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目的探讨鼻咽部梅毒病变及病原特点,总结诊断上的经验。方法回顾性总结北京同仁医院1996年6月-2005年9月耳鼻咽喉科门诊25例患者的病理资料,用HE染色观察黏膜梅毒组织损伤的病理形态学特点,用改良的W-S染色和免疫组织化学ABC法以梅毒螺旋体(treponema pallidum,TP)多克隆抗体标记,观察侵袭到组织内TP的形态特点及侵袭规律;快速血浆反应素环状卡片试验和TP血凝试验佐证早期梅毒的病理诊断。结果25例血清学检查均为快速血浆反应素环状卡片试验阳性(1:8—128)、TP血凝试验阳性。20例黏膜被覆鳞状上皮内有中性粒细胞浸润、微小脓肿形成,25例固有膜内均有大量浆细胞浸润,小血管内皮细胞肿胀及梅毒性小血管炎。14例扁桃体黏膜表面溃疡,大量浆细胞、淋巴细胞、组织细胞浸润,其中1例扁桃体见各种转化淋巴细胞增殖。1例喉黏膜伴鳞状上皮假瘤样增生。改良的W-S染色发现20例黏膜微脓肿中及鳞状上皮间TP,5例小血管周围见TP,14例扁桃体溃疡面见大量TP,6例渗出物涂片内均见大量TP。4例用免疫组织化学方法在鳞状上皮内见TP。结论鼻、咽喉部早期梅毒有一定的病理形态学特点,改良的W-S染色显示TP是诊断黏膜梅毒的关键性方法。
Objective To explore the characteristics of nasopharyngeal syphilis and pathogen, summarize the experience of diagnosis. Methods The pathological data of 25 cases of otolaryngology clinics in Beijing Tongren Hospital from June 1996 to September 2005 were retrospectively reviewed. The morphological features of mucosal tissue lesions were observed by HE staining. The pathological features of the lesions were evaluated by modified WS staining and immunohistochemistry The ABC method was used to label the polyclonal antibody against treponema pallidum (TP), and the morphological characteristics and invasion of TP were observed. Rapid plasma cyclophilin and TP hemagglutination test were used to confirm the pathological diagnosis of early syphilis. Results 25 cases of serological tests were positive for fast plasma cardin plasma card (1: 8-128), TP hemagglutination test was positive. In 20 mucosa-covered squamous epithelium, neutrophil infiltration and tiny abscess were formed. There were a large number of plasma cell infiltration, small blood vessel endothelial cell swelling and syphilitic vasculitis in all of 25 patients. 14 cases of tonsil mucosal surface ulcers, a large number of plasma cells, lymphocytes, tissue cells infiltration, of which 1 case of tonsil see a variety of lymphocytes proliferation. One case of laryngeal mucosa with squamous pseudotumor-like hyperplasia. Modified W-S staining found that TP was found in 20 mucosal micro abscesses and squamous epithelium, 5 were seen around the small vessels in TP, and 14 tonsil ulcers were seen in large numbers. A large amount of TP was seen in 6 cases of exudate smears. In 4 cases, immunohistochemistry was used to observe TP in squamous epithelium. Conclusion Early syphilis in the nose and throat has some pathomorphological features. The modified W-S staining shows that TP is the key method for the diagnosis of mucosal syphilis.