恶性血液病继发骨髓纤维化71例病理及临床研究

 【摘要】 目的 探讨继发性骨髓纤维化(secondary myelofibrosis,SMF)患者的临床及骨髓病理学特征。方法 对71例继发性骨髓纤维化患者的临床表现、外周血涂片、骨髓涂片及骨髓活检情况进行了回顾性研究,同时对不同疾病骨髓纤维化程度与巨核细胞数目作了相关分析。结果 分析71例SMF患者,其原发病情况为慢性粒细胞白血病(CML)20例(28.2%),急性淋巴细胞白血病（ALL）6例（8.5%）,急性髓系细胞白血病(AML)、骨髓增生异常综合症（MDS）、淋巴瘤各10例（14.1%）,多发性骨髓瘤（MM）、淋巴增殖性疾病（LPD）各4例（5.6%）,骨髓增殖性肿瘤（MPN）3例,慢性淋巴细胞白血病（CLL）2例,骨髓转移癌、传染性单核细胞增多症各1例。骨髓纤维化程度与巨核细胞数具有明显相关性（P＜0.05）。结论 继发性骨髓纤维化患者骨髓切片巨核细胞增生明显,且与纤维化程度有相关性。这可能与巨核细胞克隆性增殖释放的多种细胞因子积极参与骨纤的发生发展密切相关。     

前列腺癌骨髓转移继发骨髓纤维化1例分析

1病史摘要 患者,男性,66岁,于2009年3月出现腰腿疼痛,行腰椎CT,提示：腰3／4,4／5间盘膨出,椎管狭窄;5月查血常规,提示：     

骨髓纤维化74例临床分析

 目的 探讨骨髓纤维化（MF）的诊治方法,提高对该类疾病的认识。方法 回顾性分析1994年1月至2004年10月沈阳市红十字会医院74例MF患者的临床资料。结果 MF约占同期因血液系统异常行骨髓活检人数的1.86 %,病因依次为：慢性骨髓增生性疾病（CMPD）、原发性骨髓纤维化（IMF）、急性白血病（AL）、慢性肾功能不全及其他。结论 MF的主要病因为CMPD、IMF及慢性肾功能不全等内科疾病所致,凡疑为MF者必须进行骨髓活检确诊。     

原发性骨髓纤维化治疗进展

 原发性骨髓纤维化（PMF）属于慢性骨髓增生性肿瘤的一种,传统治疗以改善贫血、缓解巨脾引起的相关症状为目的。近年来通过实施减低强度预处理后的异基因造血干细胞移植,部分患者获得血液学缓解乃至分子水平的缓解。而一些靶向JAK2V617F突变和其他更广泛的肿瘤发生机制的新药,则为那些不能实施干细胞移植的患者提供了实用、有效的治疗手段。     

恶性肿瘤骨髓转移13例分析

我院 1994年 6月～ 1999年 10月共做骨髓检查 80 4人次 ,查到骨髓转移癌 13例 ,分析报道如下。1　临床资料1.1　一般资料男 8例 ,女 5例 ,年龄 17～ 72岁 ,平均 46 7岁 ,原发肿瘤为肺癌 3例 ( 2 3 1% ) ,乳腺癌 2例 ( 15 4% ) ,胃癌、鼻咽癌、前列腺癌、肾癌、神经母细胞瘤各 1例。余 3例未见原发灶。1.2　临床表现13例患者均有不同程度的贫血 ,其中重度贫血 3例 ,血红蛋白最低者为 2 3ｇ Ｌ ,中度贫血 6例 ,轻度贫血 4例 ;皮肤、牙龈出血 4例 ,消化道出血、血尿、鼻衄各 1例 ;发热 5例 ;骨癌 9例 ,以腰腿痛为主 ,13例中均有乏力和明显的体…     

69例恶性淋巴瘤骨髓侵犯后骨髓象与血象分析

目的了解恶性淋巴瘤骨髓侵犯后骨髓与外周血白细胞之间的关系.方法对69例恶性淋巴瘤具有骨髓侵犯的骨髓细胞分类及外周血白细胞检验结果作回顾性分析.结果 69例恶性淋巴瘤骨髓侵犯者外周血白细胞计数异常33例,分类计数异常35例,骨髓增生正常者19例,增生异常者50例.结论当恶性淋巴瘤发展到骨髓侵犯或淋巴瘤细胞白血病时,外周血白细胞计数和分类计数与骨髓象之间没有绝对的对应关系,但如明确诊断为恶性淋巴瘤时则应把骨髓涂片细胞形态学列为常规检查,如其外周血白细胞形态出现异常,则应高度怀疑有淋巴瘤细胞白血病.     

透明质酸在恶性血液病中作用的研究进展

 透明质酸（HA）是一种在体内广泛存在的非硫酸化糖胺聚糖。HA的异常表达与恶性血液病的进展密切相关,HA与其受体CD44、RHAMM等的相互作用参与血液系统恶性肿瘤的增殖、运动、迁移、侵袭以及多药耐药等过程。根据近年来有关的最新文献报道,对HA在肿瘤中的研究以及在恶性血液病进展中的作用进行综述。     

