骨髓活检与涂片同步观察对诊断慢性淋巴细胞白血病的探讨

目的 :探讨骨髓活检和骨髓涂片同步观察在慢性淋巴细胞白血病 (CLL)诊断方面的重要性。方法 :针对 2 0例CLL患者 ,采用骨髓抽吸 活检双标本一步法取材 ,同时观察其骨髓涂片和活检塑料包埋切片。结果 :①骨髓活检切片增生度检出率为 10 0 % ,骨髓涂片检出率为 70 % ,两者差异有显著性意义 (P <0 .0 5 ) ;②切片中原始和幼稚淋巴细胞百分率略高于涂片 ;③ 85 %CLL患者伴有网状纤维增高 ,5 %CLL患者有胶原纤维增高。结论 :同步观察比常规涂片形态学观察的检出率、准确率均明显增高。     

骨髓涂片结合活检对血液病诊断的价值

目的　探讨骨髓涂片结合活检在血液病诊断中的价值。方法　回顾性分析了 72 8例血液病患者的骨髓涂片和活检资料及部分结合免疫组织化学检查结果。结果　在白血病的预后及微小残留、骨髓增生异常综合征 (MDS)诊断及转归、恶性肿瘤的骨髓浸润方面 ,骨髓活检优于涂片 ;而对于白血病及MDS的FAB分型、巨幼细胞性贫血、特发性血小板减少性紫癜等的诊断 ,骨髓涂片优于活检。结论　骨髓涂片结合活检对许多血液病的诊断、分期和预后判断有重要的价值     

非霍奇金淋巴瘤患者骨髓浸润的诊断价值分析

目的探讨不同的检查方法在非霍奇金淋巴瘤(NHL)患者骨髓浸润诊断中的价值,并分析骨髓浸润与NHL其他临床特征、中期疗效的关系及对预后的影响。方法收集74例经病理确诊并在该院接受治疗NHL患者的病例资料,并进行随访调查,用常用的几种诊断试验评价指标评价不同检查方法对骨髓浸润的诊断价值;相关分析判断骨髓浸润与NHL其他临床特征的相关性;χ2检验分析骨髓浸润与NHL中期疗效的关系;K-M法生存分析判断骨髓浸润是否影响预后。结果 74例NHL患者中骨髓浸润22例,其中骨髓细胞学检出18例,骨髓病理学检出12例(共检查66例),PET/CT检出12例(共检查68例);骨髓浸润与B症状,IPI评分弱相关(P=0.012、0.007,r=0.290、0.311),与临床分期中度相关(P=0.000,r=0.731);骨髓浸润与中期疗效有关(χ~2=5.305,P=0.006);骨髓浸润患者的2年无进展生存率(PFS)和总生存率(OS)均低于无浸润患者,K-M生存分析发现无显著影响(Log Rank P=0.098、0.129)。结论骨髓细胞学、骨髓病理学及PET/CT三种方法对诊断骨髓浸润均有价值,三者联合诊断价值最大,推荐三种方法联合应用诊断骨髓浸润,有助于评估患者病情,及时制定适合的治疗方案,提高患者的生命质量并延长生存时间。     

非霍奇金淋巴瘤骨髓侵犯细胞形态分析

目的：对骨髓侵犯非霍奇金淋巴瘤患者的淋巴瘤细胞形态进行分析。方法：对243例病理上确诊的非霍奇金淋巴瘤患者进行骨髓涂片,分析其形态学改变。结果：243例中发生侵犯40例,侵犯率为16.5%,其中淋巴瘤细胞骨髓浸润27例（67.5%）;淋巴瘤细胞白血病13例（32.5%）。总体上瘤细胞异形性明显,胞体大小不等,核明显畸形,易见到双核或多核,核染色质较粗而密,核仁可见或不见,胞质量少,染色偏碱性。结论：骨髓涂片观察瘤细胞形态,不仅可确定瘤细胞浸润程度,而且可分辨淋巴瘤细胞类型。     

130例骨髓增生异常综合征的骨髓穿刺涂片和骨髓活检切片结果分析

目的：通过对130例骨髓增生异常综合征(MDS)患者的涂片和切片联合检测来观察两者的临床价值。方法：采用简易一步法抽吸——活检技术。在同一穿刺点先做抽取物涂片后，再做环钻活检。结果：粒系、巨核系病态造血检出率切片远高于涂片，而红系病态造血检出率切片低于涂片。结论：两种方法联合应用最大限度地减少MDS的漏诊率和误诊率。     

104例非霍奇金淋巴瘤诊断回顾分析

目的 总结现今非霍奇金淋巴瘤确诊途径和方法及病理类型.方法 回顾我院1995～2006年104例非霍奇金淋巴瘤诊断方法和临床主要症状,并对其病理诊断类型加以总结.结果 104例淋巴瘤患者结内发病62例,其中颈部,锁骨上淋巴结确诊50例.结外发病42例,其中皮疹和皮下结节活检确诊9例,脾切除确诊9例,胃镜活检确诊6例,骨髓形态学诊断6例.病理分型弥漫大B细胞淋巴瘤占32例,外周T细胞淋巴瘤15例,滤泡型12例,MALT 8例.结论 颈部和锁骨上淋巴结活检是确诊淋巴瘤的主要途径,但由于淋巴瘤的结外发病,使其诊断相当困难,组织活检是确诊的金指标.病理类型诊断非常重要,其中弥漫大B细胞淋巴瘤是NHL的主要类型.     

