骨髓活检在转移性癌病理诊断中的作用

Pathologic Diagnosis of Bone Marrow Biopsy for Metastatic Carcinomas

目的探讨骨髓活检诊断转移性癌的价值。方法收集我院2002年～2005年21例骨髓活检诊断为转移性癌的病例，结合组织学和免疫组化检测的结果，分析骨转移性癌与临床的关系。结果21例骨转移性癌占同期骨髓活检总病例数的0．31％（21／7006）。临床表现为局部或全身性骨痛，三系下降。影像学检查所有病例均见局部或全身性骨病变。光镜下骨小梁间区基质不同程度纤维组织增生，异型上皮样细胞散在或片状分布，腺样、小梁状或实体巢状排列。最后病理诊断证实胃肠道癌5例、肺癌5例、乳腺癌5例和前列腺癌4例，肝癌和甲状腺癌各1例。其中免疫组化胃肠道癌CAl9-9阳性，肺癌TTF-1阳性而TG阴性，甲状腺癌TTF-1和TG均阳性，乳腺癌E-Cadherin阳性，前列腺癌PSA阳性，肝癌HepPar1阳性。结论对于临床不明原因的骨痛或贫血患者，影象学又表现局部或全身性骨病变时，建议进行骨髓活检，当病理学见骨髓内异型上皮样细胞浸润，纤维组织增生时提示骨髓转移性癌，免疫组化进一步明确原发肿瘤。

Objective To study the pathologic diagnosis of bone marrow biopsy for metastatic carcinomas. Methods Bone marrow biopsies were performed on 21 patients whose metastatic carcinomas were highly suspected but the associated original tumors were not found. They were also analysed by histology and immunohistochemistry. Results Most patients complained of local or systemic bone pain,and some had pancytopenia. Local or systemic osteal lesions were found in 21 patients by imaging diagnosis. Histopathologically, there were proliferation inter trabecular fibrous tissues and atypical epithelial cells with glandular, trabecular or solid patterns. The final diagnosis included 5 patients of gastroenteric adenocarcinomas, 5 pulmonary adenocarcinomas, 5 mammary adenocarcinomas, 4 prostate adenocarcinomas, 1 hepatocellular carcinoma and 1 thyroid carcinoma. Immunohistochemically, CA19-9 was positive in gastroenteric adenocarcinoma, TTF-1 was positive and TG was negative in pulmonary adenocarcinoma, TTF-1 and TG were positive in thyroid carcinoma, E-Cadherin was positive in mammary adenocarcinoma, PSA was positive in prostate adenocarcinoma and HepParl was positive in hepatocellular carcinoma. Conclusion In patients with bone pain or anemia, bone marrow biopsy should be performed to those cases with local or systemic osteal lesions revealed by imaging diagnosis. Atypical epithelial cells invasion and fibrous tissue proliferation found in the bone marrow biopsy suggest the diagnosis of metastatic carcinomas, and immunohistochemistry may be helpful to find the original tumors.