神经母细胞瘤骨髓转移的细胞形态学及免疫组化

神经母细胞瘤在小儿恶性肿瘤中，仅次于白血病及中枢神经系统肿瘤，约占小儿恶性实体瘤的10％。多见于肾上腺、腹膜后、后纵隔等处。此病高度恶性、分化差，常于短期内转移至骨、淋巴结、肝和肺等处。转移至骨的神经母细胞瘤在细胞形态学上常与恶性淋巴瘤、Ewing瘤、小细胞未分化癌等混淆，鉴别颇难，现收集6例，对其细胞形态学及免疫组化观察分析。     

神经母细胞瘤误诊1例分析

病人男，3岁。其母述因阵发性发热、食欲不振、腹泻等，在某医院诊断为伤寒，经治疗效果欠佳，病情加重，遂来我院就诊。查体：T38．7℃，贫血貌，全身皮肤、粘膜无黄染及出血点，浅表淋巴结无肿大，胸骨压痛，肝脾未及。     

骨髓转移癌初诊伴骨髓坏死1例

骨髓转移癌是指髓外的肿瘤细胞,通过血液或体液循环,扩散侵犯到人体的造血组织,而引起临床及血液学某些改变的一组疾病,临床上并非少见。现将我院收治1例报告如下。     

以关节炎起病的神经母细胞瘤一例

儿童恶性肿瘤可以表现为关节痛或关节炎,神经母细胞瘤是儿童常见的恶性肿瘤之一,主要见于幼儿。由于其临床表现复杂,病变部位隐匿,早期无症状,原发肿瘤及肿瘤转移的临床表现各异,容易误诊。本文报告一例以关节炎为突出表现的少年神经母细胞瘤。患者男,15岁,因“左膝关节肿痛伴发热2个月”入院。     

小儿神经母细胞瘤11例临床分析

报道了１１例神经母细胞瘤病儿，均经病理或骨髓检查确诊。该病无特异性表现，极易误诊。作者分析了其常见误诊原因，提出在诊断方面，要首选Ｂ超检查，阳性率为９０％，骨髓检查也尤为重要，阳性率为８０％。在预后方面，Ｓ－１００抗体标记的鞘细胞分化是本病组织学成熟的标志，Ｓ－１００阳性瘤细胞越多，瘤组织分化越成熟，病儿预后越好。     

骨髓转移癌40例检测报告

４０例骨髓转移癌中最长见原发癌是肺癌和胃肠癌，由于癌细胞浸润破坏，引起血清中ＬＤＨ，ＡＬＰ，ＡＣＰ，癌胚抗原升高，多部位骨髓涂片对转移癌确诊十分重要。     

婴儿神经母细胞瘤术后合并霍纳综合征一例

<正>1病例介绍患儿,男,6个月,因呛咳5 d入院。患儿于2014-12-05吃米线后出现咳嗽,阵发性,无喘息、气促,无面色青紫,无犬吠样咳及鸡鸣样尾声,无呼吸困难。在当地县医院X检查考虑支气管异物可能,来我院就诊。入院查体:体温36.6℃,心率130次/min,呼吸30次/min,一般情况欠佳,面色无青紫,呼吸平稳,三凹征(-),胸廓无畸形,双肺呼吸音粗,可闻及     

恶性黑色素瘤骨髓转移并骨髓纤维化1例

患者 ,男 ,48岁。因面黄、乏力、消瘦、胸闷半年于 1 998年 7月就诊。自述右胸部有一黄豆大黑色肿物约 5年 ,近日发痒且增生较快。体检 :贫血貌 ,心、肺无阳性体征 ,肝肋缘下未能及 ,脾肋缘下 4ｃｍ ,质硬 ,无压痛。右胸部有一 1 .5× 1 .5ｃｍ肿物 ,呈棕褐色 ,边缘不清 ,表面有溃疡。实验室检查 :血红蛋白 73ｇ/Ｌ ,红细胞 2 .2× 1 0 1 2 /Ｌ ,白细胞 1 1 .5×1 0 9/Ｌ ,血小板 1 2 0× 1 0 9/Ｌ ,ＲＣ 3 % ,分类中原始粒细胞加早幼粒细胞偶见 ,中、晚幼粒细胞 0 .1 7,嗜酸性粒细胞 0 .0 9,嗜碱性粒细胞 0 .0 4 ,中幼红细胞 0 .0 4 ,晚幼…     

