骨髓增生异常综合征（MDS）的形态学分类：骨髓穿刺液与骨髓活检切片的联合应用

Morphologic classification of the myelodysplastic syndromes (MDS): combined utilization of bone marrow aspirates and trephine biopsies.

作者信息

Bartl R, Frisch B, Baumgart R

机构信息

Department of Bone Marrow Diagnosis, University of Munich, F.R.G.

出版信息

Leuk Res. 1992;16(1):15-33. doi: 10.1016/0145-2126(92)90096-p.

DOI:10.1016/0145-2126(92)90096-p

PMID:1732665

Abstract

In a retrospective and prospective follow-up study from 1975 to 1991, bone marrow biopsies, aspirates and clinical features of 495 patients with MDS were investigated. Sections of undecalcified plastic embedded biopsies and smears of bone marrow aspirates were stained according to Giemsa. Bone marrows with MDS were characterized by three main categories of morphologic alterations: (1) cellular abnormalities, (2) architectural disorganization in the bone marrow and (3) stromal changes; the combined use of aspirates and trephine biopsies enabled a more reliable and accurate diagnosis of MDS than either one alone. The bone marrow findings fell into one of 7 subtypes, with the frequencies and median survivals in brackets: (1) MDS sideroblastic (19%, 62 months), (2) MDS megaloblastoid (13%, 56 months), (3) MDS proliferative (22%, 31 months), (4) MDS blastic (15%, 9 months), (5) MDS hypoplastic (15%, 26 months), (6) MDS fibrotic (6%, 29 months), and (7) MDS inflammatory (10%, 42 months). In follow-up studies patients with secondary MDS were excluded and the prognosis and subsequent evolution for each of the morphologic subtypes were evaluated. The conclusion is drawn that aspirates and trephine biopsies are complementary procedures and both are required for diagnosis, classification and decisions on current treatment modalities of patients with MDS.

摘要

在一项1975年至1991年的回顾性和前瞻性随访研究中，对495例骨髓增生异常综合征（MDS）患者的骨髓活检、穿刺样本及临床特征进行了调查。未脱钙塑料包埋活检组织切片及骨髓穿刺涂片按吉姆萨染色法进行染色。MDS骨髓具有三类主要形态学改变：（1）细胞异常，（2）骨髓结构紊乱，（3）基质改变；与单独使用穿刺样本或活检组织相比，联合使用穿刺样本和环钻活检组织能更可靠、准确地诊断MDS。骨髓检查结果分为7种亚型之一，括号内为各亚型的发生率及中位生存期：（1）铁粒幼细胞性MDS（19%，62个月），（2）类巨幼细胞性MDS（13%，56个月），（3）增殖性MDS（22%，31个月），（4）原始细胞增多性MDS（15%，9个月），（5）低增生性MDS（15%，26个月），（6）纤维化MDS（6%，29个月），（7）炎症性MDS（10%，42个月）。在随访研究中，排除了继发性MDS患者，并对每种形态学亚型的预后及后续病情演变进行了评估。得出的结论是，穿刺样本和环钻活检组织是互补的检查方法，对于MDS患者的诊断、分类及当前治疗方式的决策均需二者结合使用。