100例骨髓转移癌骨髓组织病理学的观察

目的：观察100例骨髓转移癌患者骨髓组织病理学的改变,并与骨髓涂片结果进行比较。方法：100例骨髓转移癌患者骨髓检查,行一步法骨髓抽吸取材,石蜡或塑料包埋骨髓组织,切片2μm或3μm厚作HGF或MGG染色,切片5μm厚作Gomori染色,必要时作Masson三色染色,按三种方法各染色1张切片。骨髓涂片行瑞特染色。结果：活检切片的诊断阳性率及判断骨髓增生度等较涂片明显为优。胶原纤维Masson三色染色呈阴性,提示骨髓转移癌并发骨髓纤维化,绝大多数为网硬蛋白型。结论：骨髓活检可作为诊断骨髓转移癌的常规检测手段,能够提高诊断率及评估疗效和预后。     

Clinicopathological study on 3441 cases of benign and malignant ulcers

Resected specimens of benign and malignant gastric ulcers from 3441 cases were studied and compared clinically and pathologically. Among them, 421 cases of malignant ulcer were found. The malignant ulcers differed notably from the ulcerated gastric carcinoma and showed many similarities to the benign chronic gastric ulcer (CGU). The most distinct feature of malignant ulcer was lack of cancerous infiltration and muscular residue in the scar tissue of ulcer base. The existence of this type of ulcer clinically and pathomophologically supports the viewpoint that CGU can undergo malignant change. The rate of malignant change of CGU in this study was 3. 48%.     

血液肿瘤患者抑郁障碍的调查及干预性治疗

 目的　对血液肿瘤患者进行心理评估,探讨血液肿瘤患者合并抑郁障碍的发病情况,并给予干预性治疗。方法　对134例血液肿瘤患者予Zung氏抑郁自评量表（SDS）及汉密顿抑郁量表（HAMD）评分,对确诊合并抑郁症的患者随机分为二组（治疗组和对照组）,对照组给予常规治疗,治疗组在常规治疗的基础上给予心理疏导及抗抑郁药物治疗,并测定干预前后患者免疫功能的改变以及神经递质的改变。结果　134例血液肿瘤患者合并抑郁障碍的发病率达37 %。治疗组患者治疗后SDS及HAMD评分下降,抑郁症状改善,治疗前后比较差异有统计学意义（P＜0.01 ）,而对照组治疗前后比较差异无统计学意义（P＞0.1）。治疗组患者经抗抑郁药治疗后血浆神经肽Y（NPY）水平较治疗前明显升高（P＜0.01）,而对照组治疗前后NPY无明显差异（P＞0.05）。治疗组患者治疗后CD+4／CD+8比值增加,治疗前后比较差异有统计学意义（P＜0.05）,而对照组治疗前后比较差异无统计学意义（P＞0.5）。结论　心理干预和药物干预可改善血液肿瘤患者的抑郁症状,提高免疫功能,改善生活质量。     

Defining disease modification in myelofibrosis in the era of targeted therapy

The development of targeted therapies for the treatment of myelofibrosis highlights a unique issue in a field that has historically relied on symptom relief, rather than survival benefit or modification of disease course, as key response criteria. There is, therefore, a need to understand what constitutes disease modification of myelofibrosis to advance appropriate drug development and therapeutic pathways. Here, the authors discuss recent clinical trial data of agents in development and dissect the potential for novel end points to act as disease modifying parameters. Using the rationale garnered from latest clinical and scientific evidence, the authors propose a definition of disease modification in myelofibrosis. With improved overall survival a critical outcome, alongside the normalization of hematopoiesis and improvement in bone marrow fibrosis, there will be an increasing need for surrogate measures of survival for use in the early stages of trials. As such, the design of future clinical trials will require re-evaluation and updating to incorporate informative parameters and end points with standardized definitions and methodologies.     

Histopathological study of bone marrow biopsies in 30 cases of T-cell lymphoma with clinical, biological and survival correlations

Forty-five bone marrow (BM) biopsies have been studied in 30 T-cell malignant lymphoma (ML). According to the updated Kiel classification, these ML comprised 12 low grade ML and 18 high grade ML. BM involvement was not significantly more frequent in low grade ML (41.6 per cent) than in high grade (33.3 per cent). This involvement was discovered in 85 per cent of the cases at the time of diagnosis. A correlation was found between BM and other visceral localizations for histological type in all cases. Infiltrates principally showed a nodular pattern in low grade and a diffuse pattern in high grade ML. Hematopoietic hyperplastic reaction was frequent (66.6 per cent) not correlated to involvement. Clinical staging showed extensive spreading. Our patients had an overall median survival of 40 months, worse in high grade ML (median: 19 months) than in low grade ML (41 months) but not statistically different (p = 0.25). Extranodal localizations are a significant criteria for poor prognosis (p = 0.018). Among them, BM involvement appears to be the most significant criteria (Cox model, p = 0.006). Patients with BM localization had a median survival of 9 months contrasting with 40 months in patients without BM localization (p = 0.007). Thus, BM biopsy is useful for the diagnosis of patients with T-ML and essential to establish the prognosis.     

胃肠道间质瘤39例临床病理分析

目的　探讨胃肠道间质瘤 (gastrointestinalstromaltumor ,GIST)的临床病理特点及免疫组化表型特征。 方法　对 3 9例GIST进行组织学、免疫组化观察。结果　肿瘤具有梭形和 (或 )上皮样细胞成份 ,间质可有团丝样纤维(SP) ,CD 117表达者 3 5例 (89.7% ) ,CD3 4表达者 2 8例 (71.8% )。结论　GIST可能起源于卡哈尔细胞或向卡哈尔细胞分化 ,组织学上类似于平滑肌肿瘤或神经鞘瘤 ,CD117、CD3 4是较为特异且敏感的标记物。