Bae Go Eun, Suh Yeon-Lim, Sung Ki Woong, Kim Jung-Sun
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Pathol. 2013 Oct;47(5):433-42. doi: 10.4132/KoreanJPathol.2013.47.5.433. Epub 2013 Oct 25.
The aim of this study is to evaluate the histologic features of metastatic neuroblastic tumors (NTs) in bone marrow (BM) before and after chemotherapy in comparison with those of primary NTs.
A total of 294 biopsies from 48 children diagnosed with NTs with BM metastasis were examined. There were 48 primary neoplasm biopsies, 48 BM biopsies before chemotherapy, 36 primary neoplasm excisional biopsies after chemotherapy, and 162 BM biopsies after chemotherapy.
Metastatic NTs in BM before chemotherapy were composed of undifferentiated and/or differentiating neuroblasts, but had neither ganglion cells nor Schwannian stroma. Metastatic foci of BM after chemotherapy were found to have differentiated into ganglion cells or Schwannian stroma, which became more prominent after further cycles of chemotherapy. Persistence of NTs or tumor cell types in BM after treatment did not show statistically significant correlation to patients' outcome. However, three out of five patients who newly developed poorly differentiated neuroblasts in BM after treatment expired due to disease progression.
Metastatic NTs in BM initially consist of undifferentiated or differentiating neuroblasts regardless of the primary tumor subtype, and become differentiated after chemotherapy. Newly appearing poorly differentiated neuroblasts after treatment might be an indicator for poor prognosis.
本研究旨在评估骨髓（BM）中转移性神经母细胞瘤（NTs）化疗前后的组织学特征，并与原发性NTs的组织学特征进行比较。
对48例诊断为NTs伴BM转移的儿童的294份活检标本进行了检查。其中有48份原发性肿瘤活检标本、48份化疗前BM活检标本、36份化疗后原发性肿瘤切除活检标本以及162份化疗后BM活检标本。
化疗前BM中的转移性NTs由未分化和/或分化中的神经母细胞组成，但既没有神经节细胞也没有雪旺氏基质。化疗后BM的转移灶已分化为神经节细胞或雪旺氏基质，在进一步的化疗周期后变得更加明显。治疗后BM中NTs或肿瘤细胞类型的持续存在与患者的预后没有统计学上的显著相关性。然而，五名治疗后BM中新出现低分化神经母细胞的患者中有三名因疾病进展而死亡。
无论原发性肿瘤亚型如何，BM中的转移性NTs最初均由未分化或分化中的神经母细胞组成，化疗后会发生分化。治疗后新出现的低分化神经母细胞可能是预后不良的指标。
