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目的 探讨Kikuchi淋巴结炎病理形态变化规律及与非霍奇金淋巴瘤 (包括NK T细胞淋巴瘤 )、不典型分枝杆菌结核、猫抓病鉴别的诊断。方法 应用组织病理学、免疫组化、结核杆菌DNA、巢式聚合酶链反应 (N PCR)技术观察 6 0例Kikuchi淋巴结炎活检标本的病理形态学特征。结果 Kikuchi淋巴结炎 95 %的病例同时可见增生(PT)、坏死 (NT)及黄色瘤 (XT) 3型改变 ,其中PT为主占 5 6 % ,NT占 39% ,XT占 5 % ;受损区域可见到组织细胞、巨噬细胞、浆样单核细胞、免疫母细胞、小淋巴细胞 5种类型细胞 ;组织细胞每例可见 ,常共同表达CD6 8、MAC387及髓过氧化物酶 (MPO) 3种抗原 ;PT期抗体Ki 6 7强 (+) ,NT灶内细胞FAS(+) ;PCR检测发现 10 6 0 (16 7% )结核杆菌阳性 ,在 10例阳性中仅有 6例抗BCG(antimycobacteriumbovis) (+)。结论 Kikuchi淋巴结炎病变特征复杂 ,以组织细胞为主体的多细胞组成 ,以凋亡坏死为主 ,存在PT→NT→XT病变发展规律 ;针对组织细胞进行免疫酶标及巨噬细胞结核杆菌DNA检测有助于诊断及鉴别诊断
Objective To investigate the pathological changes of Kikuchi’s lymphadenitis and its relationship with non-Hodgkin’s lymphoma (including NK T-cell lymphoma), atypical mycobacterium tuberculosis and cat scratch disease. Methods Histopathology, immunohistochemistry, Mycobacterium tuberculosis DNA and nested polymerase chain reaction (N PCR) were used to observe the histopathological features of 60 Kikuchi lymphadenitis biopsy specimens. Results 95% of Kikuchi’s lymphadenitis showed PT, NT and XT 3 type changes, of which PT accounted for 56%, NT NT 39% and XT 5% There are 5 types of cells, including tissue cells, macrophages, plasmacytoid mononuclear cells, immunoblastic cells and small lymphocytes. Each tissue cell can be seen and often co-expressed CD68, MAC387 and myeloperoxidase (MPO) 3 kinds of antigens; PT6 antibody (Ki67) (+), FAS (+) cells in NT foci; PCR detected 10 6 0 (16 7%) Mycobacterium tuberculosis positive in 10 cases positive only 6 cases anti-BCG (antimycobacteriumbovis) (+). Conclusions Kikuchi’s lymphadenitis is characterized by complicated features, mainly composed of multiple cells in the tissue cells, mainly in the form of apoptosis and necrosis. The pathological changes of PT → NT → XT are observed. Immuno-enzyme labeling and Mycobacterium tuberculosis DNA detection Help diagnosis and differential diagnosis