组织细胞坏死性淋巴结炎32例临床病理分析

目的探讨组织细胞坏死性淋巴结炎(HNL)临床病理特点及其与淋巴瘤的鉴别。方法对32例HNL的临床表现、病理形态及7例免疫组化特点进行分析。结果32例中,25例颈部淋巴结肿大,半数有发热,1例有皮诊,外周血白细胞计数正常或偏低;血细胞沉降率增快。形态特征为在活跃的反应性增生的背景下,出现程度不同的凝固性坏死,伴有多种形态的组织细胞增生,细胞内外见不等量碎片。病变区及周围有免疫母细胞及浆样单核细胞增生,无中性粒细胞浸润。免疫组化示坏死灶及边缘CD68、CD3、CD45RO呈片块状( )。CD20在滤泡生发中心,少数散在淋巴细胞阳性。结论HNL为淋巴结反应性增生的特殊表现,女性多见,临床病理特征复杂,易误诊。

Histiocytic necrotizing lymphadenitis:a clinic pathological study of 32 cases

Objective To study the clinic pathological features of histicytic necrotizing lymphadenitis,and the differences from lymphoma.Methods Clinic pathological characteristics,morphological appearance and immunohistochemical features were analyzed in 32 cases of Kikuchi lymphadenitis.Results The most common symptoms were cervical lymphadenopathy.All the lymph nodes were mild to median size.Twentyfive patients developed cervical lymphnode swelling and sixteen with fever,only one with Dermatitis.Laboratory examination showed increase in erythrocyte sedimentation,and decrease in total white blood cells.The lymphnode biopsy revealed necrosis,loss of lymphode structure with many histiocytes and absence of granulomatous reaction.Many plasmacytoid monocytes and immunoblasts existed and neutrophils were absent.Immunophenotyping revealed,CD_3 and CD_(45)RO positive for lymphocytes,CD_(68) for histilcytes,and CD_(20) in follicle center cells and scattered lymphocytes.Conclusion HNL Predominantly affects young women,who present with solitary or multiple cervical lymphadennopatay a companied by fever.HNL is often mistaken for malignant lymphoma.