Clinicopathological features of superficial lymphadenopathy caused by infectious diseases in HIV infection/AIDS patients

doi:10.3969/j.issn.1000-6621.2021.03.013

Abstract

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

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

Figures/Tables 3

References 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