嗅神经母细胞瘤骨髓转移临床及形态学特征(附1例报告)

The clinical and morphology features of bone marrow metastasis in olfactory neuroblastoma

目的:探讨嗅神经母细胞瘤(ONB)骨髓转移的细胞形态学特征,并复习ONB相关文献。方法:对1例经病理组织学确诊为ONB骨髓转移的患者,行血象、骨髓象和细胞化学染色分析,并对骨髓象与病理结果进行比较。结果:血象可见贫血及血小板减少,外周血涂片见瘤细胞、原粒、幼粒及幼红细胞。骨髓象示瘤细胞增生明显活跃,散在或成团分布,胞体较为均一中等大小,类圆或不规则形;胞浆量中等或丰富,色蓝,有或无少许细小红色颗粒,空泡易见且常近边缘分布,浆边缘易见日珥状突起;胞核深染,圆或类圆形,可见双核及多核,核染色质细致或粗颗粒状均匀分布,核仁模糊或可见,淡蓝色。裸核常见。可见多个瘤细胞聚集并呈放射状环形排列,形成菊形团结构。瘤细胞POX染色全阴性。结论:ONB是罕见的神经源性恶性肿瘤,起病隐匿,当外周血出现至少一系减低或可见幼粒或幼红细胞,应考虑肿瘤骨髓转移的可能性,及时行骨髓细胞形态学检查以明确诊断并确定分期及肿瘤负荷,可为临床治疗及预后提供可靠依据。

Objective：To explore the cytomorphology features of olfactory neuroblastoma （ONB）with bone marrow metastasis and the literatures were reviewed. Methods：The hemogram, myelogram and cytochemical staining were an- alyzed in 1 case of ONB patient with bone marrow metastasis diagnosed by histopathological examination, and the my_ elogram was compared with pathology. Results：The hemogram showed anemia and thromboeytopenia. The tumor cells, myeloblasts, immature granulocytes and erythroblasts were visible in the peripheral blood smear. Myelogram revealed that the tumor cell proliferation was significantly active, tumor cells were scattered or into a mass, cell body was rela- tively uniform medium - sized and round or irregular; Cytoplasm was moderate or rich, color blue, with or without ti- ny red granules , vacuoles were easy to see and usually close to the edge, cytoplasmic edge was easy to see the protru- sions like prominence shaped; Nucleus was round or oval and hyperchromatic, binueleated and multinucleated tumor cells were visible, nuclear ehromatin was finely or coarsely granular evenly dispersed, nucleolus was indistinct or clear and light blue. Bare nuclei were common. Many tumor cells gathered and arranged in radial and annular to form a cell mass, which like rosettes. The tumor cells stained with POX full negative. Conclusion：ONB is a rare neurogeniemalignancies, onset occult, when peripheral blood show at least one sery to reduce or can see et.＇ythrnblasts or imma- ture granuloeytes, shouht consider the possibility of bone marrow metastatic tumors,and timely do bone marrow cyto- morphologyexamination to confirm the diagnosis and to determine the staging and tumor load,which can provide a reliable basis for clinical treatment and prognosis.