HIV感染/AIDS患者感染性浅表淋巴结病的临床病理特征分析

doi:10.3969/j.issn.1000-6621.2021.03.013

摘要/Abstract

摘要：

目的探讨HIV感染/AIDS患者感染性浅表淋巴结病组织病理学特征、致病病原体形态学特点和分布部位。方法回顾性分析2018年1月至2019年6月广西壮族自治区龙潭医院收治的,经组织病理学明确诊断为浅表性淋巴结感染性疾病的88例HIV感染/AIDS患者的淋巴结活检组织病理学特点,并对其标本进一步行抗酸染色、过碘酸雪夫(periodic acid schiff, PAS)染色及六胺银染色查找病原体,应用荧光定量PCR技术检测MTB DNA和荧光定量PCR熔解曲线法进行分枝杆菌菌种鉴定。结果 88例患者淋巴结活检组织病理学诊断结果为MTB感染50例(56.8%)、马尔尼菲蓝状菌(Talaromyces marneffei,TM)感染32例(36.4%)、非结核分枝杆菌(nontuberculous mycobacterium,NTM)感染3例(3.4%)、MTB并发TM感染2例(2.3%)、隐球菌感染1例(1.1%)。其中苏木精-伊红(hematoxylin-eosin,HE)染色条件下,不同病原体感染的88例患者可有相同组织病理学表现,如23例(26.1%)MTB、TM、MTB并发TM、隐球菌感染患者可共同表现为典型肉芽肿伴坏死,19例(21.6%)MTB、MTB并发TM、TM感染患者可共同表现为不典型肉芽肿伴坏死;38例(69.1%,38/55)分枝杆菌感染患者可经抗酸染色找到分枝杆菌,34例TM和1例隐球菌感染患者可经PAS染色和六胺银染色找到真菌;分子病理检测MTB DNA阳性52例,菌种鉴定NTM感染3例。结论 HIV感染/AIDS患者感染性浅表淋巴结病的组织病理学形态表现多样,不具有特异性,特殊染色和分子检测技术可提高确诊率。

关键词: HIV感染, 淋巴结炎, 活组织检查, 病理学,临床, 诊断技术和方法

Abstract:

Objective To explore the clinicopathological features, morphological characteristics and distribution patterns of pathogens in HIV infection/AIDS patients with superficial lymphadenopathy caused by infectious diseases. Methods Eighty-eight HIV infection/AIDS patients with superficial lymphadenopathy caused by infectious diseases were retrospectively recruited between January 2018 and June 2019 from Guangxi Zhuang Autonomous Region Longtan Hospital, and the clinicopathological features were analyzed. These biopsy specimens of lymph nodes were examined with acid-fast staining, periodic acid-schiff (PAS) staining, Giemsa staining, taqman fluorescent quantitative PCR and fluorescence PCR melting curve method. Results Pathological diagnosis confirmed 50 cases of tuberculosis (TB), 36 cases of talaromycosis caused by talaromyces marneffei (TM) infection, 3 cases of nontuberculous mycobacterial diseases (NTM), 2 cases of co-infection of TB and TM, and one case of cryptococcus. These different infectious diseases showed similar histopathological manifestations with HE (hematoxylin-eosin,HE) staining. For example, 23 cases (26.1%) with TB, TM, TB complicated with TM and cryptococcus showed typical necrotizing granulomas, and 19 cases (21.6%) with TB, TB complicated with TM and TM showed atypical necrotizing granulomas. Special staining showed that acid-fast bacilli were detected in 38 cases (69.1%, 38/55) of mycobacterial infection, and fungus were found in 34 cases of TM and 1 case of cryptococcus by PAS and Giemsa staining. The results of molecular pathology showed that 52 cases were TB and 3 cases were NTM. Conclusion The histopathological features of HIV infection/AIDS patients with superficial lymphadenopathy caused by infectious diseases are atypical. Special staining and molecular pathological techniques are useful in improving diagnostic accuracy.

