205例多发性骨髓瘤患者骨髓涂片与活检切片内浆细胞浸润的比较研究

Comparative study of plasma cell infiltration in marrow smear and marrow biopsy section in 205 cases of multiple myeloma

目的:比较多发性骨髓瘤(MM)患者骨髓涂片与活检切片内浆细胞浸润的情况,以明确骨髓活检切片在诊断MM中的价值。方法:回顾性分析1993年1月至2009年6月上海交通大学附属第六人民医院收住的205例初治MM患者资料,观察骨髓涂片与活检切片内浆细胞浸润的情况及骨髓活检切片内浆细胞的增殖模式、组织学分期,行网硬蛋白纤维(Gomori)染色判断骨髓纤维化程度,同时比较骨髓组织学分期与Durie-Salmon(DS)分期的相符情况。结果:51例患者(24.9%)骨髓涂片中浆细胞百分率在5%～20%,108例患者(52.7%)在20%～50%,另46例(22.4%)>50%。组织学分期,本组20例患者(9.8%)骨髓瘤细胞负荷处于Ⅰ期,70例(34.1%)处于Ⅱ期,27例(13.2%)处于Ⅲ期,88例(42.9%)处于Ⅳ期。增殖模式,本组27例(13.2%)为间质型,90例(43.9%)为结节型,66例(32.2%)为塞实型,22例(10.7%)为肉瘤型。基质内纤维增生程度,Gomori染色示-～+者为30例(14.6%),+者为142例(69.3%),++者为26例(12.7%),+++者为7例(3.4%)。146例(71.2%)显示骨髓涂片与活检切片内浆细胞的浸润度相当,59例(28.8%)患者的骨髓涂片浆细胞浸润度较活检切片为低,无一例涂片中的浆细胞浸润度较切片明显增高,2种方法检测浆细胞浸润度差异有统计学意义(P<0.05)。结论:骨髓涂片结合活检切片对于MM的诊断、肿瘤负荷的判断有较大作用,同时骨髓组织学分期与DS分期有部分不相符合,其意义有待于进一步积累病例进行观察。

Objective To compare status of the plasma cell infiltration in marrow smear and marrow biopsy section in multiple myeloma patients and evalute the role of marrow smear and marrow biopsy section in the diagnosis of multiple myeloma.Methods Plasma cell infiltration in marrow smear and marrow biopsy section in 205 cases of multiple myeloma were analyzed retrospectively.Cell proliferation mode,histological stage and grade of myelofibrosis were observed in marrow biopsy section.Meanwhile,the histological stage and Durie-Salmom stage were compared.Results In the marrow smear,percentages of plasma cell in 51 cases （24.9%） were between 5% and 20%,108 cases（52.7%） were between 20% and 50%,the other 46 cases （22.4%）were higher than 50%.For histological stage,20 cases （9.8%） were in stageⅠ,70 cases（34.1%） in stage Ⅱ,27 cases （13.2%） in stage Ⅲand 88 cases （42.9%）in stage Ⅳ.The proliferation modes were interstitial type in 27 cases （13.2%）,nodal type in 90 cases （43.9 %）,pack type in 66 cases （32.2%） and sarcoma type in 22 （10.7%） cases.Myelofibrosis was （-） to （＋） in 30 cases （14.6%）,（＋） in 142 cases （69.3%）,（＋＋） in 26 cases （12.7%）,（＋＋＋） in 7 cases （3.4%）.In 146 cases （71.2%）,plasma cell infiltration in marrow smear was corresponding with marrow biopsy sections.The plasma cell infiltration in marrow smear in 59 cases （28.8%） was lower than that in marrow biopsy section.Conclusions Marrow smear combined with marrow biopsy section is important for the diagnosis of multiple myeloma and the judging of tumor burden.Histological stage and Durie-Salmon stage was different in some cases.The significance of this phenomenon remains to be further investigated.