Hoffmann E O, Loose L D, Harkin J C
Am J Pathol. 1973 Oct;73(1):47-58.
The stages in the development of the Mikulicz cell in human rhinoscleroma were studied in biopsy specimens obtained from 10 patients using light, immunofluorescent and electron microscopy. The Mikulicz cell was identified morphologically as a macrophage, not a plasma cell. Acutely inflamed areas of rhinoscleroma presented abundant bacteria with a slime layer. The microorganism was infrequent and the mucopolysaccharide was scanty in rhinoscleromal tissue, where plasma cells predominated, and in cicatricial fibrous tissue. In the granulomatous stage of rhinoscleroma, the mucopolysaccharide was found within the Mikulicz cells. The vacuoles observed in the Mikulicz cells were considered to be phagosomes containing, principally, bacterial mucopolysaccharide and few bacteria and, to a lesser extent, swollen mitochondria. It was concluded that the slime layer of Klebsiella rhinoscleromatis plays an important role in the pathogenesis of the disease. It is postulated that this material is a nondigestible mucopolysaccharide that resides in the phagosomes of macrophages, increases the osmotic pressure and forms multiple hydropic vacuoles that rupture not only the phagosomes but also the cells, resulting in the liberation of the mucopolysaccharide. This would initiate a cycle that would prolong the disease in the absence of the bacteria.
利用光学显微镜、免疫荧光显微镜和电子显微镜，对10例人鼻硬结病患者活检标本中米库利奇细胞（Mikulicz cell）的发育阶段进行了研究。从形态学上看，米库利奇细胞被确定为巨噬细胞，而非浆细胞。鼻硬结病的急性炎症区域可见大量带有黏液层的细菌。在以浆细胞为主的鼻硬结病组织及瘢痕纤维组织中，微生物较少，黏多糖也很少。在鼻硬结病的肉芽肿阶段，在米库利奇细胞内发现了黏多糖。米库利奇细胞中观察到的空泡被认为是吞噬体，主要含有细菌黏多糖和少量细菌，其次还含有肿胀的线粒体。得出的结论是，鼻硬结克雷伯菌的黏液层在该病的发病机制中起重要作用。据推测，这种物质是一种不可消化的黏多糖，存在于巨噬细胞的吞噬体内，增加渗透压并形成多个水泡样空泡，这些空泡不仅会使吞噬体破裂，还会使细胞破裂，导致黏多糖释放。在没有细菌的情况下，这将引发一个使疾病持续的循环。
