒细胞浸润。淋巴细胞表达CD3和CD45RO,不表达CD15、CD20、CD30;组织细胞表达CD68和（或）Mac387。结论：淋巴结活检显示有多种组织细胞、转化T细胞以及凋亡碎片组成的病灶,不合并有粒细胞浸润,有利于HNL的诊断。     

Histiocytic necrotizing lymphadenitis without granulocytic infiltration

Summary Twenty-seven cases of an unusual necrotizing lymphadenitis previously described only in Japan are reported as occurring in West Germany (23 cases), Iran (1 case), Italy (1 case), Korea (1 case) and Spain (1 case). The lesion frequently develops in the cervical lymph nodes of young women. It is characterized by infiltration of the cortex and/or paracortex by large collections of proliferating histiocytes and is devoid of granulocytes. Complete or, more often, incomplete necrosis of lymphoid tissue is seen in all cases. In cases with incomplete necrosis, the histiocytes are interspersed with pyknotic cells and nuclear debris. Based on the histological findings, the term histiocytic necrotizing lymphadenitis without granulocytic infiltration is proposed. Lesions to be considered in a differential diagnosis are malignant histiocytic neoplasms and necrotizing lymphadenitis with granulocytic infiltration, which is seen in lupus erythematosus and bacterial infections. The aetiology of histiocytic necrotizing lymphadenitis without granulocytic infiltration is still unclear. Some clinical and histological features indicate the possibility of an underlying viral infection.This study was supported by the Kind-Philipp-Stiftung     

Cryptococcal lymphadenitis in HIV: A chance diagnosis by FNAC

Cryptococcosis is a life threatening, opportunistic fungal disease in human immunodeficiency virus‐infected individual. Lymph node involvement as a presenting feature in Cryptococcosis is not a common manifestation. A prompt diagnosis is of utmost importance in this disseminated form of cryptococcosis. There are very few reports, however, of cryptococcal lymphadenitis as a presenting feature. We report here a case of cryptococcal lymphadenitis that was diagnosed by fine‐needle aspiration cytology of the involved cervical lymph node. Diagn. Cytopathol. 2013. © 2012 Wiley Periodicals, Inc.     

Role of culture for mycobacteria in fine-needle aspiration diagnosis of tuberculous lymphadenitis

A total of 390 cases of tuberculous lymphadenitis was subjected to fine-needle aspiration cytology; 100 of the aspirates were subjected to culture for mycobacteria. The overall acid-fast bacilli (AFB) positivity in smears was 23.58%, with a maximum positivity of 32.94% in smears with both necrosis and granuloma. The overall rate of isolation of mycobacteria on culture was 35%. Mycobacteria were more frequently isolated from caseating lesions (40%) than noncaseating lesions (9%). Caseating lesions with granuloma had the highest AFB (smear and/or culture) positivity at 52%. Mycobacterium avium infection was diagnosed by culture in one case.     

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。