细胞形态学在鉴别噬血细胞综合征和恶性组织细胞病中的价值初探

目的　探讨细胞形态学在鉴别噬血细胞综合征(HS)和恶性组织细胞病(MH)的诊断价值。方法　应用瑞-姬氏染色,普通光镜下对39例HS和42例MH患者的骨髓片、外周血片、外周血液浓缩片中的细胞形态学进行了详细观察,并结合外周血涂片碱性磷酸酶染色的结果进行了综合分析。结果　HS与MH在骨髓和外周血中的细胞数量及形态学变化方面均有明显不同,外周血涂片碱性磷酸酶染色亦存在明显差异。结论　细胞形态学检查是鉴别HS与MH的重要手段,在确诊HS与MH方面具有重要价值。     

四例急性巨核细胞白血病实验室诊断分析

目的：探讨急性巨核细胞白血病(AMKL)的实验室诊断方法。方法采用流式细胞术单克隆抗体直接免疫标记检测白血病细胞表面相关抗原表达;48 h培养法R显带检测染色体核型;RT-PCR法检测BCR/ABL融合基因P210型与BCR/ABL融合基因P190型;骨髓活检与骨髓形态学分析骨髓异常情况。结果4例AMKL均表现CD41与CD42的高表达,其中两例伴CD13和CD33的高表达;1例核型异常47,XY,+1[6]/46,XY[14];BCR/ABL融合基因P210型与P190型均阴性;骨髓活检与骨髓形态学分析4例均见骨髓原始、幼稚巨核细胞增生。结论依靠细胞形态学、流式细胞术白血病免疫分型检测及细胞遗传学可以确定AMKL的诊断。     

307例急性髓系白血病在WHO分型标准中的探讨

目的：通过对本组病例研究，提高对WHO分型诊断标准的认识。方法：选择2004-2005年在我院确诊的307例急性髓系白血病（AML），以形态学、免疫表型、融合基因等检测进行分析探讨。结果：按WHO分型诊断标准有14例原始细胞在20％～30％之间的患者被确诊为AML。免疫表型在髓系白血病中MPO、CD13、CD33表达最强，分别为96．77％、94．67％、91．53％。对M0的诊断有特异性，CD34、CD33达99％以上。融合基因检测：AML-M2b中90％以上AML1／ETO融合基因阳性，提示t（8；21）（q22；q22）易位。AML-M3中89．28％PML／RARα融合基因阳性，提示t（15；17）（q22；q12）易位。AML-M4EO中85％的CBFβ／MYH11融合基因阳性，提示inv（16）（p13；q22）。结论：WHO分型标准综合了传统的形态学分型，加入免疫学，融合基因等检测技术，结合临床特点等信息对AML进行分型，提高了对AML的诊断符合率。与FAB相比，更具有完全性、合理性、科学性，是AML分型的发展方向。     

血细胞形态学室间质评方法的探索

目的提供高质量的细胞形态学室间质评检查内容,减少因采样、制片、染色、阅片区域等过程的差异而引起的误差,提高实验室间结果的可比性,公平、公正的体现参加者的能力水平。方法用血片连续扫描摄像的照片作为血细胞形态室间质量评价的检查内容。结果血片连续扫描摄像的细胞照片清晰度高,细胞结构特征明显,有足够的细胞可供计数;经连续扫描后软件分析的白细胞分类结果须经人工复核后才能作为白细胞分类结果。结论血片连续扫描摄像照片组成的图片文件,适用于细胞的形态识别和白细胞的分类计数。用于室间质评既可考查参加者单个细胞形态的识别能力,又可以用白细胞分类95%及99%可信限或美国临床实验室修正法案（CLIA’88）能力验证计划的分析质量要求（x-±3s）的形式来考核参加者白细胞分类的能力。     

Neuroendocrine tumours metastatic to the uvea: diagnosis by fine needle aspiration biopsy

Background Uveal metastasis from a neuroendocrine tumour is rare and can simulate other primary or metastatic uveal tumours, both clinically and cytomorphologically. We describe four cases of uveal metastasis from a neuroendocrine tumour diagnosed by fine needle aspiration biopsy (FNAB).Methods Four patients were referred for evaluation of a recently detected fundus mass. Two patients had a history of malignant, non-ocular, neuroendocrine neoplasms (Merkel cell carcinoma and lung carcinoid in one patient each). The third patient had a mediastinal mass that had been biopsied inconclusively, while the last patient reported a persistent cough.Results Ophthalmic examination revealed an amelanotic ciliochoroidal mass in 2 cases and a lightly melanotic and a pale orange choroidal mass in 1 case each. Partial, non-rhegmatogenous, retinal detachment was present in 3 patients. Ocular ultrasonography revealed moderate to high internal reflectivity of the mass in 3 cases and low internal reflectivity in the 4th. Our differential diagnosis in all cases was metastatic carcinoma versus primary uveal melanoma. FNAB of the intraocular mass was performed in all patients to establish a pathologic diagnosis and guide subsequent management. Cytomorphology and immunohistochemical profiles of the aspirates were consistent with metastatic neuroendocrine neoplasms in all patients. Our final diagnosis was metastatic lung carcinoid in 2 patients and metastatic Merkel cell carcinoma and small cell lung carcinoma in 1 patient each. Immediately after FNAB, the intraocular tumour was treated by plaque radiotherapy (3 patients) or fractionated external beam radiotherapy (1 patient). All tumours treated regressed satisfactorily. Two patients expired due to widespread lung carcinoid 11 and 12 months after our initial evaluation respectively. The other two patients are still alive after 38 and 64 months respectively.Conclusions Neuroendocrine tumours are a heterogeneous group of neoplasms whose diagnosis ultimately depends on the identification of specific cell markers (e.g., neuron-specific enolase, chromogranin, synaptophysin), hormones and neurotransmitters (e.g., gastrin, serotonin, adrenocorticotrophic hormone [ACTH]). FNAB with immunohistochemical stains for neuroendocrine markers can establish a pathologic diagnosis in cases of uveal metastasis from a neuroendocrine tumour. To our knowledge, our patient with Merkel cell carcinoma is the first pathologically proven case of uveal metastasis from this primary malignancy.Meeting presentation: XXIVth Club Jules Gonin meeting, Athens, Greece, September 2004     

非何杰金淋巴瘤白血病细胞形态学分型与生存期（附110例分析）

本文对110例NHLL细胞形态学进行了描述，并分为6个型，即：SLC型，PLC型，Lb型，Ib型，UD型及未能分型。已死亡的86例中69例（80．23％）死于确诊NHLL后的1年内，其中主要是Lb型、Ib型及UD型，以及周围血及骨髓中瘤细胞数超过50％的病例。本文就各分型与生存期的相关性及NHLL病理分型与血细胞分型的相关性进行了探讨。     

细胞形态学在诊断全血细胞减少病因中的应用

目的分析全血细胞减少患者骨髓和外周血细胞形态在病因诊断中的价值。方法对117例全血细胞减少患者的骨髓和外周血细胞形态进行分析。结果117例患者通过骨髓和外周血细胞形态分析得到肯定性诊断15例（12．82％）,提示性诊断21例（17．95％）,符合性诊断8例（6．84％）,疑似性诊断23例（19．66％）,排除性诊断13例（11．11％）,形态学描述37例（31．62％）。结论形态学检查是诊断全血细胞减少症病因的多种检查方法之一,必须结合症状、病史、体征及其相关检查作出正确诊断。