Key words: HIV infect, Lymphadenitis, Biopsy, Pathology,clinical, Diagnostic techniques and procedures

林静, 张晨, 董宇杰, 刘子臣, 李琨, 车南颖. HIV感染/AIDS患者感染性浅表淋巴结病的临床病理特征分析[J]. 中国防痨杂志, 2021, 43(3): 268-273. doi: 10.3969/j.issn.1000-6621.2021.03.013

LIN Jing, ZHANG Chen, DONG Yu-jie, LIU Zi-chen, LI Kun, CHE Nan-ying. Clinicopathological features of superficial lymphadenopathy caused by infectious diseases in HIV infection/AIDS patients[J]. Chinese Journal of Antituberculosis, 2021, 43(3): 268-273. doi: 10.3969/j.issn.1000-6621.2021.03.013

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参考文献 24

[1]	Dimopoulos Y, Moysi E, Petrovas C. The Lymph Node in HIV Pathogenesis. Curr HIV/AIDS Rep, 2017,14(4):133-140. doi: 10.1007/s11904-017-0359-7. doi: 10.1007/s11904-017-0359-7 URL pmid: 28685417
[2]	Wannakrairot P, Leong TY, Leong AS. The morphological spectrum of lymphadenopathy in HIV infected patients. Pathology, 2007,39(2):223-227. doi: 10.1080/0031302070 1230674. doi: 10.1080/00313020701230674 URL pmid: 17454752
[3]	Özkan EA, Göret CC, Özdemir ZT, et al. Evaluation of peripheral lymphadenopathy with excisional biopsy: six-year experience. Int J Clin Exp Pathol, 2015,8(11):15234-15239. URL pmid: 26823872
[4]	Sharma SK, Mohan A. Extrapulmonary Tuberculosis. Indian J Med Res, 2004,120(4):316-353. URL pmid: 15520485
[5]	Gambhir S, Ravina M, Rangan K, et al. Imaging in extrapulmonary tuberculosis. Int J Infect Dis, 2017,56:237-247. doi: 10.1016/j.ijid.2016.11.003. doi: 10.1016/j.ijid.2016.11.003 URL pmid: 27838445
[6]	Gosavi AV, Sulhyan KR, Shetty DS, et al. FNAC of lymph nodes in HIV positive patients-a diagnostic boon. J Am Soc Cytopathol, 2017,6(2):59-65. doi: 10.1016/j.jasc.2016.12.004. doi: 10.1016/j.jasc.2016.12.004 URL pmid: 31042635
[7]	Mustafa T, Wiker HG, Merkve O, et a1. Differential expression of mycobacterial antigen MPT64, apoptosis and inflammatory markers in muhinucleated giant cells and epithelioid cells jn granulomas caused by Mycobacterium tuberculosis. Virchows Arch, 2008,452(4):449-456. doi: 10.1007/s00428-008-0575-z. doi: 10.1007/s00428-008-0575-z URL pmid: 18266005
[8]	Mandal R, Mondal K, Datta S, et al. A clinicopathological study of peripheral lymph nodes in HIV-infected patients with special reference to CD4⁺ T-cell counts: experience from a tertiary care institution in Darjeeling (India) . Diagn Cytopathol, 2015,43(12):971-977. doi: 10.1002/dc.23379. doi: 10.1002/dc.23379 URL pmid: 26457991
[9]	O’Connell ML, Birkenkamp KE, Kleiner DE, et al. Lung manifestations in an autopsy-based series of pulmonary or disseminated nontuberculous mycobacterial disease. Chest, 2012,141(5):1203-1209. doi: 10.1378/chest.11-0425. URL pmid: 22194586
[10]	王宇轩, 王冲, 董宇杰, 等. 肺结核患者肺组织微生物组特征研究. 中国防痨杂志, 2018,40(11):1152-1158. doi: 10.3969/j.issn.1000-6621.2018.11.002.
[11]	Shenoy R, Kapadi SN, Pai KP, et al. Fine needle aspiration diagnosis in HIV-related lymphadenopathy in Mangalore, India. Acta Cytol, 2002,46(1):35-29. doi: 10.1159/000326713. doi: 10.1159/000326713 URL pmid: 11843556
[12]	董宇杰, 张莉, 王宇轩, 等. 免疫组织化学及PCR技术在淋巴结结核病理诊断中的应用价值. 中国防痨杂志, 2018,40(4):345-349. doi: 10.3969/j.issn.1000-6621.2018.04.002.
