电镜观察骨髓有核细胞对非霍奇金淋巴瘤的诊断价值

The role of electron microscopy in diagnosis of non-Hodgkin lymphoma by observation of nucleated cell in bone marrow aspirate

目的总结透射电子显微镜观察骨髓有核细胞形态结构对非霍奇金淋巴瘤(NHL)诊断和鉴别诊断的作用。方法电镜观察骨髓有核细胞形态结构,根据中幼稚细胞种类和分化程度对患者进行诊断,回顾分析48例NHL患者的电镜和临床诊断符合率。结果48例患者中,电镜发现41例患者骨髓液中存在幼稚淋巴细胞(85.4%),21例电镜诊断NHL,9例提示急性淋巴细胞白血病(ALL),2例提示毛细胞白血病(HCL),2例提示慢性淋巴细胞白血病(CLL),1例浆细胞白血病(PL),6例淋系增殖疾病(LPD)未进行分类。7例患者电镜观察未发现或明确幼稚淋巴细胞,1例提示急性髓系白血病(AML),2例描述发现异常细胞,但未定性,2例提示病态造血;2例无提示。48例NHL患者中,发现病态造血28例。结论电子显微镜观察骨髓有核细胞对NHL、尤其是原发部位不明的NHL具有重要诊断价值。其次,电镜能够评价NHL诱导的骨髓病理反应。

Objective： To investigate the value of transmission electron microscopy （TEM） in non-Hodgkin lymphoma （NHL） diagnosis and differentiation by observation of nucleated cell in bone marrow aspirate （BMA）. Method：Observing nucleated cells in BMA to make diagnosis according to cell classification and differentiation, analyzing the diagnostic coincidence of TEM in 48 patients with NHL. Result： Immature lymphocytes were found in 41 out of 48 cases, 21/41 were diagnosed as NHL, 9/41 as acute lymphoblastic leukemia, 2/41 as hairy cell leukemia, 2/41 as chronic lymphocytic leukemia, 1/41 as Plasma cell leukemia, 6 as lymphocyte proliferation disease without further classifications by TEM. In the 7 cases that had not found immature lymphocyte in BMA, 1 case was suggested as acute myeloid leukemia, 2 cases were demonstrated with abnormal ceils but not unqualified, 2 cases were with no suggestion, and 2 cases were indicated dyshaematopoiesis. On other hand, 28 out of 48 cases were illustrated dyshematopoiesis features by TEM. Conclusion： Investigating nucleated ceils in BMA with TEM was significant in diagnosis of NHL, especially for the unknown origin NHL. Meanwhile, TEM was useful in evaluation of dyshaematopoiesis induced by NHL.