30例骨髓增生异常综合征骨髓涂片和活检形态学诊断的比较

目的 探讨骨髓涂片和活检形态学检查对骨髓增生异常综合征(MDs)的诊断中的价值。方法 同时对30例MDS骨髓涂片和活检活组织检查结果进行分析。结果 30例患者骨髓象表现二系及三系病态造血，骨髓活组织检查可见幼稚前期细胞异常定位(ALTP)及病态造血。结论 联合应用骨髓涂片和活检，以对MDS提高检出率，并提供有价值的依据。     

骨髓增生异常综合征患者病态造血及细胞遗传学变化及其与预后的关系

目的探讨骨髓增生异常综合征(MDS)患者造血细胞中病态造血状况与骨髓单个核细胞遗传学异常变化特征,判断其在该类疾病诊断及预后中的作用和价值。方法经骨髓涂片检查及骨髓组织切片活检确诊的57例MDS患者同时进行骨髓单个核细胞直接培养法R带显带技术进行染色体核型分析,并观察该类患者骨髓造血细胞病态造血、染色体核型异常与患者生存期关系。结果 MDS的病态造血以三系病态造血为多见,其骨髓活检阳性检出率高,尤其对巨核细胞病态造血检出更突出。MDS患者多易出现染色体异常,常见为5 q-、11 q-、20 q-、+8、-7和染色体异位、复杂异常核型,复杂异常染色体核型患者生存期明显缩短。结论骨髓活检是准确反映MDS患者病态造血的特异性检查方法。三系病态造血及复杂异常染色体患者转为急性白血病概率大、生存期短,预后差。     

51例骨髓增生异常综合征的临床和病理电镜研究

本文资料对51例骨髓增生异常综合征(MDS)患者进行骨髓活检透射电镜与血小板过氧化物酶(PPO)检测以及粒单祖细胞(CFU—GM)、白血病祖细胞(CFU—1)培养。结果显示骨髓活检透射电镜与PPO检测比骨髓涂片较易找到巨核系病态造血,结合PPO更提高了小原巨核细胞的检出率。且可在骨髓涂片出现原始细胞增多之前,在骨髓活检中找到未成熟白细胞的位置异常(ALIP),这不仅对MDS的诊断有重要意义,且有助于判断预后。进行CFU—GM,CFU—L同步检测动态观察对急性白血病的诊断及预后判断有更好的价值。     

结合WHO诊断标准浅谈骨髓细胞形态学在骨髓增生异常综合征诊断中的意义

按照WHO标准,主要依靠外周血细胞减少、细胞形态学(骨髓细胞病态造血、环形铁粒幼红细胞计数、原始细胞比例)、细胞遗传学核型分析,对骨髓增生异常综合征(MDS)进行诊断和分型。重要的辅助诊断包括骨髓病理活检或(和)免疫组织化学、流式细胞免疫表型和MDS相关基因突变的检测。病态造血是MDS诊断分型的形态学基础,原始细胞不增多的MDS主要依靠病态造血进行诊断分型。病态造血巨核细胞≥10%或环状铁粒幼红细胞≥15%,对MDS具有较确定性的诊断意义。部分MDS-SLD及MDS-MLD,巨核细胞系无病态造血,仅有红细胞系和(或)粒细胞系病态造血细胞的比例≥10%,属于真正意义上的MDS最低诊断标准,在实际操作起来难以准确把握,诊断MDS时应慎重,并需排除反应性病态造血。该文详细介绍了细胞形态学对MDS的诊断意义,详细解读了各系病态造血的细胞形态学特征以及笔者的经验和体会,分析总结了MDS的诊断思路,阐述了MDS诊断中应注意的问题,对于MDS的精准诊断及防止误诊具有建设性意义。     

骨髓增生异常综合征MIC异常和临床特点

目的：研究骨髓增生异常综合征（MDS）形态学、免疫学、遗传学（MIC）异常变化及临床特点.方法：对65例MDS患者的血液学、免疫学、遗传学异常改变资料进行了回顾性分析.结果：65例中外周血象全血细胞减少36例（55.4%），2系细胞减少19例（29.2%），分类可见幼红细胞35例（53.8%），幼粒细胞27例（41.5%）.贫血60例（92.3%），以中重度为主58例（89.2%），表现为大细胞或正细胞性贫血.白细胞异常56例（86.2%），以减少为主45例（69.2%）.血小板减少41例（63.1%）.65例行骨髓细胞学检查：增生活跃至极度活跃55例（84.6%），1系或1系以上病态造血54例（83.1%），11例难治性质血患者病态造血不明显（16.9%）.59例行骨髓病理学检查：3系不同程度病态造血30例（50.8%），粒系幼稚前体细胞异常定位（ALIP）29例（49.2%）.45例行骨髓细胞流式细胞仪（FCM）免疫表型测定，表现2系或2系以上异常40例（88.9%）.41例做FCM-DNA倍体分析，检出DNA非整倍体26例（63.4%）.32例做骨髓细胞染色体分析，发现异常克隆13例（40.6%）.结论：MDS临床表现不典型，血液学改变复杂，缺乏特异性，部分RA病态造血不明显，仅依靠形态学难以做出正确诊断，应提倡MIC分型诊断。     

