骨髓形态学在霍奇金淋巴瘤诊断分期中的价值

Value of Bone Marrow Histology in Diagnosis of Hodgkin Lymphoma

目的 :研究霍奇金淋巴瘤骨髓受累发生率 ,骨髓组织细胞形态学变化及其在诊断分期中的价值。方法 :对霍奇金淋巴瘤 4 2例的外周血、骨髓液涂片采用瑞特染色 ,骨髓活检标本采用塑料包埋后半薄切片 ,常规化学染色。结果 :霍奇金淋巴瘤 4 2例中骨髓受累切片检出 7例 (16 % ) ,其中 1例 (2 .4 % )涂片同时检出瘤细胞。 7例骨髓受累者中 5例外周血相异常。 4例在骨髓活检后分期升至 期。霍奇金淋巴瘤骨髓受累 5例局灶型 (71.4 3% )和 2例弥漫型 (2 8.5 7% )。受累骨髓组织细胞形态 :多形性淋巴细胞、组织细胞、浆细胞、嗜酸细胞、RS细胞或变异 RS细胞。 7例受累骨髓网硬蛋白纤维显著增多。结论 :在髓外组织病理已确诊为 HL的前提下 ,病变骨髓具备多形性淋巴细胞、组织细胞浸润及纤维化 ,骨髓受累的诊断即可成立。

Objective:To determine the incidence of Hodgkin Lymphoma involvement of the bone marrow, the value of pathologic histology and morphologic spectrum in marrow for diagnosis and staging.Methods:Smears of peripheral blood and bone marrow from 42 cases of Hodgkin lymphoma were stained according to Wright. All biopsies were embedded in plastic.Sections were cut at 3 or 5um and routinely stained with: HE, HGF and Gomori.Results:7 (16%) of 42 cases exhibited bone marrow involvment(BMI). BMI was identified by bone marrow trephine biopsy(BMT) in 7 patients but in only one of these by bone marrow smears(BMA).4 cases were promoted to stage Ⅳ after BMT. Of the 7 cases with positve BMT,5 cases had abnormal full blood count.BMI might be focal(71.43%) or diffused(28.57%). There were mainly polycellular, containing lymphocytes, histiocytes, eosinophils, plasma cells, and RS cells and their variants. The reticulin stains showed increased in all of the cases.Conclusions:When the HL was established, we agree with the cellular infiltration, fibrosis alone or incombination as evidence of BMI.BMT was an important examination in patients with Hodgkin lymphoma.