骨髓和外周血检查在首诊非霍奇金淋巴瘤中的价值

Bone marrow and peripheral blood examination in non-Hodgkin lymphoma at initial diagnosis

目的 探讨骨髓和外周血检查在非霍奇金淋巴瘤 (NHL)诊断和分期中的价值。方法 对 10 3例NHL患者外周血、骨髓涂片采用瑞特染色 ,骨髓和淋巴结活检组织采用石蜡包埋切片、H -Giemsa -E染色和免疫组化分型。结果 10 3例NHL中 2 8例 (2 7 2 % )骨髓受累 (BMI)。其中 8例无明显浅表淋巴结肿大者经外周血、骨髓涂片及切片联合检查确诊为NHL ;7例原分期属Ⅰ期、Ⅱ期、Ⅲ期者经骨髓检查后归入Ⅳ期。淋巴瘤细胞形态多样 ,同一病例亦表现各异 ,大致分为原始细胞型、多形性淋巴细胞型、小淋巴细胞型、组织细胞样淋巴细胞型。与无BMI者相比 ,BMI者血细胞明显减少 ,骨髓三系造血明显抑制 ;无BMI者骨髓亦有激惹现象。结论 骨髓和外周血检查对NHL诊断和分期具有重要价值 。

Objective To explore the value of bone marrow and peripheral blood examination in non-Hodgkin lymphoma(NHL) at initial diagnosis.Methods Smears of bone marrow and peripheral blood from 103 cases of NHL were stained according to Wright. Paraffin-embedded sections of bone marrow and lymphadenopathy biopsy were stained according to H-Giemsa-E. Immunotyping of NHL was performed immunohistochemically.Results Bone marrow involvement (BMI) by NHL was found in 28 (27 2%) cases.In 8 of the 28 cases without superficial lymphadenopathy,the diagnosis of NHL was established through bone marrow and peripheral blood examination.Seven of the 28 cases in stage Ⅰ?Ⅱ?Ⅲ were confirmed to be in stage Ⅳ based on bone marrow examination. Lymphoma cells in bone marrow and peripheral blood varied in morphology,they were mainly of four patterns:blast type?polymorphic lymphocyte type?small lymphocyte type?histiocyte-like lymphocyte type.Patients with BMI were more likely to have cytopenias in peripheral blood and trilineage of bone marrow depressed than those without BMI.Patients without BMI had a stimulated phenomenon in bone marrow.Conclusion Examination of bone marrow and peripheral blood is important for diagnosis and staging of NHL,especially for the diagnosis of patients without histological evidence of lymph node.