广州医药2024，Vol.55Issue(2)：121-126,6.DOI:10.3969/j.issn.1000-8535.2024.02.003
模仿IgG4相关淋巴结病的多中心型Castleman病:易误诊病例的鉴别诊断及文献复习
Multicentric Castleman disease mimicking IgG4-related lymphadenopathy:differential diagnosis of misdiagnosed cases and literature review
李春艳 1刘国荣 2常丽君 2李秀博 2丁文双2
作者信息
- 1. 广州市第一人民医院,华南理工大学第二附属医院病理科(广东广州 510180)||南方医科大学附属茂名医院病理科(广东茂名 525000)
- 2. 广州市第一人民医院,华南理工大学第二附属医院病理科(广东广州 510180)
- 折叠
摘要
Abstract
Objective By studying a rare case of the plasma cell type idiopathic multicentric Castleman disease(PC-iMCD)with histological characteristics similar to IgG4-related lymphadenopathy,the differential points of the two easily misdiagnosed diseases were summarized to improve the level of pathological diagnosis.Methods The clinical data of one patient with PC-iMCD were collected,the structure alteration and cell morphology were observed by hematoxylin-eosin(HE)stains.The immunophenotype of cells was marked by immunohistochemical staining and the infections status of EB virus was detected by in situ hybridization.Besides,the differential diagnosis between IgG4-RD and PC-iMCD were analyzed and discussed based on literature analysis.Results This article reported a 48-year-old female who was admitted to the hospital with dry mouth,polydipsia,skin itching and multiple lymphadenopathy.The levels of various classes of serum immunoglobulin were all increased,such as IgG,IgA,IgM and IgE.Specially,the serum IgG4 was also significantly increased(14.7 g/L)and interleukin 6(IL-6)was abnormally raised(150.84 pg/mL).The pathological examination indicated that the lymph node germinal center was atrophied and mantle zones were expanded which were composed of concentric rings of lymphocytes in an"onion skinning"appearance.Besides,the interfollicular area was expanded in which mature plasma cells were infiltrated in sheet-like,hemosiderin was deposited as well as the vessels were proliferated.Immunohistochemistry showed that the number of IgG4-positive plasma cells was＞100/HPF,IgG4/IgG-positive cells ratio was＞40%,and Kappa and Lambda light chains were expressed unrestrictedly.In situ hybridization revealed that the expression of EBER was negative.Conclusions PC-iMCD and IgG4-related lymphadenopathy shares similar histopathological characteristics and it's challenging to distinguish these two diseases by their histology and immunophenotype.In conclusion,the correct diagnosis should be combined with the diagnostic criteria,exclusion diagnostic criteria,clinical manifestations and related laboratory examinations.关键词
Castleman病/IgG4相关淋巴结病/淋巴结/浆细胞/鉴别诊断Key words
Castleman disease/IgG4-related lymphadenopathy/lymph node/plasma cells/differential diagnosis引用本文复制引用
李春艳,刘国荣,常丽君,李秀博,丁文双..模仿IgG4相关淋巴结病的多中心型Castleman病:易误诊病例的鉴别诊断及文献复习[J].广州医药,2024,55(2):121-126,6.
