骨髓细胞学检查对恶性淋巴瘤病理诊断、临床分期及预后价值

Clinical Value of Bone Marrow Cytologic Examination in Pathological Diagnosis, Clinical Staging and Prognosis for Malignant Lymphoma

[目的]探讨骨髓细胞学检查对恶性淋巴瘤病理诊断和临床分期的价值。[方法]总结回顾101例恶性淋巴瘤患者的骨髓细胞学检查和临床分期结果。[结果]霍奇金淋巴瘤(HL)24例;非霍奇金淋巴瘤(NHL)77例。NHL分型:B细胞型49例,T细胞型26例和NK细胞型2例。恶性淋巴瘤的骨髓侵犯(BMI)32例(31.68%),其中恶性淋巴瘤性白血病(MLL)8例。HL的淋巴细胞削减型和混合细胞型;NHL的小淋巴细胞淋巴瘤,前B淋巴母细胞淋巴瘤和T淋巴母细胞淋巴瘤BMI多见。10例无明显浅表淋巴结肿大的NHL患者经骨髓活检确诊为BMI,分期则由原Ⅱ、Ⅲ期升为Ⅳ期。恶性淋巴瘤发展至MLL的间期<3.5年,生存期<28个月,预后不良。[结论]骨髓细胞学检查对恶性淋巴瘤的诊断和临床分期有重要价值,尤其对无淋巴结病理证据的患者可提供诊断依据,伴有BMI患者为临床晚期,可能进展为白血病。

Purpose] To investigate the value of bone marrow cytologic examination (BMCE) in pathological diagnosis and clinical staging for malignant lymphoma(ML). [Methods] The BMCE and clinical stage of 101 cases with ML from 1993 to 2001 were reviewed. [Results] There were 24 cases with Hodgkin's Lymphoma(HL) and 77 cases with non-Hodgkin's Lymphoma(NHL). The subtypes of NHL were B-cell, 49 cases; T-cell, 26 cases and NK cell, 2 cases. ML with bone marrow involvement(BMI) was found in 32 cases(31.68%). Among them, 8 with malignant lymphoma leukemia(MLL). Lymphocyte depleted and mixed cellularity in HL;small lymphocytic lymphoma,precursor B-lymphoblastic lymphoma and T-lymphoplastic lymphoma,which may be more common BMI. In 10 cases with NHL without superficial lymphadenopathy, the diagnosis of BMI was established after BMCE, which were changed to be stage Ⅳ from stage Ⅱ and Ⅲ. The interval from ML to MLL and survivals time were less than 3.5 years and 28 months respectively. The outcome is poor. [Conclusion] The BMCE is important in diagnosis and clinical staging for ML, especially for the patients without histological evidence of lymph node; ML with BMI is clinically advanced case, with a tendancy of developing to MLL.