组织细胞坏死性淋巴结炎55例临床病理诊断和鉴别诊断

目的 提高对组织细胞坏死性淋巴结炎(HNL)的临床病理学特征的认识，以减少误诊、漏诊。方法结合文献，回顾性分析55例HNL的临床资料，应用光镜观察其病理形态改变。结果55例中女性35例，平均27．5岁。47例头颈部淋巴结肿大。形态特征为在活跃的反应性增生淋巴结病变的背景下，出现不同程度的凝固性坏死，淋巴细胞凋亡及核碎片几乎见于所有病例，伴有多种形态的组织细胞增生。吞噬现象明显，无中性粒白细胞浸润，组织学上可分为3型：增生型，坏死型及黄色瘤样型。结论HNL的临床病理特征复杂。确诊有赖于病理形态学，此病是自限性疾病，预后多良好，但易误诊为恶性淋巴瘤，应注意随访。

Clinicopathology diagnosis and differential diagnosis of histiocytic necrotizing lymphadenitis of 55 cases

[Objective] To recognize the clinical and pathological features of histiocytic necrotizing lymphadenitis (NNL) and to reduce the rates of misdiagnosis and missed diagnosis. [Methods] The clinical and histopathologic findings by light microscopy in the related literature review of HNL were retrospectively reviewed. [Results] There were 35 females and age range was from 6~47 years (mean 27.5 years). 47 patients developed head cervical lymph node swelling. The lymph node biopsy revealed a background of reactive lymphadenopathy and necrosis in some cases and apoptosis, nuclear debris in all cases, loss of lymph node structure, proliferation of lymphocytes and various types histiocytes with phagocytosis, no infiltration of neutrophils. Three histological types: proliferative, necrotizing and xanthomatous were classified. [Conclusion] HNL can be correctly diagnosed based on their clinical symptoms and the above described pathological morphologic change. HNL is self-limited disorder with good prognoses. HNL is often mistaken for malignant lymphoma, so long-term follow-up is necessary.