Kaiserling E, Patsouris E, Müller-Hermelink H K, Wichterich D, Lennert K
Institute of Pathology, Eberhard-Karls University, Tübingen, FRG.
Histopathology. 1989 Feb;14(2):161-78. doi: 10.1111/j.1365-2559.1989.tb02126.x.
Three cases with the typical light microscopic picture of lymphoepithelioid cell lymphoma (so-called Lennert's lymphoma) were investigated by electron microscopy. Surprisingly, Lennert's lymphoma could be excluded in two cases. These two cases exhibited, in addition to pleomorphic lymphocytes and epithelioid cells, macrophages with accumulations of bacteria, indicating that a bacterial infection was the cause of the disease. By comparing the typical case of Lennert's lymphoma with the other cases, we found several criteria for distinguishing between Lennert's lymphoma and bacterial lymphadenitis. In bacterial lymphadenitis: (1) small and medium-sized lymphocytes exhibited a wide cytological spectrum whereas the lymphocytes in Lennert's lymphoma were relatively uniform; the lymphocytes with prominent lysosome-like granules found in Lennert's lymphoma were not seen; (2) cytology and distribution of epithelioid cells were similar to those in Lennert's lymphoma; (3) epithelioid venules contained recirculating lymphocytes, which were rarely found in Lennert's lymphoma; (4) numerous interdigitating reticulum cells, fibroblasts and myofibroblasts were seen, but not in Lennert's lymphoma; (5) focal increase in reticulin fibres was the main difference in light microscopy; (6) rod-shaped bacteria were accumulated in the cytoplasm of a few macrophages. The presence of bacteria could not be demonstrated unequivocally by light microscopy. In both cases the large number of intracytoplasmic bacteria suggests that this unusual and until now unknown lymphadenitis is the result of an infection caused by facultative intracellular parasitic bacteria. The outcome of bacterial lymphadenitis that gives the false impression of Lennert's lymphoma is uncertain. Cure was achieved in one of our cases. The other patient died before therapy was commenced.
对3例具有典型光镜表现的淋巴上皮样细胞淋巴瘤（所谓的 Lennert 淋巴瘤）进行了电镜研究。令人惊讶的是，其中2例可排除 Lennert 淋巴瘤。这2例除了有多形性淋巴细胞和上皮样细胞外，还可见巨噬细胞内有细菌聚集，提示细菌感染是该病的病因。通过将典型的 Lennert 淋巴瘤病例与其他病例进行比较，我们发现了一些区分 Lennert 淋巴瘤和细菌性淋巴结炎的标准。在细菌性淋巴结炎中：（1）中小淋巴细胞呈现广泛的细胞学谱，而 Lennert 淋巴瘤中的淋巴细胞相对均匀；未见到 Lennert 淋巴瘤中可见的具有明显溶酶体样颗粒的淋巴细胞；（2）上皮样细胞的细胞学和分布与 Lennert 淋巴瘤相似；（3）上皮样小静脉内含有再循环淋巴细胞，这在 Lennert 淋巴瘤中很少见；（4）可见大量指状网状细胞、成纤维细胞和肌成纤维细胞，而 Lennert 淋巴瘤中未见；（5）网状纤维局灶性增多是光镜下的主要区别；（6）少数巨噬细胞胞质内可见杆状细菌聚集。光镜下不能明确证实细菌的存在。在这2例中，大量胞质内细菌提示这种不寻常且迄今未知的淋巴结炎是由兼性细胞内寄生菌引起的感染所致。给人以 Lennert 淋巴瘤假象的细菌性淋巴结炎的预后尚不确定。我们的1例患者治愈。另1例患者在开始治疗前死亡。
