Vicandi B, Jiménez-Heffernan J A, López-Ferrer P, Gamallo C, Viguer J M
Department of Pathology, La Paz Hospital, Madrid, Spain.
Diagn Cytopathol. 1999 May;20(5):302-6. doi: 10.1002/(sici)1097-0339(199905)20:5<302::aid-dc11>3.0.co;2-x.
Spontaneous, suppurative-necrotizing changes associated with Hodgkin's disease (HD) are not infrequent. They are mostly observed in the nodular sclerosis variant of HD and can cause an erroneous histologic diagnosis of suppurative lymphadenitis. Few cytologic reports describing this presentation of HD are available. We describe 5 cases of HD that showed cytologic abscess-like smears dominated by a massive neutrophilic infiltrate and necrosis. Since therapy can induce similar changes, this study did not include patients with known HD. In 2 cases erroneously diagnosed as suppurative lymphadenitis, the presence of neoplastic cells was minimal and only detected after revision. A third case was misdiagnosed as abscessified metastasic carcinoma. Two cases were correctly identified as HD, although in one, the possibility of anaplastic large-cell lymphoma could not be ruled out. In conclusion, necrosis and massive neutrophilic infiltrates can occur spontaneously and can be prominent findings in smears from patients with HD, mainly the nodular sclerosis variant. The cytopathologist should always consider this possibility in the presence of an abscessified, suppurative, lymphadenitis-like aspirate. A detailed search for the characteristic neoplastic cells of HD is mandatory in these cases.
霍奇金淋巴瘤（HD）相关的自发性化脓性坏死改变并不罕见。它们大多见于HD的结节硬化型，可导致对化脓性淋巴结炎的错误组织学诊断。很少有细胞学报告描述HD的这种表现。我们描述了5例HD病例，其细胞学涂片呈脓肿样，以大量中性粒细胞浸润和坏死为主。由于治疗可引起类似改变，本研究未纳入已知HD的患者。在2例被错误诊断为化脓性淋巴结炎的病例中，肿瘤细胞数量极少，仅在复查时才被发现。第三例被误诊为脓肿性转移癌。2例被正确诊断为HD，尽管其中1例不能排除间变性大细胞淋巴瘤的可能性。总之，坏死和大量中性粒细胞浸润可自发发生，且可能是HD患者涂片的突出表现，主要见于结节硬化型。在出现脓肿样、化脓性、淋巴结炎样抽吸物时，细胞病理学家应始终考虑到这种可能性。在这些病例中，必须仔细寻找HD的特征性肿瘤细胞。
