Lee Kam-Fai, Lin Paul-Yann, Cheung Yun-Chung
Department of Pathology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC.
Chang Gung Med J. 2002 Apr;25(4):271-4.
Leiomyomatosis of lymph nodes is an extremely rare disease. Only a few cases have previously been reported in pelvic lymph nodes. They were related to a benign uterine leiomyoma, a metastasizing uterine leiomyoma, an endometrial adenocarcinoma, and an ovarian endometrioid carcinoma. We report on a case of leiomyomatosis of the mesenteric lymph nodes associated with a duodenal adenocarcinoma with no history of uterine leiomyoma or any gynecological malignancy. The patient, a 56-year-old woman, was found to have an adenocarcinoma of the duodenum. All mesenteric lymph nodes removed showed leiomyomatosis, which was verified by immunohistochemical study showing positive immunostaining for smooth muscle actin, desmin, and vimentin, but negative staining for HMB-45. It is necessary to make a differential diagnosis from other examples of spindle cell proliferation involving lymph nodes such as a hemorrhagic spindle cell tumor with amianthoid fibers (palisade myofibroblastoma), angiomyolipoma, lymphangiomyomatosis, inflammatory pseudotumor, and Kaposi's sarcoma.
淋巴结平滑肌瘤病是一种极为罕见的疾病。此前仅有少数盆腔淋巴结病例的报道。这些病例与子宫平滑肌瘤、转移性子宫平滑肌瘤、子宫内膜腺癌及卵巢子宫内膜样癌有关。我们报告一例肠系膜淋巴结平滑肌瘤病，其与十二指肠腺癌相关，且患者无子宫平滑肌瘤病史或任何妇科恶性肿瘤病史。该患者为一名56岁女性，被发现患有十二指肠腺癌。所有切除的肠系膜淋巴结均显示平滑肌瘤病，免疫组化研究证实平滑肌肌动蛋白、结蛋白和波形蛋白免疫染色呈阳性，但HMB - 45染色呈阴性。有必要与其他累及淋巴结的梭形细胞增殖病变进行鉴别诊断，如含石棉样纤维的出血性梭形细胞瘤（栅栏状肌成纤维细胞瘤）、血管平滑肌脂肪瘤、淋巴管平滑肌瘤病、炎性假瘤及卡波西肉瘤。
