不同骨髓检查在淋巴瘤诊断中的价值

探讨3种骨髓检查方法（骨髓涂片、活检、流式细胞术分析）对淋巴瘤骨髓浸润的诊断及分期价值。方法：对74例患者进行3种方法的骨髓检查,评估不同方法的检出率、对分期的影响以及各亚型中骨髓浸润的风险。结果：骨髓涂片阳性者12例（16.2%）,骨髓活检阳性10例（13.5%）,流式细胞术分析阳性23例（31.1%）,流式细胞术分析的阳性率显著高于涂片和活检检查（P<0.05）;骨髓涂片、活检、流式细胞术分析可互相修正淋巴瘤患者的临床分期;弥漫大B细胞淋巴瘤亚型骨髓浸润比例最高;对于无淋巴结、肝脾肿大者,骨髓检查具有明确诊断的作用。结论：骨髓涂片、活检及流式细胞术分析对淋巴瘤有重要的诊断及分期价值,三者互为补充,不能相互替代。     

骨髓活检术及FDG-PET/CT在淋巴瘤骨髓侵犯诊断中的临床应用

摘 要：骨髓活检是目前临床常用的骨髓受侵评价方法,在淋巴瘤的分期中有重要意义。目前针对淋巴瘤的分期,在临床中骨髓活检和18F-氟代脱氧葡萄糖-正电子发射断层扫描（FDG-PET/CT）检查手段均发挥着重要作用,在判断淋巴瘤患者骨髓是否受侵犯时,FDG-PET/CT分期检查能否代替骨髓活检值得探讨。全文综述骨髓活检及FDG-PET/CT检查在不同类型淋巴瘤患者中的应用,并分析对比这两种骨髓评价手段各自的应用价值。     

骨髓活检在骨髓转移癌病理诊断中的价值

目的:探讨骨髓活检对转移癌的诊断价值.方法:应用塑料包埋骨髓活检制片技术对43例诊断为转移性癌的病例进行观察,同步对比骨髓涂片.结果: 活检中骨髓的增生程度明显高于涂片;涂片中23例增生减低,20例增生活跃.活检中3例增生减低,40例增生活跃.涂片中16例可见癌细胞,骨髓活检中29例可见癌巢.结论:骨髓活检结合涂片对转移癌有互补诊断价值.     

淋巴瘤侵犯骨髓的诊断与鉴别诊断

介绍了骨髓活检在淋巴瘤侵犯骨髓诊断中的意义,淋巴瘤侵犯骨髓、淋巴瘤细胞白血病或白血病性淋巴瘤及急、慢性淋巴细胞白血病的概念,14种HNL与HL侵犯骨髓的病理组织学特点和鉴别要点。     

骨髓活检对诊断非霍奇金淋巴瘤骨髓浸润及分期意义的探讨

目的:探讨骨髓活检切片分析在非霍奇金淋巴瘤骨髓浸润(NHLBMI)诊断及临床分期方面的价值。方法:对128例非霍奇金淋巴瘤患者行骨髓活检术,分析活检切片。结果:骨髓活检切片中非霍奇金淋巴瘤骨髓浸润的阳性率为35.9%(46例)。经骨髓活检后,16例Ⅰ～Ⅲ期提升为Ⅳ期,骨髓活检前、后Ⅳ期所占比例有明显差异(P<0.01)。结论:骨髓活检切片分析对非霍奇金淋巴瘤骨髓浸润的诊断及临床分期具有重要意义。     

淋巴瘤侵犯骨髓的骨髓活检病理学诊断研究进展

淋巴瘤侵犯骨髓(lymphomabonemarrowinvolvement,LBMI)主要靠骨髓活检确诊。霍奇金淋巴瘤(Hodgkin蒺slymphoma,HL)、非霍奇金淋巴瘤(non-Hodgkin蒺slymphoma,NHL)侵犯骨髓各有其不同病理特点。骨髓中瘤细胞的形态特点、分布方式及免疫表型多数与髓外部位一致,少数又可存在差别。本文比较了各型HL、B-NHL、T-NHL的骨髓侵犯病理学特点,并从形态学、免疫组化及淋巴瘤基因重排检测三方面对LBMI的骨髓活检诊断研究进展进行了综述。     

