慢性粒-单细胞白血病的骨髓组织病理学研究

Observation of bone marrow histology pathology in MDS/MPD-CMML

目的:探讨慢性粒-单细胞白血病的(CMML)骨髓组织病理学改变。方法:骨髓活检块以Hema-pun865塑料包埋剂包埋,制备成3μm做HGF染色,5μm做Gomori染色。观察切片内骨髓组织学和细胞形态学改变。并与20例正常人骨髓切片进行对照。结果:46例CMML患者骨髓切片表现增生异常活跃骨髓象,原始细胞增多,ALIP易见,各例均检出典型原始幼稚前体细胞异常定位大簇(>5个髓系前体细胞)位于小梁旁区或间区。粒系细胞和单核系细胞增多(平均值为19.7%)。巨核细胞增多与否不定,但多形性明显。红系呈小簇或散在分布。间质示11例骨小梁破坏,14例静脉窦扩张。网状纤维异常增生(16例,达34.7%,Gomori染色+++)。结论:骨髓切片能全面反映CMML骨髓组织病理学改变,提高诊断率,并能提示预后。

Objective：To study the specific change of bone marrow histology pathology in CMML. Method.. The bone marrow tissues are embedded by Hemapun865 plastic-embed fluid. Every sample is stained by HGF （3μm） and Gomori （5 μm）. Observe the specific change of bone marrow sliced sheet in histology and cytomorphologic. Compare them with 20 bone marrow sliced sheets of normal person. Result：The bone marrow slice of CMML behaves abnormal hyperplasia, with manifold original cell, salient ALIP. Typical ALIP large cluster （〉5 medullary precursor cells） is found at paratrabecula or intertrabecula in all samples. The amount of granulocytic series and monocytic series is increasing. The amount of megalokaryocytes are various. Erythron distributes in small-clusters or scatters. Esenchyme displays destroyed bone trabecula in 11 samples and enlarged sinus venosus in 14 ones. Lattice fibers shows abnormal hyperplasia in 16 samples （34.7%, Gomori stain＋ ＋ ＋）. Conclusion： Combining the bone marrow biopsy and bone marrow cell smear can reflect the change of bone marrow histology pathology in MDS/MPD-CMML, improve the diagnose rate and suggest the prognosis.