| OBJECTIVE: To analyze the clinical features of histiocytic necrotizing lymphadenitis(HNL),in order to deepen the understanding of the diagnosis and management of the disease and to provide convenience for the effective clinical diagnosis and management.METHODS: The clinical data of patients with histopathocytic necrotizing lymphadenitis diagnosed by lymph node biopsy in our hospital from January2010 to December 2020 were collected,and the general data,symptoms and signs,laboratory data,imaging findings and pathological features were retrospectively analyzed,and the relevant literature was reviewed.RESULTS: Thirty-seven cases were enrolled,with a median age of 15years(range from 3 to 59 years)and a male-to-female ratio of 1.85:1.Minors and adults accounted for 54.1% and 45.9%,respectively.(1)Fever is the most common symptom,accounting for 75.7%,while fatigue,headache and cervicodynia accounting for 13.5%,10.8%,10.8%,respectively.The type of fever was irregular,and the average maximum temperature was 39.7±0.8℃.There was no correlation between fever and gender or age(P > 0.05).There was no significant correlation between body temperature and visit time.(2)Cervical lymphadenectasis was the common sign which accounting for 89.2%,while cutaneous mucosal lesions and weight loss accounting for 27.0%,24.3%,respectively.The diameter of lymphadenectasis was between 1 and 6cm,with a median of 2.0cm.No correlation was found among sex,age,fever,CRP,ESR,LDH and lymph node size(P > 0.05).There was no significant correlation between the maximum diameter of lymph node and the duration of fever,nor did the highest temperature of fever.(3)The most common findings of laboratory evaluation are leukopenia(43.2%),elevated levels of erythrocyte sedimentation(82.6%),elevated levels of C-reactive protein(75.9%),elevated levels of lactate dehydrogenase(68.2%).Anti-nuclear antibody is positive in28.6% of cases.The incidence of leukopenia in the juvenile group was higher than that in the adult group(60% vs 23.5%,P=0.045).There was no significant correlation among leukopenia,temperature and the size of the lymphadenectasis.(4)Ultrasonography showed that 72.0% of the cases and CT showed that 61.5% of the cases had lymphadenectasis located in bilateral neck without specificity.(5)Histopathology of HNL was mainly characterized by coagulation necrosis with nuclear debris.Immunohistochemistry showed the positive expression rates of CD68,CD123,CD3,CD163,CD8 and MPO were100%,100%,96.3%,93.3%,83.3%,80.0%,respectively.All of the acid fast staining,special staining and in situ hybrid EBERS were negative.(6)In terms of management,45.9% of the cases were treated with NSAIDs as antipyretic treatment,29.7% were not treated without any drugs,and 27.0% were treated with glucocorticoids.Follow-up data of 21 cases(56.8%)were obtained with favourable prognosis,and the follow-up time ranged from 2 to 38 months with a median 9 months.CONCLUSION:(1)The common clinical manifestations of HNL include irregular fever,lymphadenectasis and rash.(2)There were no correlation among fever,leukopenia and lymphadenectasis,and there was no significant difference in sex and age of fever.(3)There were no significant correlation between lymphadenectasis and other clinical indicators.(4)Leukopenia is an important laboratory feature of HNL which is more common in juvenile patients.(5)Coagulation necrosis with nuclear debris and the positive expression of CD123 and CD68 were the standards for diagnostics for the pathological diagnosis of HNL. |
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