양성 및 악성 임파절 질환시 임파절 피막 및 내부 망상조직의 변화에 관한 연구

Abstract

[한글]

임파절은 말초임파조직의 주요 일원으로 면역기능을 수행하며 여러 질환시에 그 실질세포의 구성 비율이나 미세순환의 변화가 초래된다. 그러나 그 골격을 이루는 결체조직에 대해서는 아직 체계적으로 연구된 바가 없으며, 단지 매독, 동조직구증식증, 그리고 Hodg

kin씨병의 소결절성 경화형에서 피막 섬유증이 나타난다고 보고되어 있을 뿐이다. 이에 저자는 임파절을 침범한 여러 질환에서 그 피막과 망상섬유 골격이 어떠한 변화를 하는지 검토하고자 1978년 1월부터 1982년 7월까지 만 4년 7개월 동안 조직검사 목적으로 의뢰된 임파절중 전반적인 구조와 피막을 형태계측학적으로 검색하기에 충분하였던 404예를 대상으로 하여, 이들을 반응성 중식, 결핵, 악성 임파종, 전이암, 기타 질환으로 분류한 다음, 비자극 임파절을 대조군으로 삼아 임파절 크기 및 이에 대한 피막의 비율을 측정

하고, 병리조직학적으로 검색하여 다음과 같은 결과를 얻었다.

1. 임파절 직경에 대한 피막 두께의 비율은 대조군에서는 1.72±0.27%였으며, 결핵과 전이암에서는 3.46±0.27% 및 3.88±0.35%로서 의의있는 증가를 보였다. 반응성 중식, 악

성 임파종은 일반적으로 피막 두께 비율이 낮은 경향을 보였으나 통계적으로는 의의가 없었다.

2. 피막의 망상섬유와 교원섬유는 반응성 중식, 전이암, 악성 임파종, 기타 질환에서는 대조군에서와 같이 비교적 가늘거나 다소 굵은 다발을 이루면서 피막에 평행하게 분포하는 양상을 보였으나 결핵에서는 이 섬유들이 다른 군들에 비하여 굵은 다발을 형성하는

경향을 보였다.

3. 임파절 실질내의 망상섬유와 교원섬유는 반응성 중식, 악성 임파종, 기타 질환에서는 대조군과 같이 비교적 가는 선으로 임파절내 세포들을 하나씩 또는 소군으로 둘러싸고 있었으나, 결핵에서는 망상섬유와 교원섬유가 증가하여 육아종 주변을 환형으로 둘러싸

고 있었고, 전이암에서는 이 섬유들이 굵은 다발을 이루면서 암세포의 집단을 둘러싸고 경향을 보였다.

4. 기타 임파절 기질내 소견으로서 동조직구증식증 2예에서는 임파절 기질내 호산성의 균질성 물질이 관찰되었고, 다른 동조직구증식증 5예에서는 피막 변화가 뚜렷하지 않으면서 소주만 두꺼워진 것을 볼 수 있었으며, Hodgkin씨병의 소결절성 경화형 6예에서는 굵은 띠 모양의 결체조직이 임파절 실질을 소질로 나누고 있는 것을 볼 수 있었다.

5. 탄력섬유는 가는 선상으로 피막에서만 매우 드물게 관찰되었을 뿐 대조군을 포함한 각 집단의 임파절 실질내에서는 거의 찾아볼 수 없었다.

이상의 결과를 요약하면 임파절 피막과 실질내의 섬유조직 반응은 결핵성 임파선염과 전이암 및 소결절성 경화형의 Hodgkin씨병에 있어서 현저한 증가를 보였으나, 임파종과 반응성 증식에 있어서는 상호간 또는 대조군과의 뚜렷한 차이를 보이지 않았다.

A Study on the Changes of Capsule and Internal Framework of Lymph Nodes in Benign

and Malignant Diseases

Hyeon Joo Jeong

Department of Medical Science The Graduate School Yonsei University

(Directed by Prof. Yoobock Lee, M.D.)

The lymph node is a major component of the peripheral lymphoid system, always in

dynamic state and responds to diverse stimuli by changing the proportion of

cortical, paracortical and medullary areas. However the response of capsule and the

connective tissue framework of the lymph nodes to various diseases has not been

studied systematically.

The present study is aimed to evaluate the response of the capsule and supportive

framework of the lymph nodes in various disease conditions.

The material consisted of 404 cases of lymph nodes examined at the Department of

Pathology, Yonsei University College of Medicine from January, 1978 through July,

1982.

The lymph nodes were classified histologically into unstimulated, reactive

hyperplasia, tuberculosis, metastatic cancer, lymphoma and others. The unstimulated

lymph node was considered as the control, which was characterized by deficient

germinal centers of the cortical lymphoid follicles and more or less hypocellular

paracortex. The reactive hyperplasia was subdivided into germinal center

hyperplasia, paracortical hyperplasia and sinus histiocytosis.