同步骨髓涂片与骨髓活检在2761例血液疾病诊断中的对比分析

目的探讨骨髓涂片和骨髓活检同步对比分析在血液病诊断中的意义。方法收集1989—2009年沈阳军区总医院2761例血液疾病患者,骨髓样本采用骨髓抽吸、活检同步法取材,骨髓涂片与活检染色后,行增生程度及细胞形态学观察。结果在急性白血病(AL)、再生障碍性贫血(AA)、原发性骨髓纤维化(PMF)、骨髓转移癌(MCBM)、多发性骨髓瘤(MM)、慢性淋巴细胞白血病(CLL)、慢性粒细胞白血病(CML)、骨髓增殖性疾病(MPD)及恶性淋巴瘤的诊断符合率,骨髓活检高于骨髓涂片(P<0.05);对于白血病的分型、特发性血小板减少性紫癜(ITP)的诊断符合率,骨髓涂片高于骨髓活检(P<0.05)。骨髓活检在监测PMF和继发性骨髓纤维化疾病的骨髓增生程度及纤维化程度占显著的优势。结论在血液疾病的诊断中骨髓活检和骨髓涂片各具优缺点,两者的结合对提高疾病的诊断率有重要的价值。     

40例多发性骨髓瘤患者骨髓涂片与活检切片内浆细胞浸润的比 …

骨髓涂片内浆细胞的百分率是多发性骨髓瘤(MM)确诊的主要依据之一。临床上 ,骨髓涂片和活检切片内的浆细胞计数常出现矛盾 ,与髓内纤维化或浆细胞的结节状浸润阻碍浆细胞的抽吸 ,致使涂片内浆细胞数减少有关。本文旨在比较 MM患者骨髓涂片与活检切片内浆细胞浸润度 ,以期查明骨髓涂片在诊断中的价值。1　资料与方法1 .1 　 观察对象收集 1 993年 1月～ 1 999年 1 0月 40例 MM患者化疗前的骨髓抽吸涂片和骨髓活检标本。男 2 4例 ,女 1 6例 ,年龄 32～ 82岁。诊断根据国内外常用标准 期 7例 (1 7.5% ) , 期 2 3例 (57.5% ) , 期1 0例 (2 5…     

非霍奇金淋巴瘤的免疫分型与诊断

非霍奇金淋巴瘤 (NHL)是根据免疫学检查进行分型诊断。 1994年 Harris等将淋巴组织肿瘤分为 B细胞肿瘤、T细胞肿瘤和 NK细胞肿瘤、霍奇金病 (REAL分类 )。 1997年美国血液病理学年会又提出 WHO淋巴系肿瘤分类 ,并为临床逐渐广泛采用。现就此作一综述。1　外周 B细胞淋巴肿瘤 [1     

非霍奇金淋巴瘤的诊断与治疗进展

占恶性淋巴瘤90％以上的非霍奇金淋巴瘤（NHL）是一组异质性很强的疾病,其病理分类复杂,临床表现各异,常给诊断治疗造成很大的困难。近年来随着各种先进技术的应用、新药研发的进展及各种临床试验的数据不断更新,对 NHL 发病机制的认识、诊断分类的更新、预后的判断以及其治疗效果均取得了很大的进展,现综述如下。     

Comparison of Bone Marrow Involvement with Bone Marrow Biopsy and PET–CT and Evaluation of Any Effects on Survival in Patients Diagnosed with Hodgkin and Non-Hodgkin Lymphoma

We aimed to demonstrate whether PET–CT can replace bone marrow biopsy in detecting bone marrow involvement in subtypes of lymphoma. In addition, we aimed to also reveal whether there is a difference between the mean survival of patients with bone marrow involvement via PET–CT or biopsy. A total of 276 newly diagnosed lymphoma patients who underwent bone marrow biopsy and PET–CT prior to the treatment were scanned retrospectively. Bone marrow biopsy was used as the standard method to investigate the presence of bone marrow involvement in PET–CT. The relationship between bone marrow involvement and mean survival was compared using both methods. Out of the 276 patients, bone marrow involvement was detected with PET–CT and with biopsy, respectively in 56 patients (20.2%) and in 78 patients (28.2%). In terms of PET–CT’s accuracy with respect to revealing bone marrow involvement, the highest rates were achieved respectively in diffuse large B cell lymphoma (DLBCL) (87.4%) and Hodgkin lymphoma (HL) (77.7%). In both the PET–CT and bone marrow biopsy methods, Overall Survival (OS) was found to be significantly shorter in patients with involvement than in patients without involvement (P: 0.001). PET–CT may replace bone marrow (BM) biopsy in detecting the bone marrow involvement in aggressive lymphoma subtypes such as DLBCL and HL. The presence of BM involvement at the time of diagnosis in both PET–CT and BM biopsy is associated with poor prognosis, and OS is short in this group.     

