Homans A C, Barker B E, Forman E N, Cornell C J, Dickerman J D, Truman J T
Division of Pediatric Oncology, Brown University, Providence, RI.
Blood. 1990 Nov 1;76(9):1807-11.
The presence of meningeal involvement in children with acute lymphoblastic leukemia (ALL) may have important prognostic and therapeutic implications. Conventional methods of diagnosing central nervous system (CNS) leukemia rely on the interpretation of cerebrospinal fluid (CSF) cell morphology, which may produce ambiguous results in the presence of minimal leukemic involvement. A methodology has been developed for immunophenotyping small numbers of CSF cells while preserving cell morphology. CSF samples from 33 children with CD10 (common ALL antigen [CALLA]) positive ALL were examined at initial presentation using both conventional morphology and this combined immunohistopathologic technique. Six (18%) of the samples contained lymphoblasts or cells considered morphologically suspicious for leukemic involvement. Nine additional samples (27% of the total) had normal CSF morphology, but contained increased numbers of CALLA positive cells. Twelve of the 33 samples were also examined for the simultaneous presence of nuclear terminal deoxynucleotidyl transferase (TdT) and demonstrated increased numbers of cells positive for both TdT and CD10. These data suggest that a large proportion of children with ALL may have abnormalities of CSF cells at initial diagnosis consistent with the presence of occult leukemic involvement.
急性淋巴细胞白血病（ALL）患儿出现脑膜受累可能具有重要的预后和治疗意义。诊断中枢神经系统（CNS）白血病的传统方法依赖于对脑脊液（CSF）细胞形态的解读，在白血病累及极少的情况下可能产生不明确的结果。已开发出一种在保留细胞形态的同时对少量CSF细胞进行免疫表型分析的方法。对33例CD10（普通ALL抗原[CALLA]）阳性ALL患儿的CSF样本在初次就诊时同时使用传统形态学方法和这种联合免疫组织病理学技术进行检查。6份（18%）样本含有成淋巴细胞或形态上怀疑白血病累及的细胞。另外9份样本（占总数的27%）CSF形态正常，但含有数量增加的CALLA阳性细胞。33份样本中的12份还检测了核末端脱氧核苷酸转移酶（TdT）的同时存在情况，结果显示TdT和CD10双阳性细胞数量增加。这些数据表明，很大一部分ALL患儿在初诊时可能存在CSF细胞异常，提示存在隐匿性白血病累及。
