组织细胞性坏死性淋巴结炎的临床病理特点及免疫组化研究

目的 探讨组织细胞性坏死性淋巴结炎(HNL)的临床病理特征及免疫组化表型。方法分析24例NHL的临床资料，光镜观察其HE切片的形态学特点；应用SP法及TUNEL法检测细胞的免疫表型和凋亡。结果24例HNL中女性20例，男性4例；年龄18～46岁，平均29岁；主要累及颈部淋巴结伴发热。病理组织学淋巴结副皮质区各种大小散在或融合病灶，有多种形态的组织细胞，转化的淋巴细胞以及凋亡碎片组成，缺乏粒细胞浸润；免疫组化淋巴细胞表达CD3和CD45RO，不表达CD15、CD20、CD30；组织细胞表达CD68；凋亡细胞及碎片TUNEL强阳性。结论HNL为淋巴结反应性增生的特殊表现。HNL临床病理特征复杂，临床及病检均易误诊。淋巴结活检显示有多种形态组织细胞，转化的T淋巴细胞以及凋亡碎片组成的病灶，不伴有粒细胞浸润，有助于HNL的诊断。

Histiocytic necrotizing lymphadenitis:a clinicopathological and immunohistochemical study of 24 cases

Objective To study the clinicopathological and immunohistochemistry features of 24 cases histiocytic necrotizing lymphadenitis (HNL). Methods The clinicopathological features of 24 cases HNL were analyzed. Immunophenotyping and detection of apoptotic DNA fragments were performed using SP and TUNEL methods respectively. Results There were 20 females and 4 males, with age ranged from 18~46 years (mean 29 years). Superficial lymph nodes are primarily involved, especially the cervical lymph nods swelling with fever. Histologically variable sized discrete or confluent nodules were seen in the paracortex, which were composed of proliferative pleomorphic histiocytes, transformed lymphocytes and karyorrhectic debris. Immunohistochemistry revealed CD3(+) and CD45RO(+)for lymphocytes, CD68(+)for histiocytes, and no expression for CD15, CD30 and CD20 in the lesion. Conclusions HNL is often mistaken for malignant lymphoma. A backgroud of reactive lymphadenopathy, prominent karyorrhexis and pathy nodal involvement in the form of non-expansive patchs are the important points of differential diagnosis. The presence of pleomorphic histiocytes, transformed T-cells, and karyorrhectic debris in the biopsy of lymph nodes, together with thd absence of neutrophils support the diagnosis of HNL.