骨髓涂片、骨髓活组织检查及流式细胞术在淋巴瘤骨髓侵犯诊断中的比较

目的 比较骨髓涂片、骨髓活组织检查和流式细胞术三种方法对淋巴瘤患者骨髓受累的检测情况,为临床检测骨髓受累提供选择.方法 收集68例恶性淋巴瘤初治患者,观察骨髓涂片、骨髓活组织检查和流式细胞术三种方法检测淋巴瘤患者骨髓受累的阳性率.结果 68例恶性淋巴瘤患者检测骨髓受累时,骨髓涂片、骨髓活组织检查和流式细胞术的阳性率分别为16.2％（11/68）、33.8％（23／68）和10.3 ％（7/68）,骨髓活组织检查阳性率高于涂片和流式细胞术检查,三种方法阳性率差异有统计学意义（P＜0.05）.对三种检测方法进行相关性分析,骨髓涂片与骨髓活组织检查存在相关性（P=0.002）,与流式细胞术没有相关性（P=0.270）.结论 骨髓涂片细胞形态学检查是检测淋巴瘤患者是否有骨髓受累的基础方法,骨髓活组织检查阳性率较高,有明显的优势,但需与骨髓涂片互为补充.     

流式细胞术联合形态学检查对淋巴瘤骨髓累犯的诊断价值

目的 探讨流式细胞术(FCM)联合形态学检查对淋巴瘤骨髓累犯的诊断价值.方法 对52例淋巴瘤患者的骨髓标本行FCM、涂片及活组织病理切片检查,观察骨髓受累率、免疫表型数据和检查前后临床分期(CS)、国际预后指数(IPI)的变化.结果 6例霍奇金淋巴瘤(HL)切片法仅发现1例骨髓受累;46例非霍奇金淋巴瘤(NHL)中,骨髓受累FCM检出3l例,涂片法检出5例,切片法检出12例.FCM发现的3l例受累患者中,21例为早期浸润(瘤细胞＜5%);12例为小细胞淋巴瘤(SLL);6例同时表达T、B细胞抗原,1例弥漫大B细胞性淋巴瘤同时表达髓系抗原CD13、CD33;检查后,19例由原分期Ⅰ、Ⅱ、Ⅲ期升至Ⅳ期,18例进展型NHL的IPI提高.结论FCM联合形态学检查提高了骨髓受累的检出率,并能了解骨髓增生程度,提供免疫表型数据,尤对早期浸润和SLL声重要鉴别价值.准确的骨髓检查提高了患者CS和IPI.     

淋巴瘤骨髓浸润的磁共振成像定性和定量诊断价值

 【摘要】　目的　探讨磁共振成像（MRI）对淋巴瘤患者骨髓浸润的定性及定量诊断价值。方法　回顾性分析28例确诊淋巴瘤骨髓浸润的患者,MRI定性分析脊柱骨髓浸润的影像特征,定量测量病变骨髓与脑脊液在T1加权图像上的信号强度比（SIR1）。以31例正常脊柱骨髓为对照组。结果　定性诊断：27例患者脊柱骨髓MRI见异常信号,1例假阴性,MRI诊断的敏感度为96.4 %;淋巴瘤骨髓浸润的脊柱MRI表现主要有4种类型,分别为局灶型21.4 %（6／28）,多灶型53.6 %（15／28）,斑驳型14.3 %（4／28）,弥漫型7.1 %（2／28）。定量诊断：淋巴瘤组骨髓的SIR1（1.251±0.253）明显低于对照组（2.625±0.434）,两组差异有统计学意义（t＝15.022,P＜0.001）;轻、中、重度骨髓浸润SIR1值（分别为1.390±0.172、0.982±0.790、0.908±0.122）与对照组比较,差异均有统计学意义（均P＝0.000）,骨髓浸润轻度与中度组间、轻度与重度组间SIR1值差异有统计学意义（LSD法,P＝0.012,P＝0.025）,中度与重度组间的SIR1值的差异无统计学意义（LSD法,P＝0.757）;淋巴瘤骨髓浸润的骨髓SIR1值与骨髓中浸润的瘤细胞百分比呈负相关（r＝-0.765,P＜0.001）。结论　MRI无创、直观,能够展示骨髓全貌,对淋巴瘤骨髓浸润诊断敏感度高,定量分析能一定程度区分骨髓浸润程度,并反映骨髓中瘤细胞负荷量。     

