骨髓涂片检查对神经母细胞瘤诊断的意义

Significance of bone marrow smear examination in the diagnosis of neuroblastoma

目的探讨神经母细胞瘤（NB）骨髓侵犯的细胞形态学特征。方法对19例经骨髓涂片拟诊并最后确诊的NB患儿临床资料进行总结。结果19例患儿中，年龄〈5岁者占78．9％。主要临床表现为中、重度贫血、白细胞减少和（或）血小板减少，部分患者血涂片见中晚幼红细胞或晚幼粒细胞。骨髓象有核细胞增生明显活跃～极度活跃占78．9％，其中NB细胞占30％～87％，可见到不同形态及不同分化阶段的NB细胞，以原始未分化阶段为主，73．7％的病例骨髓涂片中NB细胞团呈典型Homerwrigth假菊形排列。结论根据临床表现，在骨髓涂片中找到NB细胞并呈假菊形排列的NB细胞团，对NB诊断具有重要指导意义，结合病理活检、影像学及生物化学检查可确诊。形态不典型者还需结合细胞表型或免疫组化等检查协同诊断。

Objective To investigate morphological characteristics of neuroblastoma （NB） in bone marrow involvement. Methods The clinical data were analyzed in 19 cases of NB children patients who had been suspected by the bone marrow smears and finally identified with NB. Results The 78.9% of NB patients were less than 5 years old. The main clinical manifestations included moderate-severe anemia, leukopenia and （or） thrombocytopenia. Late immature red cells and metamyelocytes presented in some peripheral blood smears. Bone marrow smear examination showed that nucleated cell proliferating distinctly actively to extremely actively accounted for 78.9%, of which NB cells accounted for 30% -87%. The NB cells displayed various shape different stages with original undifferentiated stage as main part. 73.7% cases in the gToup showed NB cell mass with typical Homer wrigth false daisy-shaped arrangement. Conclusions Basing on clinical manifestations, NB cell and cell mass cells with typical Homer wrigth false daisy-shaped arrangement are found in bone marrow smears, which are significant in NB diagnosis. The diagnosis can be made with the further combination of biopsy, imaging and biochemical examination. If the form is not typical, it will be needed to have a synergetic diagnosis combining cell phenotype or immunohistochemistry examinations.