Medeiros L J, Kaynor B, Harris N L
Department of Pathology, Massachusetts General Hospital, Boston.
Hum Pathol. 1989 Mar;20(3):295-9. doi: 10.1016/0046-8177(89)90141-x.
A case of lupus lymphadenitis with frozen section immunohistologic studies is presented. Clinically, the patient had well-documented systemic lupus erythematosus (SLE) when rapid development of generalized lymphadenopathy raised the possibility of a diagnosis of malignant lymphoma. Histologically, the findings of paracortical foci of necrosis and hematoxylin bodies were diagnostic of SLE. Granulocytes were absent. Monoclonal antibodies applied to frozen sections demonstrated two predominant cell populations within and surrounding the paracortical zones of necrosis: OKM1+, Leu-M1+ histiocytes and OKT8+, Leu-4+ T cytotoxic/suppressor cells. In the lymph node not involved by necrosis, lymphoid follicles were composed of polytypic B cells and the interfollicular regions of T cells. Leu-3a+, Leu-4+ T helper/inducer cells outnumbered T cytotoxic/suppressor cells in a 3:1 ratio. Since lupus lymphadenitis may closely resemble histiocytic necrotizing lymphadenitis of Kikuchi and Fujimoto, particularly if hematoxylin bodies are not found, we compared the findings in this case with findings of cases of histiocytic necrotizing lymphadenitis of Kikuchi and Fujimoto reported in the literature. The immunologic findings in both diseases are similar. We conclude that immunologic studies using frozen sections are probably of no help in differentiating between these two disorders when histologic findings are not conclusive.
本文报告一例狼疮性淋巴结炎并进行了冰冻切片免疫组织学研究。临床上，该患者有明确记录的系统性红斑狼疮（SLE），当全身淋巴结病迅速发展时，增加了恶性淋巴瘤诊断的可能性。组织学上，副皮质区坏死灶和苏木精小体的发现可诊断为SLE。未见粒细胞。应用于冰冻切片的单克隆抗体显示，在坏死副皮质区内及周围有两种主要细胞群：OKM1 +、Leu - M1 +组织细胞和OKT8 +、Leu - 4 + T细胞毒性/抑制细胞。在未发生坏死的淋巴结中，淋巴滤泡由多型性B细胞组成，滤泡间区为T细胞。Leu - 3a + Leu - 4 + T辅助/诱导细胞与T细胞毒性/抑制细胞的比例为3:1。由于狼疮性淋巴结炎可能与菊池和藤本组织细胞坏死性淋巴结炎极为相似，特别是在未发现苏木精小体的情况下，我们将该病例的结果与文献中报道的菊池和藤本组织细胞坏死性淋巴结炎病例的结果进行了比较。两种疾病的免疫结果相似。我们得出结论，当组织学结果不明确时，使用冰冻切片进行免疫研究可能无助于区分这两种疾病。
