11例急性巨核系白血病患者巨核细胞的超微结构分析

为了研究急性巨核细胞白血病患者骨髓中幼稚巨核细胞的超微结构特点,根据电子显微镜观察结果,回顾性分析11例急性巨核白血病患者骨髓巨核细胞的形态结构和血小板过氧化物酶（PPO）表达情况。结果表明：11例中7例例巨核细胞直径在20μm以内,其中2例细胞直径10-15μm,PPO阳性率50%以上,大部分细胞外形规则,大小均匀,表面突起少,核不规则,核质比大,胞浆颗粒细小,分界膜发育不完全,管道排列无规律;5例巨核细胞直径20μm左右,PPO阳性率在8%-22%之间,核呈圆形或马蹄形,异染色质不等,其中3例无幼稚分界膜和致密颗粒,2例偶见。11例中5例细胞直径在20-40μm之间,PPO阳性率16%-80%,大细胞表面有不规则突起,核质比不等,核不规则,异染色质多,核仁不明显,胞质有成熟分界膜结构、管道系统和成熟α-颗粒。结论：大部分患者巨核细胞以Ⅰ期分化阶段为主,少数病例伴有少量Ⅱ、Ⅲ期细胞;相同或不同患者骨髓中未成熟巨核细胞的发育程度存在差异。

Ultrastructural Characteristics of Megakaryocytes in 11 Patients with Acute Megakaryocytic Leukemia

The purpose of study was to investigate the ultrastructural features of leukemic megakarocyte (LMK) in patients with acute megakaryocytic leukemia (M(7)). Analyzing the ultrastructure characteristics of LMK and positive ratio of platelet peroxides (PPO) in 11 patients with M(7) were analyzed on basis of transmission electron microscopic observation retrospectively. The results showed that the diameter of LMK in 7 out of 11 cases was less than 20 microm, in 2 cases of them, the LMK diameter was from 10 to 15 microm and their PPO positive ratio was more than 50%, most LMK displayed regular shape, less protrusions, irregular nucleus, high nuclear/cytoplasm ratio, tiny granules, undeveloped demarcation membrane system (DMS) and irregular tubules in cytoplasm; in 5 out of those 7 cases the diameter of LMK was about 20 microm, PPO positive cell count was from 8% to 22%, most showing round or horseshoe nuclei, more or less heterochromatin, no DMS and granules were found in LMK in 3 cases and 2 cases occasionally. In other 5 out of 11 cases, the diameter of LMK was from 20 to 40 microm and PPO positive ratio was from 16% to 80%, in which smaller LMKs were similar to those in former cases in shape, and the larger LMK had irregular protrusions, varied nuclear/cytoplasm ratio, more heterochromatin, prominent nucleolus, some of them contained developed DMS, tubules and alpha-granules. It is concluded that most patients with M(7) are predominant of LMK in stage-I and minority contained LMK in II or III stage simultaneously. The differentiation degrees of LMK are different in individual and various cases.