骨髓活检切片与涂片同步分析对诊断非霍奇金淋巴瘤骨髓浸润意义的探讨

非霍奇金淋巴瘤(NHL)是淋巴干细胞克隆性增殖性肿瘤,常常发生骨髓浸润(bone marrow infiltration BMI).临床将有BMI者归纳为Ⅳ期[1],对治疗方案的选择及判断预后均有重要意义.     

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.     

Prolonged Bone Marrow Failure With Monosomy 7 After Engraftment Failure Following Bone Marrow Transplantation

A patient with acute myelogenous leukemia developed prolonged bone marrow failure along with the monosomy 7 chromosome abnormality. The patient had undergone bone marrow transplantation with CD34+ selection following induction failure. However, she then suffered engraftment failure and long-term pancytopenia. Her white blood cell count gradually increased with supportive therapy including granulocyte colony-stimulating factor (G-CSF), and chromosomal analysis of bone marrow cells revealed an abnormal karyotype. Thirty months after the bone marrow transplantation we observed monosomy 7 together with the existing chromosomal abnormality in the patient's bone marrow cells. It has been reported that some patients with idiopathic and posthepatitis aplastic anemia develop clonal disorders such as myelodysplastic syndrome/acute myelogenous leukemia with monosomy 7. The findings in our case suggest that the appearance of monosomy 7 in patients with aplastic anemia may be caused by prolonged low-level hematopoiesis, with or without G-CSF stimulation.     

Abnormal Peripheral Blood Lymphocytes and Bone Marrow Infiltration in Non-Hodgkin''s Lymphoma

The blood lymphocytes of 21 normal blood specimens, 20 patients with various malignant disorders and 63 patients with non-Hodgkin's disease lymphoma, all with lymphocyte counts below 6 x 10(9)/l, were examined by sheep red cell rosetting, fluorescent antisera to surface immunoglobulin and for sensitivity to colchicine. The results were correlated with bone marrow infiltration and lymph node histological findings. The ratio of kappa to lambda light chains in the surface immunglobulin was used to determine if an abnormal clone of lymphocytes was present. In the normals and the non lymphoma controls the expected normal ratio of approximately 2K to 1 lambda was found with a narrow spread. In non-Hodgkin's lymphoma cases there was a wide spread of ratios with half the cases outside the range of the controls. These cases were considered to have a clone of abnormal lymphocytes in the blood although their routine blood and differential counts were usually normal. There was a very significant correlation of the presence of a clone with ultrasensitivity to colchicine and with involvement of the bone marrow. 81% of the cases with a histological diagnosis of well-differentiated diffuse lymphocytic lymphoma, 64% of those with poorly differentiated diffuse but only 22% of those with diffuse histiocytic had an abnormal lymphocyte clone demonstrated by an abnormal K:lambda ratio.     

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.     

Appearance of Bone Marrow Smears With Necrotic Tumor Cells

Bone marrow smears of necrotic tumorcells stained with Romanowsky dyes frequently have a definite reddish colorthat contrasts so strikingly with the bluecolor of normal marrow that necrosismay be suspected from gross examination. The bone marrow cells appear"smudged" and are difficult to identifyon microscopic examination. Commonly,only a small amount of material is obtainable by ordinary needle aspiration ofbone marrow containing necrotic tumor,and all of it is used to make smears. Itis therefore important to recognize thatbone marrow smears with a reddishgross appearance and in which the cellsappear distorted and are difficult toidentify may represent necrotic tumorand not an artifact produced by poortechniques.

Submitted on March 5, 1971 Accepted on March 22, 1971     

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.     

自体骨髓移植治疗成人恶性淋巴瘤后的长期随访

1983年至1991年我们用高剂量长春新碱、阿糖胞苷、环已亚硝脲及环磷酰胺加全淋巴(身)照射[Hd-VCCA+TL(B)I]和自体骨髓移植(ABMT)治疗了21例中高危组成人恶性淋巴瘤患者。其中5例为晚期,6例为耐药复发,4例为部分缓解(PR),4例为首次缓解(CR_1),2例为第二次缓解(CR_2)。平均随访37个月,9年生存率在何杰金氏淋巴瘤(HL)和非何杰金氏淋巴瘤(NHL)分别预期为89%和64%,提示该方案毒性反应可以耐受。如果在患者病程早期进行,可使约70%的成人恶性淋巴瘤患者长期存活。同时提示对骨髓受累或原淋巴细胞型的患者在移植前应作适当的净化残留肿瘤细胞的处理。     

Bone Marrow Necrosis

ABSTRACT Bone marrow necrosis (BMN) is a rare finding in specimens from living patients. It is most commonly found in patients with neoplastic disorders, severe infections and sickle cell disease. We present a patient with Hodgkin's disease who developed extensive BMN 11 months before death. A concise review of the literature is also presented.