非霍奇金淋巴瘤侵犯骨髓的病理与临床研究

Clinicopathological studies on bone marrow involvement of non Hodgkin′s lymphoma

目的 探讨非霍奇金淋巴瘤 (NHL)侵犯骨髓 (BMI)的病理形态学特点及与临床表现的关系。方法 骨髓活检塑料包埋切片 ,H Giemsa E染色及免疫组化确定淋巴瘤表型。 70例NHLBMI中 ,男 5 2例 ,女 18例。中位年龄 49(4～ 78)岁。T NHL2 0例 ,B NHL5 0例。结果 NHLBMI呈轻度 15例(2 1.4% ) ,中度 16例 (2 2 .9% ) ,重度 39例 (5 5 .7% )。瘤细胞分布呈间质型 2 3例 (32 .9% ) ,结节型 7例(10 .0 % ) ,混合型 18例 (2 5 .7% )和弥漫型 2 2例 (31.4% )。结节型侵犯伴脾肿大者显著高于其他型 ,结节型者主要为B NHLBMI,表明NHLBMI伴脾肿大与淋巴瘤表型有关。显著侵犯组易合并淋巴瘤细胞白血病 (LCL) ,表明NHLBMI越重 ,越易合并LCL。还提示淋巴瘤侵犯骨髓越轻 ,疗效越好。结论NHLBMI程度和方式与临床表现有密切关系 ,通过骨髓活检检查NHLBMI。

Objective To investigate the relationship between pathomorphological features and clinical manifestations of non Hodgkin′s lymphoma (NHL) with bone marrow involvement (BMI).Methods Plastic embedded section of bone marrow biopsy was stained with H Giemsa E. Immunotyping of NHL was performed immunohistochemically.Results A total of 70 patients with NHLBMI( male:52, female:18; median age: 49 years) was studied. There were 20 patients with T cell lymphoma and 50 patients with B cell lymphoma. The extent of bone marrow involvement was minimal in 15 cases, moderate in 16 cases and severe in 39 cases. Bone marrow involvement was of interstitial type in 23 cases, nodular type in 7 cases, and mixed type in 18 cases and diffuse type in 22 cases. The frequency of splenomegaly in nodular type NHLBMI was significantly higher than that in any other type. Nodular type NHLBMI occurred mainly in B cell lymphoma. Lymphoma cell leukemia (LCL) developded in 14 of 39 (35.9%) cases of NHL with severe bone marrow involvement which was significantly more frequent than that in NHL with mild and moderate bone marrow involvement.Conclusion Difference in the extent and pattern of bone marrow involvement in NHL is related to clinical manifestations. Bone marrow biopsy helps evaluate response to treatment.