非霍奇金淋巴瘤骨髓涂片与活检标本淋巴瘤细胞形态学的比较研究

目的　探讨骨髓侵犯 ( BMl)的非霍奇金淋巴瘤 ( NHL )骨髓涂片与活检标本中淋巴瘤细胞的形态学特点。方法　骨髓涂片瑞氏 -吉姆萨染色、活检组织塑料包埋行苏木素 -吉姆萨 -伊红染色后分别进行瘤细胞形态学观察和描述。结果　 T- NHL 4 0例 ,B- NHL 10 0例。骨髓中淋巴瘤细胞 2 0 .0 %～ 90 .0 % ,L BMI轻度 30例 ( 2 1.0 % ) ,中度 32例 ( 2 3.0 % ) ,重度 78例 ( 5 6 .0 % ) ;瘤细胞分布呈间质型 4 6例 ( 32 .8% ) ,混合型 36例 ( 2 5 .8% ) ,结节型 14例 ( 10 .0 % ) ,弥漫型 4 4例 ( 31.4 % )。中度浸润组患者脾肿大发生率明显高于轻度浸润组和重度浸润组 ( P<0 .0 1) ,L BMI越重越易合并 L S/ L。结论　 L BMI程度和方式与临床表现密切相关 ,骨髓细胞学分析结合活检病理检查对L BMI诊断具有重要意义     

骨髓涂片、骨髓活检对弥漫性大B细胞淋巴瘤临床分期的价值

目的:探讨骨髓涂片、骨髓活检对弥漫性大B细胞淋巴瘤(DLBCL)临床分期的价值.方法:对44例累及骨髓的病例回顾性分析骨髓涂片及骨髓活检切片,分别比较细胞学形态、组织形态、增生程度、纤维组织增生程度、检出率和敏感性.结果:骨髓涂片中可见中到大型的异型细胞骨髓,切片中瘤细胞以灶型最常见.按Manoharm改良法评估,骨髓切片中网状纤维含量有不同程度增多.骨髓涂片与骨髓切片增生程度的比较,差异有统计学意义(P＜0.05),切片组增生程度高于涂片组.骨髓涂片与骨髓切片检出率的比较,差异有统计学意义(P＜0.05),切片组检出率高于涂片组.骨髓涂片与骨髓切片敏感性的比较,差异有显著统计学意义(P＜0.01),切片组敏感性明显高于涂片组.结论:骨髓涂片简单易行,骨髓切片在骨髓组织状况、优势增生细胞等方面有优势,同时开展涂片和切片的检测,提高检出率,可以修正临床分期,如能同时进行流式细胞免疫表型分析,则更能提高检出率.     

非霍奇金淋巴瘤骨髓侵犯69例临床分析

目的：探讨非霍奇金淋巴瘤（NHL）骨髓侵犯患者的临床特点、病理类型、细胞形态特征、治疗效果与预后。方法：对404例经病理学确诊为非霍奇金淋巴瘤患者行血常规,骨髓细胞学检查,分析其骨髓侵犯发生率、细胞形态特征、病理类型、临床表现、分期、疗效及预后的关系。结果：例患者中骨髓侵犯69例．404NHL（17．1％）,形态学特征与原发肿瘤一致,年龄35岁以下者多见（53．6％）,病理类型以B细胞淋巴瘤为主（78．2％）,骨髓侵犯晚期多见,其侵犯程度越重,临床症状越重,化疗效果差,缓解率低,预后不良。结论：NHL骨髓侵犯程度与临床症状严重程度、病理类型、治疗与预后等密切相关,骨髓侵犯程度重,临床分期晚,疗效及预后差。     

