Osborne B M, Butler J J, Mackay B
Am J Surg Pathol. 1979 Apr;3(2):137-45. doi: 10.1097/00000478-197904000-00004.
Three cases of a morphologically distinctive "sclerosis" of lymph nodes are presented. Two patients experienced recurring lymph node enlargement with associated mild malaise over an extended period. The first patient had unilateral axillary lymph node enlargement, but was asymptomatic and died of chronic obstructive pulmonary disease 17 years later with no evidence of lymph node enlargement at autopsy. Each patient had at least transient hypergammaglobulinemia, one with elevated IgM and IgA, one with elevated IgM, and one (from 1958) not further analyzed. Lymph node biopsies revealed extensive deposition of eosinophilic material in all three patients. Identical changes in lymph nodes have been described in chronic diseases. The eosinophilic material may be related to amyloid, but differs from it histochemically and ultrastructurally. The relationship of this lesion to the few cases reported as amyloidosis presenting as lymph node enlargement is discussed. Malignant lymphoma with sclerosis is the most important consideration in the differential diagnosis.
本文报告了3例形态学上具有独特表现的淋巴结“硬化”病例。2例患者在较长时间内反复出现淋巴结肿大，并伴有轻度不适。首例患者为单侧腋窝淋巴结肿大，但无症状，17年后死于慢性阻塞性肺疾病，尸检时未发现淋巴结肿大迹象。每位患者均至少有过短暂的高球蛋白血症，其中1例IgM和IgA升高，1例IgM升高，另1例（1958年病例）未作进一步分析。3例患者的淋巴结活检均显示有大量嗜酸性物质沉积。慢性疾病中也曾描述过淋巴结的类似改变。这种嗜酸性物质可能与淀粉样蛋白有关，但在组织化学和超微结构上与之不同。本文还讨论了该病变与少数报道为以淋巴结肿大形式出现的淀粉样变性病例之间的关系。鉴别诊断时最重要的考虑因素是伴有硬化的恶性淋巴瘤。
