淋巴結外Rosai-Dorfman病 — 病例報告

一63歲男性病患主訴聲音沙啞兩個月至門診求診，間接喉頭鏡下發現左側聲帶有充血及變厚情形，經口服類固醇及嗓音休息後，症狀並無改善，遂安排於喉部顯微內視鏡下將囊腫狀之病變切除。術後病理切片發現黏膜下有淋巴球，泡沫狀組織球及漿細胞之浸潤及吞噬淋巴球之組織球。病患於後續2個月逐漸表現出兩側結膜充血及左側耳郭約1.5cm之皮膚腫塊，於眼科實施結膜切片及皮膚科為左側耳郭皮膚切片檢查後，結果皆顯示淋巴球及泡沫狀組織球之浸潤。以CD68及S-100免疫染色輔助診斷，左側聲帶病灶CD68呈陽性，右眼病灶S-100呈陽性。配合H&E染色顯微鏡下所見吞噬淋巴球之組織球，淋巴球及漿細胞之浸潤，確定該病患為淋巴結外Rosai-Dorfman病。病患兩側眼睛紅腫及左側耳郭硬塊於切片後，採觀察及定期追蹤。門診追蹤6個月後，三處病灶並無復發或惡化情形。Rosai-Dorfman病於耳鼻喉科範圍內，表現於喉部者相當罕見。而從處理該病患之經驗得知：若無重大器官侵犯或危害生命，則以保守治療為宜。

關鍵字

淋巴結外；喉部； Rosai-Dorfman病

並列摘要

A 63-year-old man presented to our clinic with a two-month history of husky voice. Injection and thickening of the left vocal cord was found. Oral prednisolone was prescribed and voice rest recommended. Symptoms did not, however, improve. Laryngomicroscopic surgery was arranged and the cystic lesion was excised from the left vocal cord. Using h&Estaining, the specimen exhibited lymphocytes, plasma cells and foamy histiocytes phagocytosing lymphocytes that had infiltrated the submucosa. Bilateral conjunctival injection and left auricular induration of about 1.5cm were noted over the following two months. Biopsies of the right conjunctiva and left auricular skin were performed that showed lymphocyte and foamy histiocyte infiltration. With immunochemical staining, the left auricular lesion produced a CD68 positive response and right ocular lesion produced an S-100 positive response. These findings, in combination with the H&E microscopic findings, led to the diagnosis of extranodal Rosai-Dorfman disease. The conjunctival and ocular lesions were observed with regular follow up. No recurrence or deterioration of the three lesions was seen over the following six months. Rosai-Dorfman disease involving the larynx is quite rare indeed. The presented patient demonstrates that supportive treatment is appropriate if the disease does not threaten life or involve vital organs.

並列關鍵字

extranodal ； larynx ； Rosai-Dorfman disease

國際替代計量

淋巴結外Rosai-Dorfman病 — 病例報告

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