[13]	Pinder SE, Colville A. Mycobacterial cervical lymphadenitis in children: can histological assessment help differentiate infections caused by non-tuberculous mycobacteria from Mycobacterium tuberculosis? Histopathology, 1993,22(1):59-64. doi: 10.1111/j.1365-2559.1993.tb00070.x. doi: 10.1111/j.1365-2559.1993.tb00070.x URL pmid: 8436342
[14]	Evans MJ, Smith NM, Thornton CM, et al. Atypical mycobacterial lymphadenitis in children—a clinicopathological study of 17 cases. J Clin Pathol, 1998,51(12):925-927. doi: 10.1136/jcp.51.12.925. doi: 10.1136/jcp.51.12.925 URL pmid: 10070335
[15]	孙磊, 张亮, 王玉亮, 等. 细针吸取细胞学在HIV感染者体表肿大淋巴结和肿块诊断中的应用. 临床与实验病理学杂志, 2011,27(10):1070-1074.
[16]	Sfeir MM, Schuetz A, Van Besien K, et al. Mycobacterial spindle cell pseudotumour: epidemiology and clinical outcomes. J Clin Pathol, 2018,71(7):626-630. doi: 10.1136/jclinpath-2017-204777. doi: 10.1136/jclinpath-2017-204777 URL pmid: 29367301
[17]	Dhibar DP, Sahu KK, Singh S, et al. Tubercular Mycobacterial Spindle Cell Pseudotumour: A Case Report. Iran J Med Sci, 2018,43(1):94-96. URL pmid: 29398759
[18]	Hu Y, Zhang J, Li X, et al. Penicillium marneffei infection: an emerging disease in mainland China. Mycopathologia, 2013,175(1/2):57-67. doi: 10.1007/s11046-012-9577-0.
[19]	Le T, Wolbers M, Chi NH, et al. Epidemiology, seasonality, and predictors of outcome of AIDS-associated Penicillium marneffei infection in Ho Chi Minh City, Viet Nam. Clin Infect Dis, 2011,52(7):945-952. doi: 10.1093/cid/cir028. doi: 10.1093/cid/cir028 URL pmid: 21427403
[20]	Boyce KJ, Andrianopoulos A. Morphogenetic circuitry regulating growth and development in dimorphic pathogen penicillium marneffei. Eukaryot Cell, 2013,12(2):154-160. doi: 10.1128/EC.00234-12. doi: 10.1128/EC.00234-12 URL pmid: 23204189
[21]	Chayakulkeeree M, Perfect JR. Cryptococcosis. Infect Dis Clin North Am, 2006,20(3):150-544,v-vi. doi: 10.1016/j.idc.2006.07.001.
[22]	Srinivasan R, Gupta N, Shifa R, et al. Cryptococcal lympha-denitis diagnosed by fine needle aspiration cytology: a review of 15 cases. Acta Cytol, 2010,54(1):1-4. doi: 10.1159/000324958. URL pmid: 20306981
[23]	Ghosh A, Tilak R, Bhushan R, et al. Lymphnodal Co-infection of Cryptococcal and Histoplasma in HIV-infected Patients and Review of Published Reports. Mycopathologia, 2015,180(1/2):105-110. doi: 10.1007/s11046-015-9882-5.
[24]	Mohanty SK, Vaiphei K, Dutta U, et al. Granulomatous cryptococcal lymphadenitis in immunocompetent individuals: report of two cases. Histopathology, 2003,42(1):96-97. doi: 10.1046/j.1365-2559.2003.01513_4.x. doi: 10.1046/j.1365-2559.2003.01513_4.x URL pmid: 12493035

组织病理学特征	MTB感染 (50例)	TM感染 (32例)	NTM感染 (3例)^a	MTB并发TM 感染(2例)^a	隐球菌感染 (1例)^a	χ²值^b	P值^b
典型肉芽肿伴坏死	15(30.0)	6(18.8)	0	1	1	1.296	0.255
不典型肉芽肿伴坏死	16(32.0)	2(6.2)	0	1	0	-	0.006
组织细胞浸润伴坏死	0(0.0)	6(18.8)	1	0	0	-	0.002
仅见坏死	8(16.0)	1(3.1)	0	0	0	-	0.083
仅见组织细胞浸润	0(0.0)	10(31.2)	0	0	0	-	<0.01
仅见不典型肉芽肿	3(6.0)	4(12.5)	2	0	0	-	0.423
仅见典型肉芽肿	3(6.0)	2(6.2)	0	0	0	-	1.000
淋巴结反应性增生	5(10.0)	1(3.1)	0	0	0	-	0.099
伴化脓性感染	14(28.0)	2(6.2)	1	0	0	-	0.013
可见多核巨细胞	8(16.0)	2(6.2)	0	0	1	-	0.302