老年骨髓转移癌72例临床及血液学分析

骨髓穿刺涂片检查是诊断骨髓转移癌的简单而实用的方法。检出的肿瘤类型多种多样,可以来自肝脏、肺、胃肠、前列腺、乳腺、子宫、附件等器官。有的肿瘤在疾病晚期才发生转移,有的肿瘤在疾病早期原发灶不明显的情况下已经发生转移。骨髓受累对肿瘤分期、治疗方案选择及判断预后有重要意     

ATRA诱导神经母细胞瘤细胞分化的实验研究

目的 观察不同浓度全反式维甲酸(ATRA)体外对自建神经母细胞瘤(NB)细胞系细胞增殖抑制和形态分化的影响。方法 取住院手术的NB患儿的新鲜标本，进行原代细胞培养，并对培养的细胞进行分离与纯化，建立细胞系，作为细胞模型。通过台盼蓝拒染计数活细胞，用倒置相差显微镜观察加药处理前后细胞形态学变化。结果 5μm／L、20／μm／L，ATRA作用NB细胞后，细胞形态发生显著变化，并对体外增殖有抑制作用。结论 所建立的NB细胞系为可诱导分化型(即N型)，ATRA能抑制细胞增殖并诱导其分化，而且有剂量依赖关系；5μm／L，ATRA对NB细胞体外增殖有抑制作用并诱导其分化。     

骨髓涂片诊断输入性黑热病1例

黑热病即内脏利什曼病,是由雌性白蛉传播的杜氏利什曼原虫引起。我国1950年多数地区已基本上消灭了黑热病,近年来,在新疆、甘肃、内蒙、陕西、山西和四川等6省出现当地感染的黑热病。由于该病相对少见,容易误诊,其诊断很大程度上归功于骨髓涂片找到了利杜小体。现报告1例输入性黑热病的骨髓像特征及诊断过程,     

骨髓转移癌28例临床分析

目的:探讨骨髓转移癌的常见病因、临床特点及治疗方法。方法:回顾性研究经骨穿明确诊断的病例。结果:28例患者符合纳入标准。明确找到原发灶19例(67.9%),不明病灶9例(32.1%)。骨痛17例(60.7%);贫血12例(42.9%);出血患者9例;碱性磷酸酶升高者14例(50%)。6例行放化疗或者手术干预,其中2例经化疗或者放疗骨痛改善。结论:骨髓转移癌的原发病灶常见于胃癌、前列腺癌、肺癌、卵巢癌;骨痛并贫血、出血和碱性磷酸酶升高患者需警惕骨髓转移癌的存在;原发灶部位明确的患者早期根据部位治疗可延长存活时间,未明病灶有条件者可试用病变局部小剂量放疗或化疗,对缓解症状及延长生存期可能有一定帮助。     

Disseminated carcinomatosis of the bone marrow originating from hepatocellular carcinoma. A case report

A 50‐year‐old male patient was admitted to the hospital for persistent high fever and back pain. He was diagnosed with hepatocellular carcinoma (HCC), bone marrow metastasis and disseminated intravascular coagulation (DIC). Despite the diagnosis and treatment, the general condition deteriorated rapidly and he died of cerebral hemorrhage associated with generalized bleeding tendency. Autopsy showed multiple HCC in the liver and systemic metastasis including bone marrow. The case describes a rare complication of HCC with disseminated carcinomatosis of the bone marrow (DCBM) complicated with DIC, with rapid deterioration and death. This is the first case of DCBM from HCC. Physicians need to be aware of DCBM in patients with HCC.     

ICSH guidelines for the standardization of bone marrow immunohistochemistry

Bone marrow (BM) tissue biopsy evaluation, including trephine biopsy and clot section, is an integral part of BM investigation and is often followed by ancillary studies, in particular immunohistochemistry (IHC). IHC provides in situ coupling of morphological assessment and immunophenotype. The number of different IHC tests that can be applied to BM trephine biopsies and the number of indications for IHC testing is increasing concurrently with the development of flow cytometry and molecular diagnostic methods. An international Working Party for the Standardization of Bone Marrow IHC was formed by the International Council for Standardization in Hematology (ICSH) to prepare a set of guidelines for the standardization of BM IHC based on currently available published evidence and modern understanding of quality assurance principles as applied to IHC in general. The guidelines were discussed at the ICSH General Assemblies and reviewed by an international panel of experts to achieve further consensus and represent further development of the previously published ICSH guidelines for the standardization of BM specimens handling and reports.     

