两例颈部淋巴结转移性低分化癌伴Langhans样巨细胞反应针吸细胞学误诊分析

摘要

Objective To explore the neek lump Fine Needle Aspiration eytology(Fine Needle from Cytology, FNAC)miscliagnose;cl reasons and improve FNAC diagnostic ability. Methods We analysized two misdiag-nosed eases by FNAC of poor differentiated cervical lymph node metastatic cancer with Langhans - like giant cell reaction via clinical date, radiological examination,cytology characteristics, pathological changes and immnnohisto-chemical staining results. Results The neck lump puncture from two patients showed that both were with lymphocyte given priority to a few epithelial cells and multinucleated giant cells,encountered with necrotic tissue and scattered oval cells as well as a few cells with large nuclei. The FNAC diagnosis was lymph node granidoma venereal change,and tend to be tuberculosis. By surgical specimens examination, several nodules, which completely coated with capsule and gray in cut,were seen with medium texture and focal necrosis. Histological features;Mid-tifocal cancer nests were observed in lymph nodes,with small round and ellipse cells. Langhans giant cells was scattered or patchy around the nests. Mnltifocal coagidative necrosis were observed within the nests. Immnnohisto-chemical staining; both cases were CKpan and p63 positive, while CK5/6 positive in one case and CK8/18 positive in the other. The pathological diagnosis was lymph node metastasis squamons cell carcinoma and poorly differentiated with Langhans giant cell response. Conclusion Misdiagnosis of lymph node granidoma venereal change or tuberculosis might happen when miilti nucleated giant cells and necrotic tissue were found in lymph node tissues with fine needle aspiration cytology. Carefully looking for tumor cells is very important. When necessary, lymph node biopsy and immunohistochemistry should be considered as the correct diagnosis.%目的 探讨颈部肿块细针吸取细胞学(Fine Needle Aspiration Cytology,FNAC)误诊原因,提高FNAC诊断水平.方法 回顾性分析两例颈部淋巴结转移性低分化癌伴Langhans样巨细胞反应的临床表现、影像学检查、细胞学特征、病理形态和免疫组织化学(EnVision法)染色观察.结果 两例患者颈部肿块穿刺,镜下均以淋巴细胞为主,少许类上皮细胞和多核巨细胞,以及少许坏死组织,偶见少许成团或散在的椭圆形细胞,个别细胞核大,意义不明确.误诊为淋巴结肉芽肿性病变,倾向结核.手术标本,见结节多枚,包膜完整,切面灰白、质中,可见灶性坏死.组织学特点:淋巴结组织中见多灶成巢分布小圆形或椭圆形细胞,在癌巢周围可见成片或散在的Langhans样巨细胞,癌巢中可见多灶性凝固性坏死.免疫组织化学标记结果:瘤细胞均示CKpan+ + +,p63+ + +,1例CK5/6+ + +,另1例CK8/18+ +;病理诊断为淋巴结转移性低分化鳞状细胞癌,伴Langhans样巨细胞反应.结论 淋巴结针吸细胞学发现多核巨细胞并坏死组织时易误诊为肉芽肿性病变或结核,需仔细寻找有无肿瘤细胞,必要时需经组织学活检,并辅以免疫组织化学确诊.