Eapen M, Mathew C F, Aravindan K P
Medical College, Calicut 673008, India.
J Clin Pathol. 2005 Nov;58(11):1143-6. doi: 10.1136/jcp.2005.026492.
To formulate evidence based histopathological criteria for the diagnosis of acquired toxoplasmic lymphadenitis, in an area of high tuberculosis prevalence.
Multiple histopathological parameters were assessed in a consecutive sample of biopsies from 68 patients presenting with lymphadenopathy with a duration of less than six months. Serum IgM enzyme linked immunosorbent assay was used as the standard reference test for the diagnosis of toxoplasmic lymphadenitis. The sensitivity, specificity, and likelihood ratios of various histological parameters were estimated.
The presence of microgranulomas (p < 0.0001), paracortical widening (p = 0.006), paracortical hyperplasia (p = 0.02), monocytoid B cells in sinuses (p = 0.007), lower than grade 2 macrogranuloma (p = 0.002), and the absence of giant cells (p = 0.05) were found to discriminate between IgM positive cases and IgM negative controls. Using a composite criterion-(1) presence of microgranulomas, (2) lower than grade 2 macrogranuloma, (3) absence of giant cells, and (4) follicular hyperplasia-toxoplasmic lymphadenitis can be diagnosed with a high degree of sensitivity (100%), specificity (96.6%), and positive likelihood ratio (29).
Toxoplasma lymphadenitis can be diagnosed with a high degree of confidence using the specific histopathological criteria identified here.
在结核病高发地区制定基于证据的组织病理学标准，用于诊断获得性弓形虫淋巴结炎。
对68例淋巴结肿大持续时间小于6个月的患者的连续活检样本进行多个组织病理学参数评估。血清IgM酶联免疫吸附测定用作诊断弓形虫淋巴结炎的标准参考试验。估计各种组织学参数的敏感性、特异性和似然比。
发现存在微肉芽肿（p < 0.0001）、副皮质增宽（p = 0.006）、副皮质增生（p = 0.02）、窦内单核样B细胞（p = 0.007）、低于2级大肉芽肿（p = 0.002）以及无巨细胞（p = 0.05）可区分IgM阳性病例和IgM阴性对照。使用综合标准——（1）存在微肉芽肿，（2）低于2级大肉芽肿，（3）无巨细胞，以及（4）滤泡增生——可高度敏感（100%）、特异（96.6%）和具有阳性似然比（29）地诊断弓形虫淋巴结炎。
使用此处确定的特定组织病理学标准可高度可靠地诊断弓形虫淋巴结炎。
