弥漫大B细胞淋巴瘤骨髓侵犯形态学及免疫表型特点分析

目的 探讨弥漫大B细胞淋巴瘤（DLBCL）骨髓侵犯形态学及免疫表型特点，为临床DLBCL侵犯骨髓的准确诊断提供一定的科学依据。方法 收集2014年6月—2019年6月我院收治的59例DLBCL患者的骨髓组织和外周血，分析DLBCL患者的骨髓细胞形态学、骨髓病理学、流式细胞学、荧光原位免疫杂交及其他相关检测的结果与临床特征。结果 59例发生骨髓侵犯的DLBCL患者多数表现为白细胞增高、贫血、血小板减少，有43例（72.88%）外周血中可见数量不等的瘤细胞。59例患者骨髓涂片中瘤细胞占有核细胞比例≥10％的有31例（52.54%）。瘤细胞侵犯骨髓方式以弥漫性增生为主，造血组织明显减少或缺乏。免疫组化染色及流式细胞学检查示，淋巴瘤细胞 CD20、CD19、CD79b及 cCD79a均呈阳性表达，部分患者表达 HLA-DR、CD22、sIgM、CD43、CD10、FMC7及 CD123，均不表达CD38、TdT、CD103、CD25、CD3、CD2、MPO、CD33、CD13、CD7及CD56。12例患者进行FISH检测均未见C-myc基因重排。结论 骨髓形态学、病理学并结合免疫表型检测是DLBCL患者准确诊断的重要依据。

Analysis of morphological and immunophenotypic features of bone marrow invasion in diffuse large B-cell lymphoma

Objective To investigate the morphological and immunophenotypic features of the invasion in bone marrowin patients with diffuse large B-cell lymphoma (DLBCL) , and provide scientific basis for accurate diagnosis of bone marrow invasion by DLBCL cells. Methods From June 2014 to June 2019, samples of tumor tissues and peripheral blood of 59 cases of DLBCL were collected from the Fourth Hospital of the Hebei Medical University. The morphological and bone marrow pathological data, flow cytometry and fluorescent in situ hybridization analysis (FISH) features of the tumor cells of the patients with DLBCL were analyzed. Results In 59 cases of DLBCL patients with bone marrow invasion, the increased white blood cells, anemia and thrombocytopenia were found in the majority of these patients, and tumor cells were found in peripheral blood in 43 cases (72.88%). Bone marrow biopsy showed that the proportion of the lymphoma cells in bone marrow tissue ≥10％ was found in 31 patients (52.54%). The invasion pattern of the lymphoma cells was diffuse hyperplasia in the bone marrow, and hematopoietic tissue was significantly reduced or absent. The results of immunohistochemical staining andflow cytometry showed that CD20, CD19, CD79b and cCD79a were positively expressed in the lymphoma cells. HLA-DR,CD22, sIgM, CD43, CD10, FMC7 and CD123 expressions were found in some patients. CD38, TdT, CD103, CD25, CD3,CD2, MPO, CD33, CD13, CD7 and CD56 were negatively expressed in these cells. C-myc gene rearrangement was notobserved in 12 patients detected by FISH. Conclusion Bone marrow morphology and pathology combined withimmunophenotype detection are the important basis for accurate diagnosis of DLBCL.