CAJ | 학술논문

目的分析慢性硬化性颌下腺炎的临床病理特点及IgG4的表达,为临床诊断和治疗提供参考.方法收集术后病理诊断为慢性硬化性颌下腺炎的病例9例,男性6例,女性3例,年龄51 ～77岁,中位年龄66岁.对其临床资料、手术标本病理组织学特征及免疫表型总结分析.结果组织学表现为颌下腺小叶结构保存,致密的淋巴细胞和浆细胞浸润,大量淋巴滤泡反应性增生,腺泡不同程度萎缩,小叶间隔明显纤维化,静脉炎及闭塞性静脉炎形成.免疫组织化学检测显示病变组织中IgG4及IgG阳性的浆细胞均明显增加,每一高倍视野内分别平均为186个和261个,IgG4/IgG为0.71.其中3例患有系统性IgG4相关硬化性疾病.结论慢性硬化性颌下腺炎是一种IgG4相关硬化性疾病,确诊后应排除是否存在涎腺外的IgG4相关硬化性疾病,并密切随访,类固醇激素治疗效果良好.
목적 분석만성경화성합하선염적림상병리특점급IgG4적표체,위림상진단화치료제공삼고.방법 수집술후병리진단위만성경화성합하선염적병례9례,남성6례,녀성3례,년령51 ～77세,중위년령66세.대기림상자료、수술표본병리조직학특정급면역표형총결분석.결과 조직학표현위합하선소협결구보존,치밀적림파세포화장세포침윤,대량림파려포반응성증생,선포불동정도위축,소협간격명현섬유화,정맥염급폐새성정맥염형성.면역조직화학검측현시병변조직중IgG4급IgG양성적장세포균명현증가,매일고배시야내분별평균위186개화261개,IgG4/IgG위0.71.기중3례환유계통성IgG4상관경화성질병.결론 만성경화성합하선염시일충IgG4상관경화성질병,학진후응배제시부존재연선외적IgG4상관경화성질병,병밀절수방,류고순격소치료효과량호.
Objective To analyze the clinicopathologic features of chronic sclerosing submaxillaritis (CSS).Methods The clinical and pathological characteristics of 9 CSS were analyzed.Results In the 9 patients,there were 6 males and 3 females.The age of patients ranged from 51-77 years old.All of the tumors were located in the submandibular gland,presenting with painless and firm mass.Histologically,a well-defined mass lesion with extensive lymphocytes and plasma cells infiltration,preservation of lobular architecture,with acinar atrophy.The reactive hyperplasia of lymphoid follicles may be found in CSS.The phlebitis and obliterating phlebitis also formed.Immunohistochemistry showed evidence of diffuse infiltration of plasma cells.The mean number of IgG4-positive plasma cell per high-power field (HPF) was 186,mean value of the IgG4∶ IgG ratio was 0.71.Three of these 9 cases had manifestations of IgG4-associated systemic disease.Conclusions CSS is considered as a part of IgG4-related sclerosing diseases,recognition of which is very essential for a successful treatment.When diagnosis is made,it is necessary to ascertain whether lesion occurs within salivary gland only or in combination with outside IgG4-related sclerosing disease.The establishment of follow-up is also necessary.Some patients show good response to steroid therapy.