Mohan Alladi, Reddy M Kumaraswamy, Phaneendra B V, Chandra Abha
Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati 517507, Andhra Pradesh, India.
Natl Med J India. 2007 Mar-Apr;20(2):78-80.
In patients presenting with peripheral lymphadenopathy, excision biopsy of the most accessible lymph node provides material to establish an early diagnosis, and is important in the management of these patients.
A retrospective study was done of 1724 lymph node biopsy specimens obtained from adult patients and submitted for histopathological examination over a 12-year period.
About one-third (n = 614; 35.6%) of these patients had non-specific lymphadenitis. This included a heterogeneous group of disorders comprising benign follicular hyperplasia, reactive hyperplasia, marked follicular hyperplasia and reactive sinus histiocytosis. Tuberculosis lymphadenitis (n = 540; 31.3%) and malignancy (n = 447; 25.9%) were the other common causes. Of the 540 patients with tuberculosis lymphadenitis, the human immunodeficiency virus (HIV) status was tested in 424 (78.5%) patients; of these, 34 patients (8%) were HIV-seropositive. Epithelioid granulomas with caseation necrosis were more frequently seen in HIV-seronegative patients compared with HIV-seropositive ones (chi2 = 54.66; p < 0.001 ). In HIV-seropositive patients, multiple sites of lymph node involvement (chi2 = 40.597; p < 0.001), suppurative type with adjacent necrosis and panniculitis (chi2 = 68.128; p < 0.001), and non-reactive histological types (chi2 = 109.234; p < 0.001) were more commonly seen compared with HIV-seronegative patients. Kikuchi-Fujimoto disease (n = 36), Kimura disease (n = 7), Rosai-Dorfman disease (n = 6), were rare aetiological causes that have been infrequently reported from India.
Awareness of the characteristic histopathological findings and uncommon aetiological causes of peripheral lymphadenopathy may spare patients from unnecessary evaluation and treatment. In HIV-positive patients, lymph node tuberculosis may be histopathologically unusual and may be suppurative or non-reactive in nearly one-third of patients.
对于出现外周淋巴结病的患者，切除最易获取的淋巴结进行活检可提供用于早期诊断的材料，这对这些患者的治疗管理很重要。
对1724例从成年患者获取并在12年期间提交进行组织病理学检查的淋巴结活检标本进行了一项回顾性研究。
这些患者中约三分之一（n = 614；35.6%）患有非特异性淋巴结炎。这包括一组异质性疾病，包括良性滤泡增生、反应性增生、显著滤泡增生和反应性窦组织细胞增生。结核性淋巴结炎（n = 540；31.3%）和恶性肿瘤（n = 447；25.9%）是其他常见病因。在540例结核性淋巴结炎患者中，对424例（78.5%）患者进行了人类免疫缺陷病毒（HIV）检测；其中，34例（8%）患者HIV血清学呈阳性。与HIV血清学阳性患者相比，HIV血清学阴性患者中更常出现伴有干酪样坏死的上皮样肉芽肿（χ² = 54.66；p < 0.001）。与HIV血清学阴性患者相比，HIV血清学阳性患者中更常出现多个淋巴结受累部位（χ² = 40.597；p < 0.001）、伴有相邻坏死和脂膜炎的化脓型（χ² = 68.128；p < 0.001）以及无反应性组织学类型（χ² = 109.234；p < 0.001）。菊池-藤本病（n = 36）、木村病（n = 7）、罗萨伊-多夫曼病（n = 6）是病因罕见的疾病，在印度鲜有报道。
了解外周淋巴结病的特征性组织病理学表现和不常见病因，可使患者避免不必要的评估和治疗。在HIV阳性患者中，淋巴结结核在组织病理学上可能不寻常，近三分之一的患者可能为化脓性或无反应性。
