【摘要】 目的探讨游泳池肉芽肿的临床病理特征、诊断和鉴别诊断、致病机理及治疗。方法回顾性分析我院诊断为游泳池肉芽肿的病例4例,病损结节穿刺液行真菌培养、细菌培养+药敏实验及分枝杆菌培养,同时取小块组织活检并行病原学检测及特殊染色,并复习相关文献。结果镜检:表皮鳞状上皮增生,真皮及皮下灶性坏死、小脓肿形成伴淋巴细胞、中性粒细胞、上皮样细胞及少许多核巨细胞构成亚急性肉芽肿性炎,无典型结核样肉芽肿改变。真菌培养及鉴定结果:培养7天无真菌生长;细菌培养+药敏结果:培养48 h,无需氧菌生长;分枝杆菌培养(+);结核杆菌检测(-)。特殊染色:网状纤维染色(+);糖原-PAS、真菌荧光及抗酸染色均(-)。病理诊断:结合临床及实验室检查均符合游泳池肉芽肿。结论游泳池肉芽肿是由海分枝杆菌感染引起的人的皮肤和皮下组织炎症性疾病,活检及细菌培养和鉴定是确诊的必要条件,了解其临床病理特征及致病机理对该病的诊断和鉴别诊断具有重要意义。更多还原

【Abstract】 Objective To investigate the clinicopathological features,diagnosis,differential diagnosis,pathogenesis and treatment of swimming pool granuloma. Methods Retrospective analysis was performed on 4 cases of swimming pool granuloma diagnosed in our hospital. Fungal culture,bacterial culture,drug sensitivity test and mycobacterium culture were performed in the nodule puncture fluid. Meanwhile,small tissue biopsy was taken for pathogenic detection and special staining,and relevant literature was reviewed. Results Microscopic examination showed epidermal squamous hyperplasia,dermal and subcutaneous focal necrosis,abscess formation with lymphocytes,neutrophils,epithelioid cells and few nuclear giant cells constituted subacute granulomatous inflammation,without the change of typical tuberculous granuloma. Fungal culture and identification results,showed no fungal growth for seven days; Bacterial culture + drug sensitivity results showed no aerobic bacteria growth for 48 hours. Mycobacterium culture positive; TB bacteria tested negative. Special staining found reticular fiber staining was positive; Glycogen-PAS,fungal fluorescence and acid fast staining were all negative. Combined with clinical and laboratory examination,the lesions were consistent with swimming pool granuloma. Conclusion Swimming pool granuloma is an inflammatory disease of skin and subcutaneous tissue caused by marine mycobacterium infection. Biopsy, bacterial culture and identification are necessary for diagnosis.Understanding its clinicopathological characteristics and pathogenic mechanism is important to the diagnosis and differential diagnosis.更多还原