不典型慢性髓细胞白血病骨髓组织病理学的初步研究

目的:对16例不典型慢性髓细胞白血病(αCML)患者诊断时的骨髓塑胶包埋活检切片的组织病理学特点进行研究,探讨其对αCML的诊断价值。方法:切片应用常规HGF染色和Gomori网硬蛋白纤维银浸染色方法,分析16例αCML患者骨髓活检切片上髓系、红系和网硬蛋白纤维的改变,并以10例正常切片作对照。结果:在αCML时髓系和红系细胞出现一定程度的病态造血;本组10例检出幼稚前体细胞异位阳性(ALIP+),8例检出同期幼红细胞簇异位,13例示网硬蛋白纤维含量增高。结论:塑胶包埋骨髓活检切片对涂片有补充作用,在αCML的诊断中具有一定价值。     

RA型骨髓增生异常综合征79例相关资料分析

目的：探讨骨髓增生异常综合征RA型（MDS-RA）的血液、骨髓涂片、骨髓病理组织学等的改变，为其疑难病例提供诊断价值。方法：将近几年的MDS资料中筛选MDS-RA被诊断时的资料，进行相关指标统计分析。结果：外周血：以二系或三系减少者为多见；49％的患者可见幼红细胞，44％的患者可见白细胞异常改变；骨髓涂片：以增生活跃和增生低下多见，病态造血者占83％（66／79）例，骨髓病理：以增生活跃为多见；粒系前体细胞增多者32例（41％），可见或偶见“幼稚前体细胞异常定位”（ALIP）者56例（71％）；幼红细胞发育滞停，可见原红细胞岛、同一发育阶段的幼红细胞岛占58（73％）例，有异型巨核细胞者56（71％）例，纤维组织增多占72（91％）。结论：骨髓活组织检查对MDS-RA必不可少的联合诊断方法。     

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。     

外周血中性粒细胞形态异常对骨髓增生异常综合征的诊断意义

目的：评估外周血中性粒细胞形态异常对骨髓增生异常综合征（MDS）的诊断意义。方法：检测26例MDS病人外周血（PB）和骨髓（BM）标本。结果：MDS组的PPP、G－score与对照组相比差异显著（P＜0．001），MDS组PB和BM的PPP、G－score有显著相关性，MDS组PB的PPP、G－score与BM的粒系和总病态造血程度及幼稚细胞百分比有显著相关性。结论：外周血中性粒细胞的G－score和PPP间接反应骨髓病态造血程度在MDS的诊断、鉴别诊断、预后判断中与BM检查有相互补作用。     

胸骨穿刺对髂骨增生低下骨髓增生异常综合征诊断意义探讨

目的:探讨胸骨骨穿对于骨髓增生异常综合征(MDS)的诊断意义。方法:分析我院31例经胸骨骨穿诊断的MDS,对同期的髂骨和胸骨骨髓像进行对比研究。结果:31例经胸骨诊断为MDS的患者髂骨穿刺及髂骨活检表现为增生低下,按WHO分型均为MDS-RCMD;31例髂骨骨髓增生低下患者粒系、红系少见病态造血,粒系仅6.5%(2例)出现巨幼样变,12.9%(4例)患者出现核浆发育失衡,红系仅6.5%(2例)患者出现巨幼样改变,巨核细胞少见,仅3.2%(1例)患者见到4个巨核细胞,未见到病态巨核细胞;相反,同期的胸骨骨髓均表现为增生活跃或明显活跃,三系病态造血明显,在粒系病态造血表现中54.8%(17例)出现双核粒,71.0%(22例)出现了巨幼样粒细胞,93.5%(29例)出现了核浆发育失衡粒细胞,22.6%(7例)出现了假性派胡细胞;红系病态造血表现中,35.5%(11例)患者出现三核红细胞,77.4%(24例)患者出现巨幼样红细胞;87.1%(27例)患者巨核系统出现病态造血,其中小巨核、单圆核、双圆核、三圆核巨核出现的比例分别为19.4%(6例)、77.4%(24例)、35.5%(11例)、35.5%(11例)。结论:部分MDS患者表现为髂骨增生低下,髂骨穿刺发现病态造血的概率低,胸骨穿刺能有效地发现具有重要意义的病态造血表现,为诊断提供明确的依据,是诊断此类MDS的重要方法。     