The Value of PET/CT in Detecting Bone Marrow Involvement in Patients With Follicular Lymphoma

Follicular lymphoma (FL) is the 2nd most common type of lymphoma diagnosed in the Western World. Bone marrow (BM) involvement is an adverse prognostic factor in FL, routinely assessed by an arbitrary biopsy of the iliac crest. This study was aimed to investigate the role of positron emission tomography/computed tomography (PET/CT) in identifying BM involvement by FL.In this retrospective, single-center study we reviewed the records of consecutive patients with FL at diagnosis or relapse who underwent staging/restaging workup visual assessment of BM uptake was categorized as either normal, diffusely increased, or focally increased. Quantitative BM fluorine-18-fluro-deoxyglucose (FDG) uptake was measured using mean standardized uptake value (BM-SUV_mean). The diagnosis of BM involvement was based on either BM histological findings or disappearance of increased uptake at end-treatment PET/CT in patients who responded to treatment.Sixty eight cases with FL were included. Sixteen (23.5%) had BM involvement, 13 (19.1%) had a biopsy proven involvement, and 3 (4.4%) had a negative BM biopsy, but increased medullary uptake that normalized post-treatment. BM FDG uptake in these patients was diffuse in 8 (50%) and focal in 8 (50%). Focal increased uptake was indicative of BM involvement; however, diffuse uptake was associated with 17 false positive cases (32.7%). Overall, visual assessment of BM involvement had a negative predictive value (NPV) of 100% and a positive predictive value (PPV) of 48.5%. On a quantitative assessment, BM-SUV_mean was significantly higher in patients with BM involvement (SUV_mean of 3.7 [1.7–6] vs 1.4 [0.4–2.65], P < 0.001). On receiver operator curve (ROC) analysis, BM-SUV_mean > 2.7 had a PPV of 100% for BM involvement (sensitivity of 68%), while BM-SUV_mean < 1.7 had an NPV of 100% (specificity of 73%).Visual assessment of PET/CT is appropriate for ruling out BM involvement by FL. Although focal increased uptake indicates marrow involvement, diffuse uptake is nonspecific. SUV measurement improves PET/CT diagnostic accuracy, identifying additional 19% of patients with BM involvement that would have been otherwise missed.     

Bone Marrow Involvement in Burkitt''s Lymphoma: Results of a Prospective Study

Eighty-five previously untreated patients with Burkitt's lymphoma were studied prospectively for the development of generalized bone marrow involvement by tumour. Fourteen (16%) of the patients in this series manifested marrow tumour involvement at some time during the course of their disease and seven of these presented with this complication. Only 20% of the affected patients had a peripheral leukaemic picture with a high percentage of circulating tumour cells. The prognosis associated with this complication appeared to be slightly worse in patients developing this picture following initial therapy than in those presenting with it. Pretreatment bone marrow lymphocyte counts were found to be 50% higher in patients who later developed bone marrow tumour involvement than in those who remained free of this complication. The implications of these observations are discussed.     

Prevalence of Intravascolar Large B-Cell Lymphoma with Bone Marrow Involvement at Initial Presentation

We used immunohistochemical analysis to investigate 146 bone marrow (BM) clot specimens from patients with fever of unknown origin (FUO) (n = 124) or hemophagocytic syndrome (HPS) (n = 22). Intravascular lymphoma (IVL) primarily involving BM was detected in 12 (8.2%) of the 146 patients. Diagnosis was based on the presence of CD20+ and CD79a+ tumor cells confined within the lumina of sinuses and surrounded by CD34+ endothelial cells. Of the 12 IVL cases, 6 were CD5+; of these 6 CD5+ cases, 5 were positive for vimentin. The finding of a considerably high prevalence of IVL tumor cells in BM from patients with FUO or HPS suggests that immunohistochemical examination of BM may be helpful in the diagnosis of IVL in these patients. Vimentin coexpression in CD5+ IVL might be evidence of origin from a subset of prefollicular B-cells.     

Bone Marrow Involvement in Burkitt''s Tumour

The bone marrow aspirates from 100 cases of Burkitt's tumour have been analysed. Eight of these showed diffuse massive infiltration with Burkitt tumour cells and eight showed very scanty tumour cells. A leuco-erythroblastic blood picture with occasional or no tumour cells was commonly found in those cases with diffuse massive bone marrow infiltration. This type of bone marrow involvement carries a poor prognosis, the mean survival time of the eight cases in this series being 33 days. The percentage of lymphocytes in the marrow smears of 20 children with Burkitt's tumour, without tumour cells in their bone marrow, was found to be less than that in the bone marrow smears from 20 control children. This may reflect an impaired immune mechanism in children with Burkitt's tumour.