64例骨髓转移癌骨髓象诊断分析

Diagnostic analysis of myelogram for 64 cases of bone marrow metastatic carcinoma

目的探讨通过骨髓象检查诊断骨髓转移癌的价值,以及骨髓转移癌骨髓象变化的特点。方法常规髂前或髂后上棘抽取骨髓液涂片,同时制备血涂片,行瑞-姬复合染色后显微镜检查,找到转移癌(瘤)细胞,即诊断为骨髓转移癌(瘤)。结果64例患者均由骨髓涂片骨髓象检查发现癌(瘤)细胞而确诊。其中1次检查即明确诊断者52例(81.2%),2次检查明确诊断者11例(17.2%),3次检查明确诊断者1例(1.6%)。癌(瘤)细胞主要出现在涂片的尾部及边缘,有17例(26.6%)涂片所见主要为癌(瘤)细胞。根据涂片中出现的癌(瘤)细胞的形态、排列方式,结合临床表现,骨髓象检查诊断为癌细胞骨髓转移(未分类)32例(50.0%),腺癌骨髓转移29例(45.3%),神经母细胞瘤骨髓转移3例(4.7%)。结论诊断恶性肿瘤骨髓转移,骨髓象检查阳性率高,简便易行,只要涂片中找到癌(瘤)细胞,即可直接获得骨髓转移癌的病理诊断。但当骨髓有核细胞增生活跃,癌细胞单个散在或癌细胞团不典型时,诊断及判断细胞来源需慎重。

Objective To explore the diagnostic value for bone marrow metastatic carcinoma by the examination of myelogram and the characteristic of myelogram change of bone marrow metastatic carcinoma. Methods The patients＇ bone marrows were taken routinely. Bone marrow smears and blood smears were made by Wright and Giemsa staining and the finding of carcinoma （tumor） cells meant that there was bone marrow metastatic carcinoma （tumor）. Results 64 patients were all diagnosed by finding the metastatic carcinoma （tumor） cells in the bone marrow smears. 52 cases were diagnosed clearly in the first examination（81.2% ） , and 11 cases in the second examination（ 17.2% ） and 1 case in the third examination （ 1.6% ） were diagnosed. Metastatic carcinoma （tumor） cells scattered mainly on the tails and rims of the smears and there were mainly carcinoma （tumor） cells in 17 cases （26.6%）. According to the morphology and arrangement manner of the carcinoma （tumor） cells in the smears, combining the clinical features, the final diagnosis of myelogram included 32 cases carcinoma cells bone marrow metastasis （ unclassified, 50.0% ） , 29 cases adenocareinoma bone marrow metastasis （45. 3% ） and 3 cases neuroblastoma bone marrow metastasis （4. 7% ）. Conclusions Myelogram has a higher positive rate, the characteristic of simpleness and the practical approach to the diagnosis of bone marrow matastatie carcinoma （tumor） methods. However, we should be caution in the diagnosis and judgement of the cell source when we see single scattered cancer cell or atypical cancer cell mass.