The diagnostic role of complete MICM-P in metastatic carcinoma of bone marrow (MCBM) presented with atypical symptoms: A 7-year retrospective study of 45 cases in a single center

Metastatic carcinoma of bone marrow (MCBM) tends to present with atypical symptoms and can be easily misdiagnosed or miss diagnosed. This study was conducted to investigate the clinical-pathological and hematological characteristics of MCBM patients in order to develop strategies for early detection, staging, treatment selection and prognosis predicting. We retrospectively analyzed 45 patients with MCBM diagnosed by bone marrow biopsy in our hospital during the past 7 years. The clinical symptoms, hemogram and myelogram features, Hematoxylin and eosin staining and immunohistochemistry staining of bone marrow biopsies, location of primary carcinoma and corresponding treatment of the 45 MCBM patients were analyzed in this study. In total, 35 (77.9%) of all patients presented pains including bone pain (73.3%) as the main manifestation, and 37 (82.2%) patients had anemia. Metastatic cancer cells were found in only 22 patients (48.9%) upon bone marrow smear examination, but in all 45 patients by bone marrow biopsy. The bone marrow of 18 (40.0%) patients was dry extraction. Distribution of metastatic carcinoma was diffuse in 20 (44.4%) patients and multi-focal in 25 (55.6%) patients, complicated with myelofibrosis in 34 (75.6%) patients. For bone marrow biopsy immunohistochemistry, 97.8% of the patients were CD45-negative, while 75.6% of the patients were Cytokeratin-positive. There were 30 patients (66.7%) identified with primary malignancies. The overall survival (OS) of 1 year for MCBM patients was 6.7%. There was a trend that patients with cancer of known primary obtained better prognosis according to the survival curve, but the finding was not statistically significant with Log-rank P = .160. Complete MICM-P plays a significant role in early diagnosis of MCBM. Bone marrow biopsy combined with immunohistochemistry is an underappreciated method for the diagnosis of MCBM, which should be taken as part of regular tests as well as bone marrow smear. Understanding the clinical-pathological and hematological characteristics of MCBM and conducting bone marrow biopsy in time are of great significance for early detection and treatment selection.     

How I investigate bone marrow necrosis

Hematopathologists encounter bone marrow biopsy specimens with marrow necrosis relatively infrequently; when necrosis is seen, determining the clinical significance can be challenging. While bone marrow necrosis is not uncommon in site‐directed biopsy specimens or autopsy material, substantial necrosis is much less common in nondirected bone marrow biopsy specimens. Retrospective review showed the prevalence of bone marrow necrosis to vary between 0.3% and 2% antemortem, depending on the patient population. Numerous causes of bone marrow necrosis have been identified, including malignancy, radiation/chemotherapy, medication, infection, autoimmune disease, disseminated intravascular coagulation, antiphospholipid syndrome and other thrombotic disorders, granulocyte‐colony stimulating factor (G‐CSF) exposure, and hemoglobinopathies. Clinical findings associated with bone marrow necrosis include bone pain and fever, cytopenias, elevated LDH and ferritin, and leukoerythroblastosis. Rarely, such as in fat embolization syndrome (FES), bone marrow necrosis can be associated with thrombotic microangiopathy, neurologic dysfunction, and multiorgan failure. A thorough review of the patient's clinical record (including medical history, clinical presentation, and other laboratory findings), a thorough morphologic review of the bone marrow with appropriate ancillary stains, and an appreciation of the causes of bone marrow necrosis in different patient populations are required to determine the underlying cause of bone marrow necrosis. The purpose of this review is to present a strategy for evaluation of bone marrow necrosis found in an antemortem biopsy specimen.     

A simple technique for processing of bone marrow for human marrow transplantation

Summary A simple stainless steel device is described for the processing of marrow for intravenous infusion to marrow graft recipients. The device can be cleaned easily and sterilized for re-use.     

Immunocytochemical detection of bone marrow-invasive neuroblastoma cells

Abstract: We evaluated the utility of an immunocytochemical technique employing the commercially available anti-CD56 monoclonal antibody, NKH 1. The utility and sensitivity of this technique in the detection of invasive neuroblastoma (NB) cells in the bone marrow were compared with those of Wright-Giemsa staining. The correlation coefficient for the percent NB cells detected using Wright-Giemsa staining with the percent NKH 1 immunoreactive cells was 0.78. In the analysis of specificity, this monoclonal antibody showed slight cross-reactivity with normal bone marrow cells, including macrophages, lymphocytes and osteoblasts. In the evaluation of the sensitivity of the NKH 1 immunocytochemical technique, SK-N-DZ and SK-N-SH NB cell lines were added to morphologically normal bone marrow mononuclear cells from patients without NB to the final NB cell line at concentrations of 2%, 1% and 0.1%. NB cells at the final concentration of 0.1 % could be detected by the immunocytochemical technique. We conclude that the NKH 1 immunocytochemical staining technique is useful in the detection of metastatic NB cells in bone marrow.