摘要
目的对比分析鼻腔鼻窦Rosai-Dorfman病(Rosai-Dorfman disease,RDD)与鼻硬结病的临床病理特征。方法回顾6例鼻腔鼻窦RDD及4例鼻硬结病临床病理资料,EnVision免疫组化二步法行S-100、CD68、IgG、IgG4染色及Warthin-Starry(W-S)特染。结果 RDD中4例伴多部位病变,鼻硬结病1例伴喉部病变;前者无鼻腔黏膜破坏,后者多伴溃疡;前者"明区"和"暗区"交错分布,后者"Mikulicz"细胞成片分布,常见中性粒细胞聚集灶;前者组织细胞内见稀薄的嗜伊红物质,伴淋巴浆细胞"伸入",后者"Mikulicz"细胞胞质空亮,内见细小颗粒;前者组织细胞S-100、CD68阳性,后者只CD68阳性,W-S染色见鼻硬结杆菌;二者IgG4阳性计数均值分别为26个/HPF及8个/HPF,IgG4/IgG均小于40%。结论 RDD是系统性疾病,鼻硬结病多局限于上呼吸道;组织形态学、免疫组化(S-100、CD68)及特染(WS)有助于鉴别诊断;纤维化明显时二者需与IgG4相关性疾病鉴别。
OBJECTIVE To comparative analysis the clinicopathological features of extranodal Rosai- Dorfman disease（RDD） in nasal cavity and paranasal sinuses and Rhinoscleroma. METHODS Clinicopathological characteristics was evaluated in 6 cases of RDD and 4cases of Rhinoscleroma. En Vision immunohistochemical technique was used to detect the expressions of S-100, CD68, IgG and IgG4. Warthin-Starry（W-S） staining was used to detect Klebsiella rhinoscleromatis. RESULTS Two cases of RDD located in the nasal and 4 cases associated with other parts lesions. Only 1 case with laryngeal lesions was found in Rhinoscleroma. The nasal mucosa damage was not seen in RDD but mucosal ulcer was easily seen in Rhinoscleroma. ＂Bright＂ and ＂dark＂ area distribution was seen in RDD while the large empty ＂Mikulicz＂ cells were seen in patches distribution in Rhinoscleroma, with clusters of neutrophils obviously. Thin eosinophilic material was seen in RDD histocytes, in the cytoplasm of which there were some small lymphocytes and plasmocytes swallowed （imperipolesis）. Tiny particles were seen in empty ＂Mikulicz＂ cells in Rhinoscleroma. S-100 and CD68 were positive in histocytes of RDD and only CD68 was positive in the ＂Mikulicz＂ cells of Rhinoscleroma. Klebsiella rhinoscleromatis were found in Rhinoscleroma by W-S staining. The magnitude of IgG4- positive plasma cells in RDD and Rhinoscleroma were 26/ HPF and 8/HPF, respectively, with the IgG4-/IgG-positive plasmacytes ratio〈40%. CONCLUSION RDD is a systemic disease while Rhinoscleroma confined to the upper respiratory tract. Histomorphology, immunohistochemical and special staining can be used in differential diagnosis. Note correlation among lgG4-related disease and RDD and Rhinoscleroma when fibrosis obviously.
出处
《中国耳鼻咽喉头颈外科》
CSCD
2017年第5期249-252,共4页
Chinese Archives of Otolaryngology-Head and Neck Surgery
关键词
组织细胞增多症
窦
鼻窦
鼻硬结病
Histiocytosis, Sinus
Paranasal Sinuses
Rhinoscleroma
