骨髓涂片与切片联合应用在淋巴瘤诊断和分期中的价值

Thevalue of combined use of bonema Thevalue of combine duse of bone marrowsmear and sectionin lymphoma for diagnosis and staging

目的 探讨淋巴瘤骨髓涂片与切片联合应用在淋巴瘤诊断和分期中的价值。方法 对114例淋巴瘤的外周血、骨髓液涂片采用瑞特染色、骨髓活检采用塑料包埋后半薄切片 ,常规化学染色。结果 7例霍奇金淋巴瘤骨髓涂片、切片均未见淋巴瘤细胞。 10 7例非霍奇金淋巴瘤中 3 2例( 2 9.9% )骨髓受累。其中 13例 ( 4 0 .6% )原分期属Ⅰ、Ⅱ和Ⅲ期 ,后经骨髓检查升至Ⅳ期 ;3 2例中 5例无浅表淋巴结肿大者 ,经骨髓涂片及切片检查后确诊为NHL。在骨髓、外周血涂片中瘤细胞形态多样 ,同一份标本中也可各异。切片中骨髓受累可呈局灶型 ( 81.3 % )和弥漫型 ( 18.7% )。其瘤细胞形态主要有五种 :( 1)小淋巴细胞为主型 ;( 2 )原始血细胞样淋巴细胞为主型 ;( 3 )多形性淋巴细胞为主型 ;( 4 )淋 浆样细胞为主型 ;( 5 )肉芽肿型。结论 骨髓涂片和切片相结合对淋巴瘤诊断和分期具有十分重要价值 。

Objective Toexplorethevalueofcombineduseofbonemarrowsmearandsectioninlym phomafordiagnosisandstaging .Methods Smearsofperipheralbloodandbonemarrowfrom 114casesoflym phomawerestainedaccordingtoWright.Plasticembeddedsectionsofthe 114caseswerestainedaccordingtoHE , HGFandGomori.Results Noneofthe 7patientswithHodgkin′slymphoma (HD )presentedbonemarrow involvement,while 3 2 ( 2 9.9% )ofthe 10 7patientswithNon Hodgkin′slymphoma (NHL )presentedbonemar rowinvolvement,13 ( 4 0 .6% )ofthe 3 2casesinstageⅠ、Ⅱ、ⅢwerepromotedtostageⅣafterbonemarrow examination .In 5ofthe 3 2patientswithoutlymphadenopathythediagnosisoflymphomawasestablishedthrough bonemarrowstudy .Lymphomacellsinbonemarrowandperipheralbloodvariedinmorphology .Bonemarrow involvementmightbefocal( 81.3 % )ordiffused ( 18.7% ) .Thereweremainlyfivetype :( 1)Smalllymphocyte type .( 2 )blast likelymphocytetype .( 3 )multimorphologytype .( 4 )lymphoplasmacytoidcelltype.( 5 )granuloma type .Conclusion Bonemarrowexaminationisofimportanceinpatientswithknownorsuspectedlymphomasand itmaybediagnosticinpatientswithoutlymphadenopathyorincaseswithnoconclusivehistologicalevidencefrom othersites.