All cases were subjected to morphometric analysis by measuring the diameter of

each lymph node and the thickness of capsule and calculating the ratio of capsular

thickness to diameter of the lymph node.

With the connective tissue stainings such as Gomori's silver impregnation,

Masson's trichrome and Weigert's resorcin fuchsin, reticulin, collagen and elastic

fibers of the capsule and interna of the lymph nodes were examined.

Results obtained were as follows:

1. The ratios of capsular thickness to diameter of the lymph node in tuberculosis

and metastatic cancer were more than two times of that of control, which were

statistically significant, while those of reactive hyperplasia and lymphoma showed

decreasing tendency.

2. The reticulin and collagen fibers in the capsule of reactive hyperplasia,

metastatic cancer, lymphoma and others were similar to those of control, being

relatively fine or coarse, and running parallel to the direction of the capsule.

However those of tuberculosis tended to be more coarse.

3. The reticulin and collaagen fibers in the parenchyme of reactive hyperplasia,

lymphoma and others were similar to those of control, being relatively fine and

encasing individual parenchymal cell or small groups of cells. Tuberculosis showed

increased amounts of both fibers encircling the granulomas. Metastatic cancer

showed thick bundles of reticulin and cillagen fibers dncircling nests of cancer

cells.

4. In 2 cases of sinus histiocytosis homogenous eosinophilic material was

observed in stroma of the lymph nodes. Thickened trabeculae without significant

changes in the capsule were found in 5 cases of sinus histiocytosis also. Broad

collagen bands dividing the interna of lymph nodes into nodules were found in 6

cases of nodular sclerosis of Hodgkin's disease.

5. Elastic fibers were hardly found in stroma of the lymph nodes in all groups,

but short and thin thread-like elastic fibers were present in capsule of all

groups.

In summery, the results obtained from the study indicate that tuberculosis,

metastatic cancer and nodular sclerosis of Hodgkin's disease actively stimulate

proliferation of fibrous tissue in the capsule and supportive framwork of the lymph

nodes, while reactive hyperplasis and primary lymphoma induce no fibrous tissue

proliferation.

[영문]

The lymph node is a major component of the peripheral lymphoid system, always in dynamic state and responds to diverse stimuli by changing the proportion of cortical, paracortical and medullary areas. However the response of capsule and the

connective tissue framework of the lymph nodes to various diseases has not been studied systematically.

The present study is aimed to evaluate the response of the capsule and supportive framework of the lymph nodes in various disease conditions.

The material consisted of 404 cases of lymph nodes examined at the Department of Pathology, Yonsei University College of Medicine from January, 1978 through July, 1982.

The lymph nodes were classified histologically into unstimulated, reactive hyperplasia, tuberculosis, metastatic cancer, lymphoma and others. The unstimulated lymph node was considered as the control, which was characterized by deficient

germinal centers of the cortical lymphoid follicles and more or less hypocellular paracortex. The reactive hyperplasia was subdivided into germinal center hyperplasia, paracortical hyperplasia and sinus histiocytosis.

All cases were subjected to morphometric analysis by measuring the diameter of each lymph node and the thickness of capsule and calculating the ratio of capsular thickness to diameter of the lymph node.

With the connective tissue stainings such as Gomori's silver impregnation, Masson's trichrome and Weigert's resorcin fuchsin, reticulin, collagen and elastic fibers of the capsule and interna of the lymph nodes were examined.

Results obtained were as follows:

1. The ratios of capsular thickness to diameter of the lymph node in tuberculosis and metastatic cancer were more than two times of that of control, which were statistically significant, while those of reactive hyperplasia and lymphoma showed

decreasing tendency.

2. The reticulin and collagen fibers in the capsule of reactive hyperplasia, metastatic cancer, lymphoma and others were similar to those of control, being relatively fine or coarse, and running parallel to the direction of the capsule.

However those of tuberculosis tended to be more coarse.

3. The reticulin and collaagen fibers in the parenchyme of reactive hyperplasia, lymphoma and others were similar to those of control, being relatively fine and encasing individual parenchymal cell or small groups of cells. Tuberculosis showed

increased amounts of both fibers encircling the granulomas. Metastatic cancer showed thick bundles of reticulin and cillagen fibers dncircling nests of cancer cells.

4. In 2 cases of sinus histiocytosis homogenous eosinophilic material was observed in stroma of the lymph nodes. Thickened trabeculae without significant changes in the capsule were found in 5 cases of sinus histiocytosis also. Broad collagen bands dividing the interna of lymph nodes into nodules were found in 6

cases of nodular sclerosis of Hodgkin's disease.

5. Elastic fibers were hardly found in stroma of the lymph nodes in all groups, but short and thin thread-like elastic fibers were present in capsule of all groups.

In summery, the results obtained from the study indicate that tuberculosis, metastatic cancer and nodular sclerosis of Hodgkin's disease actively stimulate proliferation of fibrous tissue in the capsule and supportive framwork of the lymph

nodes, while reactive hyperplasis and primary lymphoma induce no fibrous tissue proliferation.