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化脓性淋巴结炎

关注儿童病理2018-07-21 22:19:06

化脓性淋巴结炎(Suppurative Lymphadenitis)


临床表现:化脓性淋巴结炎也称为急性淋巴结炎,好发于儿童,通常由细菌(葡萄球菌和链球菌常见)、真菌或一些病毒感染引起,也可发生于接种卡介苗疫苗后。常常是口腔脓肿,上呼吸道感染,阑尾炎或感染伤口引起局部引流的淋巴结发生化脓性炎症,最常见于浅表淋巴结,特别是腋窝和腹股沟淋巴结。表现为淋巴结肿大,质软伴皮肤红肿水肿,很少有脓肿或窦道形成。全身症状有发热、乏力,实验室检查白细胞计数升高。

组织学特征:在疾病早期,淋巴结结构正常,淋巴窦扩张,内见大量中性粒细胞和巨噬细胞(窦卡他)。中性粒细胞浸润淋巴结实质形成微脓肿。细菌菌落、真菌菌丝或病毒包涵物在切片上偶尔可见。淋巴结外周纤维脂肪组织可见炎症细胞浸润。炎症晚期以巨噬细胞吞噬细胞碎片为主,混合淋巴细胞和浆细胞。

辅助检查:免疫组化对诊断无帮助。需要做特殊染色如PAS、抗酸、银染、革兰氏染色;化脓区无菌新鲜组织送微生物室进行需氧和厌氧细菌培养;PCR技术有助于传染性病原体鉴定,特别是生长缓慢或难以生长的微生物。

鉴别诊断:主要是与中性粒细胞丰富的间变性大细胞淋巴瘤(细针穿刺时要特别注意)、猫抓病、性病性淋巴肉芽肿性淋巴结炎、伴坏死的经典型霍奇金淋巴瘤(细针穿刺时要特别注意)、梗死性淋巴瘤(细针穿刺时要特别注意)进行鉴别。

1:Bacterial lymphadenitisLow-power view demonstrating suppurative inflammation extending from the cortex into the medullary area( bottom ).

2:Reactive cortical hyperplasia is noted, with thickening of the capsule, coalesced acute inflammatory infiltrate (left of center) and inflammatory cells within and around the capsule.

3:Acute inflammatory cells are also scattered within the paracortical zone.

4:Acute inflammatory cells and histiocytes expand the subcapsular sinus (right ).


参考文献

[1] Rosado FG, Stratton CW, Mosse CA. Clinicopathologic correlation of epidemiologic and histopathologic features of pediatric bacterial lymphadenitis. Arch Pathol Lab Med. 2011;135:1490-3.

[2] Freidig EE, McClure SP, Wilson WR, et al. Clinical-histologic-microbiologic analysis of 419 lymph node biopsy specimens. Rev Infect Dis. 1986;8:322-8.

[3] Ioachim HL, Medeiros LJ. Ordinary bacterial lymphadenitis. In:Ioachim’s lymph node pathology. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2009. p. 106-9.

[4] Angelakis E, Roux V, Raoult D, et al. Real-time PCR strategy and detection of bacterial agents of lymphadenitis. Eur J Clin Microbiol Infect Dis. 2009;28:1363-8.

[5] Choi P, Qin X, Chen EY, et al. Polymerase chain reaction for pathogen identification in persistent pediatric cervical lymphadenitis. Arch Otolaryngol Head Neck Surg. 2009;135:243-8.

[6] Tamiolakis D, Georgiou G, Prassopoulos P, et al. Neutrophil-rich anaplastic large cell lymphoma (NR-ALCL) mimicking lymphadenitis: a study by fine-needle aspiration biopsy. Leuk Lymphoma. 2004;45:1309-10.