Suster S, Moran C A, Blanco M
Arkadi M. Rywlin Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140.
Am J Clin Pathol. 1994 Apr;101(4):539-42. doi: 10.1093/ajcp/101.4.539.
A case of spindle-cell pseudotumor of the spleen due to nontuberculous mycobacteria in a patient with acquired immunodeficiency syndrome (AIDS) is described. The patient was a 55-year-old, human immunodeficiency virus-positive Haitian man who died of acute neurologic complications while on treatment for central nervous system toxoplasmosis. At autopsy, an enlarged multinodular spleen was noted. Histologic examination revealed coarse nodules of splenic parenchyma replaced by a dense spindle cell proliferation, admixed with scattered inflammatory cells. Immunostains showed strong cytoplasmic positivity of the spindle cells with MAC 387, HAM 56, and alpha-1-antichymotrypsin antibodies and negative staining for actin, vimentin, and S-100 protein antibodies. Ziehl-Neelsen stains revealed numerous elongated acid-fast bacilli within the cytoplasm of the cells that were occasionally lying free within the interstitium. The organisms also had a strongly positive reaction with antibodies to desmin intermediate filaments. Mycobacterial spindle-cell pseudotumor should be included in the differential diagnosis of conditions affecting the spleen in patients with AIDS.
本文描述了一例获得性免疫缺陷综合征（AIDS）患者因非结核分枝杆菌引起的脾脏梭形细胞假瘤。患者为一名55岁的海地男性，人类免疫缺陷病毒阳性，在接受中枢神经系统弓形虫病治疗期间死于急性神经并发症。尸检时发现脾脏肿大，呈多结节状。组织学检查显示，脾实质出现粗大结节，被密集的梭形细胞增殖所取代，并伴有散在的炎症细胞。免疫染色显示梭形细胞对MAC 387、HAM 56和α-1抗糜蛋白酶抗体呈强细胞质阳性，而对肌动蛋白、波形蛋白和S-100蛋白抗体呈阴性染色。齐-尼氏染色显示细胞胞质内有大量细长的抗酸杆菌，偶尔游离于间质中。这些微生物对结蛋白中间丝抗体也有强阳性反应。在AIDS患者中，影响脾脏的疾病鉴别诊断应包括分枝杆菌梭形细胞假瘤。
