非结核分枝杆菌性淋巴结炎病理学改变的初步研究

目的 探讨非结核分枝杆菌性淋巴结炎的特征性组织病理学改变.方法 建立非结核分枝杆菌性淋巴结炎的实验动物模型,光镜下观察组织病理学改变;对1例临床初步诊断为非结核分枝杆菌性淋巴结结核患者的病理组织标本经多重PCR方法检测筛选后,光镜下观察组织病理学改变.结果 非结核分枝杆菌感染所致的淋巴结炎的病理学改变与我们所熟知的淋巴结结核的病理学改变不完全相同.在动物模型中观察到的非结核分枝杆菌淋巴结炎的特征性病理学改变如下:(1)淋巴结内可见结节状肉芽肿形成,中央呈凝固性坏死,其中可见较多的中性粒细胞及其核碎屑.坏死区周围可见类上皮细胞、淋巴细胞、单核细胞,并可见纤维组织包裹.肉芽肿内外均可见朗汉斯巨细胞;(2)淋巴结内可见匐形性坏死,坏死旱长条状,中央部分为凝固性坏死,其中有大量中性粒细胞及其核碎屑,周围可见类上皮细胞、淋巴细胞及单核细胞,并可见纤维组织包绕;(3)淋巴结内可见星状和星芒状坏死.对初步诊断为非结核分枝杆菌性淋巴结炎的1例石蜡包埋组织标本,光镜下观察淋巴结内可见上皮样肉芽肿,匐行性坏死和星状坏死,坏死中可见大量中性粒细胞及其核碎屑,周围可见类上皮细胞、淋巴细胞、单核细胞、朗汉斯巨细胞;类上皮细胞的细胞核旱极性排列,周围并可见纤维组织或胶原组织包绕.结论 匐形性坏死、星状和星芒状坏夕匕、中央十酪样坏死中可见大量的中性粒细胞和粒细胞细胞核的碎屑、在中央坏死区的周围可见类上皮细胞胞核的极性排列,是非结核分枝杆菌性淋巴结炎的部分特征性组织病理学改变.

A study of the histopathological characteristics of nontuberculous mycobacteria lymphadenitis

Objective To describe the distinctive histopathological changes of nontuberculous mycobacteria lymphadenitis.Methods An experimental animal model of nontuberculous mycobacteria lymphadenitis was established and the histopathological changes were observed by light microscope.The paraffin imbedded tissue samples from patients suspected of having lymphoid tuberculosis were also detected by triplex polymerase chain reaction and studied by light microscope.Results The distinctive histopathological changes of nontuberculous mycobacteria lymphadenitis in the animal model were as follows:(1)Tubercular granuloma formation in lymph nodes which were infected with nontuberculous mycobacteria.Coagulation necrosis was located at the center of the granuloma,and the necrosis looked different from the caseation necrosis caused by mycobacterium tuberculosis.Many neutrophils and their nuclear debris were distributed over the necrosis area.Surrounding the central necrosis area,many epithelioid cells,lymph cells and mononuclear cells could be lound.The periphery of the granuloma was surrounded by fibrous tissues.Langhans giant cells could be found in the granuloma and outside the granuloma,while these cells were usually found only in the granuloma of tuberculosis.(2)Serpiginous necrosis was found in the lymph nodes infected with nontuberculous mycobacteria.Many neutrophils and their nuclear debris were distributed over the necrosis area.Around the central necrosis area,many epithelioid cells,lymph cells and mononuclear cells could be found.The fibrous tissues were in the borderline.(3)Star-like necrosis and aristiform necrosis were also found in lymph nodes infected with nontuberculous mycobacteria.A paraffin imbedded tissue sample wag detected by triplex polymerase chain reaction and the diagnosis of nontuberculous mycobacteria lymphadenitis wag made.In this sample,epitheliuid granuloma,serpiginous necrosis and starlike necrosis were found.Neutrophils and their nuclear debris were found distributed over the necrosis area,while epithelioid cells,lymph cells,mononuclear cells and Langhans giant cells were found around the central necrosis area.Polar arrangement of the nuclei of epithelioid cells was evident.The lesion was surrounded by fibrous and collagen tissues.Conclusion Serpiginous,star-like and aristiform necrosis were the distinctive histopathological changes of nontuberculous mycobacteria lymphadenitis.Neutrophils and their nuclear debris were aboundant over the necrosis area.Polar arrangement of the nuclei of epithelioid cells was also a distinctive histopathological manifestation.