艾滋病相关淋巴结病的病理诊断

目的 探讨获得性免疫缺陷综合征（AIDS病,亦称艾滋病）相关淋巴结病的临床病理特点及鉴别诊断。方法 对18例AIDS病相关淋巴结病的病理形态学进行回顾性研究,并进行HE观察和做D-PAS、抗酸、Giemsa染色查找病变组织中病原体和进行免疫标记分类。结果 18例AIDS病相关淋巴结病中,15例为淋巴细胞衰竭期（83％）;在合并病原体感染的16例中,12例为马尔尼菲青霉菌（75％）感染,4例为分枝杆菌感染。另外1例未发现病原体,1例合并弥漫大B细胞淋巴瘤。结论 早期AIDS病相关淋巴结病易漏诊,对临床出现持续发热及多处或全身淋巴结肿大者应提高警惕;对淋巴结严重马尔尼菲青霉菌感染者应注意合并AIDS病的可能;进行AIDS病相关淋巴结病的病理诊断应注意淋巴结功能状态、病原体的鉴别。

Pathology of AIDS-related lymphadenopathy: a study of 18 biopsy cases

Objective To study the clinicopathologic features of acquired immunodeficiency syndrome (AIDS)-related lymphadenopathy and to elucidate the salient features helpful in achieving a correct pathologic differentiated diagnosis. Methods Eighteen cases of AIDS-related lymphadenopathy were retrieved from the files of the First Affiliated Hospital of Guangxi Medical University from 2001 to 2004. Histochemical stains, including periodic acid-Schiff, acid-fast, Giemsa, Grocott stains and immunohistochemistry (EnVision method), were used to detect the presence of pathogens in tissue sections and classify them. Results Fifteen of the 18 cases (83%) were stage 4 (i.e. follicular and lymphocytic depletion). Twelve cases were co-infected with Penicillium marneffei and 4 other cases with Mycobacterium, and no pathogen was found in 1. The remaining patient was complicated with diffuse large B-cell lymphoma. Conclusions When presented in early stages, AIDS-related lymphadenopathy may be overlooked, especially in routine pathology practice. Awareness of the entity in patients with persistent fever and generalized lymphadenopathy is thus crucial. Florid infection with Penicillium marneffei is also considered as an important predictor for underlying AIDS. Thorough understanding of morphologic features of AIDS-related lymphadenopathy, including possible co-infection, is essential in arriving at the correct diagnosis.