骨髓检查在全血细胞减少中的诊断价值及320例病因分析

目的:对比分析骨髓涂片与组织活检在全血细胞减少中的诊断价值以及引起全血细胞减少的常见病因。方法:选常规骨髓穿刺部位,用骨髓穿刺针先抽吸骨髓液行涂片,在隔2mm远处用骨髓活检针进针取骨髓组织活检;对比分析320例全血细胞减少患者的骨髓涂片与组织切片的结果。结果:骨髓活检切片与骨髓涂片增生程度一致者118例(36.9%),增生程度切片>涂片者41例(12.8%)。增生程度减低及重度减低者切片组152例(47.5%),骨髓涂片组193例(60.3%)。比较两者的骨髓增生程度,其差异存在统计学意义(P<0.01),骨髓活检对骨髓增生程度的判断优于涂片。两者结合起来更能反映骨髓细胞造血,提高诊断率。造血系统疾病是全血细胞减少的常见病因,也不能忽视非造血系统疾病所致的全血细胞减少。     

The diagnosis from the pathological viewpoint of a blood disease

The histopathological viewpoints of a blood diseases are namely following the cytological examinations except for the viewpoint of organ pathology and has been required only the usefulness in case with the difficulty of cytological examination. If it looks at a blood disease as hematopoietic organ disease, histopathological diagnostic study might make the new paradigm of blood diseases. In this time, I would like to present the hematological diagnosis from the pathological viewpoint by using histological bone marrow sections. *How to examine the bone marrow histology *Hematopoietic microenvironment disorder *Differential diagnosis of hypoplastic marrow lesions *Clinicopathological characteristics of Hypoplastic leukemia *Hemophagocytosis in bone marrow *How to diagnose MDS by histopathology. Bone marrow histology is the valuable diagnostic tool of many kinds of marrow disorders especial cases. By using immunohistochemistry and Giemsa staining, further information might obtain than smear film cytology. Bone marrow clot section aspirated from sternum is enough for histological examination except bone marrow biopsy. Precise cytomorphology might demonstrate by smear film than section histology. However surface phenotype would define by flow cytometric analysis, immunostaining of sections could demonstrate which cells show which markers. Structural and architectural disorder could only be represent by histology. The histological examination of bone marrow might introduce a new aspects of blood disease.     

白血病继发网硬蛋白纤维化的骨髓活检研究

目的：平估骨髓活检在急、慢性白血病继发网硬蛋白纤维经的诊断价值。方法：Ｃ地比分析７６例急、慢性白血病多网硬蛋白纤维化的骨髓切片与涂片诊断结果，动态观察１０例急非淋患者化疗过程中网硬蛋白纤维量的变化情况，结果：风硬蛋白纤维可致白血病患者骨髓涂片假性增生低并引起误诊，活检可起作用正作用，伴骨髓纤维化和早期白血病发片能我早作出诊断，网硬蛋白纤维量的变化与白血病化疗疗效有关，结论：骨髓切片与涂片起互补作用     

骨髓活检在多发性骨髓瘤诊断中的价值

目的：探讨骨髓活检与骨髓涂片在多发性骨髓瘤(MM)诊断中的价值。方法：对29例MM患者骨髓活检采用石蜡薄切片苏木素伊红染色，骨髓涂片采用瑞特染色。结果：骨髓活检与骨髓涂片的增生程度相符者13例(44．8％)，骨髓活检增生程度高于骨髓涂片者12例(41．4％)，骨髓涂片高于骨髓活检者4例(13．8％)。骨髓涂片和切片相结合有助于MM的诊断和分型。结论：骨髓活检可作为MM的常规检查手段。     

The diagnosis from the pathological viewpoint of a blood disease

The histopathoogical viewpoints of a blood diseases are namely following the cytological examinations except for the viewpoint of organ pathology and has been required only the usefulness in case with the difficulty of cytological examination. If it looks at a blood disease as hematopoietic organ disease, histopathological diagnostic study might make the new paradigm of blood diseases. In this time, I would like to present thehematological diagnosis from the pathological viewpoint by using histological bone marrow sections.

