Sandhaus L M, Voelkerding K V, Dougherty J, Raska K
Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Piscataway.
Hematol Pathol. 1990;4(3):135-48.
The diagnosis of lymphoma involving bone marrow is often complicated by the presence of nonspecific lymphoid aggregates. Morphologic criteria may not permit the distinction of benign from malignant lymphoid aggregates with certainty in all cases. We combined morphology with immunophenotypic and immunogenotypic analyses of aspirated marrow cells to develop more reliable criteria for the diagnosis of marrow involvement by lymphoma. The presence of morphologically recognizable lymphoma cells in the bone marrow aspirate was always confirmed by immunogenotypic analysis. The yield of either immunophenotypic or immunogenotypic analyses on morphologically negative marrows was very low. Focal paratrabecular involvement by lymphoma was not always confirmed by immunophenotypic or immunogenotypic analyses, probably due to sampling error and factors interfering with aspiration of the lymphoid aggregates. Thus, the immunologic and molecular studies supported, but did not substantially improve upon the morphologic criteria that are in common usage for distinguishing benign from malignant lymphoid aggregates in the bone marrow. Finally, evidence of B-lymphocyte clonality was obtained in four of five cases in which there were nonspecific lymphoid aggregates in the bone marrow in the absence of otherwise clinically definable malignancy.
骨髓受累的淋巴瘤诊断常因非特异性淋巴样聚集物的存在而变得复杂。形态学标准在所有病例中可能无法确切地区分良性与恶性淋巴样聚集物。我们将形态学与抽吸骨髓细胞的免疫表型和免疫基因型分析相结合，以制定更可靠的标准来诊断淋巴瘤骨髓受累情况。骨髓抽吸物中形态学上可识别的淋巴瘤细胞的存在总是通过免疫基因型分析得到证实。对形态学阴性的骨髓进行免疫表型或免疫基因型分析的阳性率非常低。淋巴瘤的局灶性小梁旁受累情况并非总能通过免疫表型或免疫基因型分析得到证实，这可能是由于抽样误差以及干扰淋巴样聚集物抽吸的因素所致。因此，免疫学和分子学研究支持，但并未实质性地改进目前用于区分骨髓中良性与恶性淋巴样聚集物的常用形态学标准。最后，在五例骨髓中存在非特异性淋巴样聚集物且无其他临床可定义恶性肿瘤的病例中，有四例获得了B淋巴细胞克隆性的证据。
