CAJ | 학술논문

目的探讨儿童朗格汉斯细胞组织细胞增生症(LCH)在反射式共聚焦激光扫描显微镜(RCM)下的特征,使RCM辅助早期诊断儿童LCH成为可能.方法 14例LCH患儿常规行RCM检查,依据RCM图像确定病理取材部位,对比RCM图像和组织病理检查结果.所有病例均经组织病理及免疫组化检查结果确诊.结果 14例LCH患儿的RCM图像显示,表皮结构紊乱,正常蜂窝状结构消失,海绵水肿,可见中度折光的炎症细胞浸润,有时表皮浅层甚至在角质层出现了低折光的空洞样、火山口样外观;正常环状的真皮乳头结构模糊或消失,见较多散在的中度折光的炎症细胞浸润;真皮层出现大量明亮的树突状细胞,聚集成团,大小不等,形态不一,折光性强;真皮乳头层至网状层可见中度折光的炎症细胞浸润,部分见圆形或线状迂曲扩张的血管.同部位病理取材,行组织病理、免疫组化S100、CD1a染色,证实明亮的树突状细胞为活化的朗格汉斯细胞,RCM图像与组织病理、免疫组化病理像对比,结果具有较好的一致性.结论 RCM无创检测有助于LCH病理活检定位,提高组织病理诊断LCH的准确率.
목적 탐토인동랑격한사세포조직세포증생증(LCH)재반사식공취초격광소묘현미경(RCM)하적특정,사RCM보조조기진단인동LCH성위가능.방법 14례LCH환인상규행RCM검사,의거RCM도상학정병리취재부위,대비RCM도상화조직병리검사결과.소유병례균경조직병리급면역조화검사결과학진.결과 14례LCH환인적RCM도상현시,표피결구문란,정상봉와상결구소실,해면수종,가견중도절광적염증세포침윤,유시표피천층심지재각질층출현료저절광적공동양、화산구양외관;정상배상적진피유두결구모호혹소실,견교다산재적중도절광적염증세포침윤;진피층출현대량명량적수돌상세포,취집성단,대소불등,형태불일,절광성강;진피유두층지망상층가견중도절광적염증세포침윤,부분견원형혹선상우곡확장적혈관.동부위병리취재,행조직병리、면역조화S100、CD1a염색,증실명량적수돌상세포위활화적랑격한사세포,RCM도상여조직병리、면역조화병리상대비,결과구유교호적일치성.결론 RCM무창검측유조우LCH병리활검정위,제고조직병리진단LCH적준학솔.
Objective To assess the reflectance confocal microscopic features of pediatric Langerhans cell histiocytosis (LCH), and to evaluate the performance of RCM in the early diagnosis of pediatric LCH.Methods RCM was routinely performed to image lesions in 14 children with LCH before biopsy.Then, biopsy and histopathological examination were carried out at the sites determined according to RCM images.A comparison was conducted between the confocal microscopic and pathological findings.All the 14 cases were finally diagnosed based on histopathological and immunohistochemical examination results.Results RCM imaging in these patients showed that the epidermal structure was disorganized with spongiosis, infiltration of moderately refractive inflammatory cells and disappearance of normal honeycomb structures, slightly refractive cavernous or crateriform appearance was observed sometimes in the superficial epidermis and even stratum corneum;normal dermal papillary rings were obscure or absent with infiltration of multiple scattered moderately refractive inflammatory cells;plenty of bright hyper-refractive dendritic cells, which varied in size and shape, gathered into clusters in the dermis;moderately refractive inflammatory cells infiltrated the papillary and reticular dermis with the tangling and dilation of blood vessels giving a spherical or linear appearance in some regions.Histopathological examination and immunohistochemical staining for S100 and CD1a both demonstrated that the bright dendritic cells were activated Langerhans cells.RCM images were highly consistent with histopathological and immunohistochemical findings in these patients.Conclusion RCM, a non-invasive examination method, can facilitate the determination of biopsy sites, and promote the accuracy of pathological diagnosis of LCH.