Magnetic resonance imaging of bone marrow versus bone marrow biopsy in malignant lymphoma

Bone marrow involvement is a frequent finding in malignant lymphoma. Bone marrow biopsy of the posterior iliac crest is routinely performed for staging. Abnormal magnetic resonance imaging (MRI) signals of bone marrow was also reported to be indicative of bone marrow involvement. This study included 60 patients with malignant lymphoma. Unilateral bone marrow biopsy of the posterior iliac crest was performed. MRI of lumbar spine was studied within 24 hours of bone marrow biopsy. 22 healthy controls were used for the detection of MRI objectivity during visual evaluation. In 83% of patients (50/60), biopsy and MRI results agreed completely. In two patients, histologic sections failed to show any evidence of bone marrow involvement despite abnormal MRI signals suggestive of involvement. In three patients, MRI was completely normal despite biopsy proven bone marrow infiltration. False negativity (3/60) and false positivity (2/60) rates were very low. Negative biopsy findings with positive or equivocal MRI results should not exclude bone marrow involvement and needs further evaluation with bilateral or guided biopsy. Thus, we conclude that MRI of bone marrow is a fairly sensitive, noninvasive modality and might be of potential value in detecting bone marrow infiltration in malignant lymphoid neoplasms which can be utilized as a useful adjunct to standard staging procedures.     

继发性骨淋巴瘤的18F-FDG PET/CT影像诊断及与骨髓活检诊断效能的比较

目的:分析继发性骨淋巴瘤的PET/CT影像特点,比较骨髓活检(bone marrow biopsy,BMB)及PET/CT诊断骨淋巴瘤各自的优势,探讨如何进一步提高骨淋巴瘤的检出率.方法:回顾性分析放化疗前在我院行PET/CT检查的68例继发性骨淋巴瘤影像及骨髓活检资料.所有病例均病理确诊为淋巴瘤.骨淋巴瘤病灶的诊断标...     

Optimum trephine length in the assessment of bone marrow involvement in patients with diffuse large cell lymphoma.

BACKGROUND: The National Cancer Institute has recommended a bone marrow biopsy length of >/=20 mm for the staging and surveillance of patients with non-Hodgkin's lymphoma. However, there are few published data to support this recommendation, particularly the role of examining multiple levels. PATIENTS AND METHODS: Bone marrow biopsies from 172 patients with newly diagnosed diffuse large cell lymphoma (DLCL) entered in two consecutive trials of the Australasian Leukaemia and Lymphoma Group were analysed. The original haematoxylin and eosin-stained trephine biopsy and two or more deeper sections cut at 0.1-0.2 mm intervals were assessed with respect to the morphology, extent and pattern of lymphomatous involvement. The rate of positive diagnosis was correlated with the length of the biopsy specimen and the number of sections examined. RESULTS: Forty-seven biopsies (27%) demonstrated marrow involvement on examination of a mean of four trephine biopsy sections. The rate of positivity increased with the examination of multiple levels and correlated with increasing trephine length but was not dependent on the number of sites sampled. Twenty per cent of biopsies <20 mm in length were positive for lymphoma; this increased to 35% for biopsies >/=20 mm (P = 0.023). CONCLUSIONS: Morphological bone marrow involvement in DLCL is optimally demonstrated by a 20-mm long trephine biopsy from a single site which is examined at multiple levels (four or more). This obviates the need for bilateral sampling, thereby reducing patient morbidity from the procedure. This study provides evidence to support the National Cancer Institute recommendations regarding trephine biopsy in the staging of DLCL, providing multiple levels are examined.     

