梅毒颈部淋巴结炎的临床与病理诊断及鉴别诊断
Clinical and pathologic diagnosis and different diagnosis of syphilis cervical lymphadenitis.
作者信息
Yuan Yufen, Zhang Xinlian, Xu Nan, Wang Libo, Li Fangchao, Zhang Ping, Miao Lanfang, Yang Haijun
机构信息
Department of Pathology, Anyang Tumor Hospital Anyang 455000, Henan, China.
Department of Dermatology and Venerology, Anyang County Hospital of Traditional Chinese Anyang 455000, China.
出版信息
Int J Clin Exp Pathol. 2015 Oct 1;8(10):13635-8. eCollection 2015.
PURPOSE
To study the clinical pathologic characteristics and differential diagnosis of syphilitic cervical lymphadenitis, and to improve the rate of its diagnosis and treatment.
METHODS
Retrospectively analyzed the clinical history, Trepone pallidum-ELISA (TP-ELISA), rapid plasma regain test (RPR) and routine pathological examination of the patient diagnosed as syphilis lymphadenitis. And review related literatures.
RESULTS
The main clinical presentation was multiple palpable cervical lymph nodes. The multiple nodes were hard, fixed, and the major diameter of the larger one was 2 cm. The main pathological changes included: the capsule was significantly thickened; reactive hyperplasia of lymphoid follicular with sky star phenomenon; occlusive endovasculitis; perivascular inflammation; the proliferation of epithelioid histiocytes can form granulomas with few multinucleated giant cells; few necrosis. TP-ELISA and RPR were positive.
CONCLUSIONS
The pathological changes of syphilitic lymphadenitis have a variety of performance with relatively specific and suggestive alterations which requires a combination of clinical history and laboratory test before the diagnosis, and the clinicians can reduce misdiagnosis and missed diagnosis of the disease by increasing vigilance of it.
目的
探讨梅毒性颈淋巴结炎的临床病理特征及鉴别诊断方法，提高其诊治率。
方法
回顾性分析确诊为梅毒性淋巴结炎患者的临床病史、梅毒螺旋体酶联免疫吸附试验（TP-ELISA）、快速血浆反应素环状卡片试验（RPR）及常规病理检查结果，并复习相关文献。
结果
主要临床表现为双侧颈部可触及多个肿大淋巴结，质地硬，固定，较大者最大直径约2cm。主要病理改变为：包膜明显增厚；淋巴滤泡反应性增生伴满天星现象；闭塞性血管内膜炎；血管周围炎；上皮样组织细胞增生可形成肉芽肿，可见少量多核巨细胞；坏死少见。TP-ELISA及RPR均为阳性。
结论
梅毒性淋巴结炎的病理改变具有多种表现，其中有相对特异性及提示性的改变，诊断时需结合临床病史及实验室检查，临床医生提高对此病的警惕性可减少误诊及漏诊。
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