巨核细胞脱核和胞核胞质连体分离的形态学研究

Research on the morphology of megakaryocytes extrusion of nucleus and nucleocytoplasmic separation

目的探讨巨核细胞脱核和胞核胞质连体分离形态及其意义。方法用光镜观察4例原发性骨髓纤维化(PMF)、难治性贫血(RA)、急性粒细胞性白血病(M2)和急性红白血病(M6)初诊患者的血片、骨髓涂片和骨髓切片中巨核细胞形态特征。结果4例骨髓象均观察到多种病态巨核细胞,其中PMF和M6多为撕拉分离状的淋巴样病态巨核细胞;RA和M2多为脱核的或胞核胞质分离状的病态巨核细胞,胞体大,部分胞核远离母体,有的残留少量胞质成为小(或)淋巴样巨核细胞,细胞免疫化学染色显示分离的胞核胞质。结论巨核细胞存在脱核或胞核胞质分离现象,提示在成熟中存在多核胞核分散向周边逸去的过程,甚至完全脱离母体,并提示微小巨核细胞可能由多小核巨核细胞的胞核连胞质分离或分割而成的部分。

Objective To study the morphology of megakaryocytes extrusion of nucleus and nucleo-cytoplasmic separation and their significance.Methods We observed the morphology characteristics of megakaryocytes in the peripheral blood films, bone marrow smears and bone marrow biopsies of 4 first visit patients with primary myelofibrosis(PMF), refractory anemia (RA), myeloblastic leukemia with maturation(M2) and erythroleukemia(M6) by use of light microscope.Results Many kinds of dysmegakaryocytes were observed in 4 cases of bone marrow smears, while PMF and M6 were ripped separation of lymphoid megakaryocytes; RA and M2 were megakaryocytes of extrusion of nucleus and nucleocytoplasmic separation, cells were large, some nucleus were far away from mother body, some remain little cytoplasm which changed into small or lymphoid megakaryocytes. The nucleocytoplasmic separation can be displayed by immunocytochemistry stain.Conclusions The phenomenon of extrusion of nucleus and/or nucleocytoplasmic separation in megakaryocyte suggests the process that dispersed multinuclear releasing towards surround or even whole left the mother body during the megakaryocyte maturation. It also showed the micromegakaryocyte may be the result of nucleocytoplasmic separation or splitted in multi-separated nuclear megakaryocyte.