188例淋巴瘤累及骨髓患者的临床病理学分析

Clinico-pathological analysis of 188 cases of bone marrow involvement of lymphoma

目的观察淋巴瘤累及骨髓的临床病理、免疫表型特征,探讨其在病理诊断和分型中的意义。方法对188例淋巴瘤患者甲醛固定、石蜡包埋的骨髓活检组织进行临床病理及组织学观察, 并行免疫组织化学染色。结果①本组188例患者的骨髓浸润模式以弥漫型(44．9％)与灶型 (29．3％)多见,间质型(11．6％)、结节型(6．1％)、小梁旁型(5．1％)及结节/间质型(3．0％)较为少见;②本组病例的组织学类型多样,淋巴浆细胞性淋巴瘤最多见(21．7％);③与骨髓外的其他部位的淋巴瘤一样,骨髓活检组织中的各类淋巴瘤具有特征性的组织形态学及免疫表型特点;④淋巴瘤累及骨髓病例多出现不同程度的纤维组织增生(75．8％)及造血组织增生低下(71．1％),部分病例可出现灶性、片状或弥漫性凝固性坏死(4．5%)。结论大多数淋巴瘤累及骨髓病例可通过观察肿瘤的组织形态,结合免疫表型检测得到诊断和分型,少部分病例须结合淋巴结的病变才能确诊,个别病例虽可确定为淋巴瘤,但分型困难。

Objective To evaluate pathomorphologic and immunohistochemical characteristics of the bone marrow involvement of lymphoma and its significance in the diagnosis and subtype of lymphoma with bone marrow involvement. Methods One hundred and eighty eight formalin fixed and paraffin embedded bone marrow biopsy specimens were studied. Immunohistochemical staining was performed. Results ①Five patterns of bone marrow involvement of lymphoma were found, including diffuse （44.9%）, focal （29.3%）, interstitial（ll.6% ） and nodular（6.1%）.②There were many subtypes of lymphoma in these cases, the most common type was lymphoplasmacytic lymphoma （21.7%）. ③The lymphomas in bone marrow biopsy had their own special characteristics of morphology and immunophenotype as did in extramedulla lymphomas. ④Fibrosis （75.8%） and hematopoietic tissue hypoplasia （71.1%） were found in most cases and necrosis in a few cases. Conclusions Most cases of bone marrow involvement of lymphoma could be diagnosed and classifted by combination of histopathological and immunohistochemical analysis. Diagnosis of some cases could be made only after the review of pathological changes of lymph node. A few cases were difficult to classify their subtypes of lymphoma.