Department of Pathology, Beijing Ditan Hospital,Captial Medical University, No. 8 Jing Shun East Street, Chaoyang District, Beijing, 100015, People's Republic of China.
Center for Infectious Diseases, Beijing Ditan Hospital,Captial Medical University, No. 8 Jing Shun East Street, Chaoyang District, Beijing, 100015, China.
BMC Infect Dis. 2020 Mar 14;20(1):224. doi: 10.1186/s12879-020-4951-x.
Cervical lymphadenopathy refers to a frequently observed clinical presentation in numerous pathological conditions. A wide spectrum of diseases can cause cervical lymphadenopathy, irrespective of the fact that the patients are infected with HIV or not. The present study focuses on validating whether the causes of cervical lymphadenopathy differ significantly in HIV and non-HIV patients by using fine-needle aspiration cytology (FNAC) combining cell block.
A total of 589 patients with cervical lymphadenopathy were recruited in the FNA clinic. The samples were obtained by an auto-vacuumed syringe that benefited the sampling more materials. The cytological smears were prepared by Hematoxylin and Eosin (HE), Periodic Acid Schiff (PAS), Gomori's methenamine silver (GMS) and acid-fast staining. Cell blocks were made if required, and immunohistochemistry stain was performed on the cell block section.
The study found 453 (76.9%) patients with HIV and 136 (23.1%) patients without HIV infection. The average age of HIV-infected patients was 34.8 ± 10.2 years, which was significantly lower than that of non-HIV-infected patients (42.9 ± 18.1 years) (p < 0.01). Of all patients infected with HIV, 390 (86.1%) were males. This proportion was significantly higher than that of non-HIV-infected patients [65/136 (47.8%)] (p < 0.01). The major causes of cervical lymphadenopathy in HIV positive patients were mycobacterial infection (38.4%), reactive hyperplasia (28.9%), non-specific inflammation (19.9%), and malignant lesions (4.2%). In contrast, the most common causes in HIV negative patients were reactive hyperplasia (37.5%), malignancy (20.6%), non-specific inflammation (19.1%) and mycobacterial infection (12.5%). Opportunistic infections such as non-tuberculous mycobacteria (4.2%), cryptococcosis (1.5%), Talaromyces marneffei (1.5%) and other fungi (0.4%) were found only in HIV-infected individuals. Non-Hodgkin's lymphoma (2.4%) was the most common malignant lesion in patients with HIV infection, followed by Kaposi's sarcoma (0.9%) and metastatic squamous cell carcinomas (0.7%). However, the most common malignancy in non-HIV-infected patients was metastatic carcinomas (14%) including small cell carcinomas, adenocarcinomas, squamous cell carcinomas and hepatocellular carcinoma, which were noticeably greater than the HIV patients (p < 0.01).
There were significantly different causes of cervical lymphadenopathy in HIV infected and non-HIV infected patients. FNAC was a useful diagnostic method for differential diagnosis of cervical lymphadenopathy.
颈部淋巴结病是许多病理情况下常见的临床表现。广泛的疾病都可能导致颈部淋巴结病，无论患者是否感染了 HIV。本研究旨在通过使用细针穿刺细胞学（FNAC）结合细胞块来验证 HIV 和非 HIV 患者颈部淋巴结病的病因是否有显著差异。
在 FNA 诊所共招募了 589 例颈部淋巴结病患者。使用自动抽吸注射器获得样本，使采样获得更多材料。细胞学涂片用苏木精和伊红（HE）、过碘酸希夫（PAS）、Gomori 的六亚甲基四胺银（GMS）和抗酸染色制备。如果需要，制作细胞块，并对细胞块切片进行免疫组织化学染色。
研究发现 453 例（76.9%）HIV 感染患者和 136 例（23.1%）非 HIV 感染患者。HIV 感染患者的平均年龄为 34.8±10.2 岁，明显低于非 HIV 感染患者（42.9±18.1 岁）（p<0.01）。所有感染 HIV 的患者中，390 例（86.1%）为男性。这一比例明显高于非 HIV 感染患者[65/136（47.8%）]（p<0.01）。HIV 阳性患者颈部淋巴结病的主要病因是分枝杆菌感染（38.4%）、反应性增生（28.9%）、非特异性炎症（19.9%）和恶性病变（4.2%）。相比之下，在 HIV 阴性患者中，最常见的病因是反应性增生（37.5%）、恶性肿瘤（20.6%）、非特异性炎症（19.1%）和分枝杆菌感染（12.5%）。仅在 HIV 感染者中发现了分枝杆菌（4.2%）、隐球菌病（1.5%）、马尔尼菲青霉菌（1.5%）和其他真菌（0.4%）等机会性感染。非霍奇金淋巴瘤（2.4%）是 HIV 感染患者中最常见的恶性病变，其次是卡波西肉瘤（0.9%）和转移性鳞状细胞癌（0.7%）。然而，在非 HIV 感染患者中最常见的恶性肿瘤是转移性癌（14%），包括小细胞癌、腺癌、鳞状细胞癌和肝细胞癌，明显高于 HIV 患者（p<0.01）。
HIV 感染和非 HIV 感染患者的颈部淋巴结病病因有显著差异。FNAC 是一种用于鉴别诊断颈部淋巴结病的有用诊断方法。
