Bhargava V, Farhi D C
Institute of Pathology, Case Western Reserve University, Cleveland, Ohio.
Hematol Pathol. 1988;2(1):43-50.
Of 6,988 bone marrow biopsies seen from 1973 to 1986, granulomas were identified in 72 specimens. In this period, biopsies doubled, but the yearly incidence of granulomas increased from 0.3% to 2.2%. The granulomas were associated with infectious disease (30%), hematologic disorders (25%), sarcoidosis (11%), nonhematologic malignancies (10%), drug reaction (5%), other diseases (6%), and no final diagnosis (6%). In contrast to studies reporting a high incidence of tuberculosis and histoplasmosis, we found incidences of 6% and 4%, respectively. The proportion of hematologic disorders was constant from 1973 to 1986, while the rate of infectious disease increased from 19% in 1973-1979 to 32% in 1980-1986. The incidence of sarcoidosis dropped from 32% to 3%. Patients with fever of unknown origin were 15 times more likely to have marrow granulomas than patients biopsied for other reasons. We have documented an increase in the incidence of marrow granulomas with a corresponding change in the clinical profile. Some possible new disease and drug associations have been identified.
在1973年至1986年间所做的6988例骨髓活检中,在72份标本中发现了肉芽肿。在此期间,活检数量翻倍,但肉芽肿的年发病率从0.3%增至2.2%。这些肉芽肿与感染性疾病(30%)、血液系统疾病(25%)、结节病(11%)、非血液系统恶性肿瘤(10%)、药物反应(5%)、其他疾病(6%)以及最终未确诊(6%)有关。与报道结核病和组织胞浆菌病高发病率的研究不同,我们分别发现其发病率为6%和4%。1973年至1986年间血液系统疾病的比例保持不变,而感染性疾病的比例从1973 - 1979年的19%增至1980 - 1986年的32%。结节病的发病率从32%降至3%。不明原因发热患者出现骨髓肉芽肿的可能性是因其他原因接受活检患者的15倍。我们记录了骨髓肉芽肿发病率的增加以及临床特征的相应变化。已确定了一些可能的新疾病和药物关联。