• * How to examine the bone marrow histology
• * Hematopoietic microenvironment disorder
• * Differential diagnosis of hypoplastic marrow lesions
• * Clinicopathological characteristics of Hypoplastic leukemia
• * Hemopagocytosis in bone marrow
• * How to diagnose MDS by histopathology

Bone marrow histology is the valuable diagnostic tool of many kinds of marrow disorders especial cases. By using immunohistochemistry and Giemsa staining, further information might obtain than smear film cytology. Bone marrow clot section aspirated from sternum is enough for histological examination except bone marrow biopsy. Precise cytomorphology might demonstrate by smear film than section histology. However surface phenotype would define by flow cytometric analysis, immunostaining of sections could demonstrate which cells show which markers. Structural and architectural disorder could only be represent by histology. The histological examination of bone marrow might introduce a new aspects of blood disease.     

The hematopathological basis for studying effects of the demethylating agent 5-aza-2'-deoxycytidine (decitabine) in myelodysplasia

The myelodysplastic syndromes have, since their first recognition decades ago, been considered notoriously difficult with regard to their proper classification, determination of prognosis, and optimal treatment. With the advent of the French-American-British (FAB) classification, now aided but not superseded by the World Health Organization classification, distinct biological entities have been delineated, which in turn are very useful for stratification to different, established and experimental treatment modalities. However, precise subclassification of different types of myelodysplastic syndrome (MDS) is only possible with hematopathological studies based on the analysis of peripheral blood, bone marrow smear, and bone marrow biopsy, backed by appropriate clinical information. Bone marrow cytogenetics are also essential for any risk stratification since they still provide the second most powerful prognostic parameter after bone marrow blast enumeration. This paper will review the most important aspects of hematopathological diagnostics in MDS, risk scoring, and their application to the inclusion and stratification of patients into the European Organization for Research and Treatment of Cancer (EORTC)/German MDS Study Group Phase III multicenter trial of low-dose decitabine in patients more than 60 years old with high-risk MDS. Emphasis is placed on itemizing the broad spectrum of cytologic and histologic stigmata defining the myelodysplastic categories that are to be considered in this study.     

低增生型骨髓增生异常综合征的骨髓病理观察

目的：评估骨髓活检在骨髓增生异常综合征尤其是低增生型病例时的诊断价值。方法：对比分析５３例骨髓增生异常综合征的患者的骨髓涂片与切片的诊断结果。结果：骨髓活检病理检查对于诊断骨髓增生异常综合征,尤其在低增生型骨髓增生异常综合征患者有很大帮助。结论：骨髓活检是确诊低增生型骨髓增生异常综合征的必要手段。     

Clinical diagnosis of aplastic anemia

A study on the clinical diagnosis of aplastic anemia (AA) was carried out by using 5 different laboratory techniques including bone marrow aspiration and smear. Diagnosis of AA was established in 238 patients. Results with different methods were listed below: (1) Typical picture of AA was found in bone marrow smear of 196 patients. The positive rate was 82.4%. (2) Evaluation of marrow speckles might raise the positive rate to 89.9%. (3) Diagnosis of AA in 103 out of 110 patients was confirmed with bone marrow biopsy. The positive rate was 93.6%. (4) Typical 3-dimensional marrow tissue structure of AA was found in 68 out of 72 patients under scanning electron microscope, with a positive rate of 94.4%. (5) Total body bone marrow gamma-scintigraphy was performed in 56 patients; diagnosis of AA was reconfirmed in 54 patients with a positive rate of 96.4%. (6) 4 or 5 diagnostic techniques were used simultaneously in 30 patients with a positive diagnostic rate of 100%. The methodology of different techniques of bone marrow examination, the typical picture of AA and the causes of missing diagnosis were discussed with certain recommendations on each technique.     

Survey on examinations for diagnosis of bone marrow failure in Japan: a report from the Japanese National Research Group on Idiopathic Bone Marrow Failure Syndromes

Using a registration sheet of a prospective registration system for aplastic anemia (AA)/myelodysplastic syndromes (MDS), by the National Research Group on Idiopathic Bone Marrow Failure Syndromes, Japan, we carried out a survey on examinations for diagnosis of bone marrow failure. Bone marrow trephine biopsy was performed in 66 of 105 cases (63%) [Original diagnosis: AA 51 cases (80%), MDS 12 (32%), undiagnosable 3 (75%)]. Bone marrow aspiration was performed in all cases, and aspiration was performed at least twice in 36 cases (34%). The first-line anatomic site for bone marrow aspiration was the posterior iliac crest (62%). Cytogenetic examination was performed in 93%. The concordance rate between the original and the central review diagnosis was 93% among the studied cases: AA, Idiopathic cytopenia of undetermined significance (ICUS) and MDS in total. Flow cytometry analysis to detect paroxysmal nocturnal hemoglobinuria (PNH)-type blood cells was performed in 32%.