伴PET/CT骨髓弥漫性糖代谢增高的淋巴瘤患者骨髓浸润情况及相关因素分析

背景与目的：正电子发射计算机断层显像技术(positron emission tomography-computed tomography,PET/CT)在淋巴瘤的诊断、治疗和随访中发挥着越来越重要的作用。该研究旨在探索PET/CT显示骨髓弥漫性糖代谢异常增高的淋巴瘤患者骨髓有无浸润、淋巴瘤病理类型以及其他临床特点。方法：回顾性分析复旦大学附属中山医院62例经病理确诊为淋巴瘤且PET/CT显示骨髓弥漫性糖代谢增高患者的临床资料、病理以及PET/CT详细数据,并行统计学分析。结果：PET/CT显示有骨髓弥漫性糖代谢异常增高的患者,其淋巴瘤病理类型分布与国内所报道各亚型淋巴瘤发病比例基本一致;侵袭性与惰性淋巴瘤之间［标准摄取值(standard uptake value,SUV)分别为8.43与5.38,P=0.048］、有或无B症状之间(SUV分别为8.30与5.72,P=0.033)、有或无骨髓浸润之间(SUV分别为8.78与6.96,P=0.020),SUV的差异均有统计学意义。32例(51.6%)患者经骨髓活检病理证实骨髓受累。骨髓受累者其淋巴瘤病理类型的分布上与未受累者差异有统计学意义(P=0.001);骨髓受累者套细胞淋巴瘤、结内边缘区B细胞淋巴瘤、伯基特淋巴瘤和间变大细胞淋巴瘤者比例较高,而骨髓未受累者弥漫大B细胞淋巴瘤、外周T细胞淋巴瘤、肠病相关性T细胞淋巴瘤和NK/T细胞淋巴瘤(鼻型)者比例较高。PET/CT骨摄取假阳性可能与发热、贫血等有关。结论：PET/CT骨髓弥漫性糖代谢异常增高虽然对临床诊疗有一定的提示,但应结合PET/CT骨糖代谢异常增高的特点、患者的临床因素及病理亚型综合分析,以减少误诊与漏诊,更精确地指导分期及治疗。     

Primary bone marrow lymphoma is a rare neoplasm with poor outcome: case series from single tertiary care centre and review of literature

Primary bone marrow lymphoma is a rare disease and remains undiagnosed due to deceptive clinical presentation. Here, we report four cases of primary bone marrow B‐cell non‐Hodgkin lymphoma, which presented with cytopenias without any lymphadenopathy or organomegaly. Bone marrow examination revealed large atypical B‐cells with a reactive T‐cell infiltrate with suppression of the normal hematopoietic elements. This lymphoma is known to have a poor prognosis. Inspite of treatment, two of our patients died during chemotherapy. Two patients relapsed, of which one showed an early relapse after two months and was put on an alternative regimen. The other patient relapsed twice at an interval of 4 and 5 years, respectively, following which he remained in remission for another 5 years and had recently shown a relapse for the third time. Review of literature revealed seven case series and 11 case reports of primary bone marrow lymphoma in the last five decades.     

60例滤泡淋巴瘤骨髓肿瘤细胞的形态学分析

目的:对滤泡淋巴瘤骨髓的淋巴瘤细胞进行形态学分析总结形态特点,为骨髓病理医生对滤泡淋巴瘤骨髓累及诊断提供一定的参考依据。方法:回顾性分析2013年至2018年共565例经淋巴结活检病理确诊滤泡淋巴瘤患者,并挑选其中60例有骨髓侵犯的患者,对其骨髓涂片进行观察,根据其肿瘤细胞的形态特点进行分析归类总结,找出共同特点。结果:对本组60例滤泡淋巴瘤骨髓涂片根据肿瘤细胞形态特点共分为五种类型,包括小无裂细胞型（38.3%）、小裂细胞型（31.7%）、幼淋巴细胞型（5.0%）、母细胞化型（5.0%）以及滤泡转大B细胞型（20.0%）。结论:滤泡淋巴瘤累及骨髓病例可通过观察肿瘤细胞的细胞形态分为五种类型,其中以小无裂细胞和小裂细胞最为常见（70.0%）,每种类型肿瘤细胞具有明显的特点,具有重要的病理和临床指导意义。