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[形态学在弥漫性大B细胞淋巴瘤骨髓受累诊断中的临床作用]

[Clinical role of Morphology in Diagnosing Bone Marrow Involvement of Diffuse Large B Bell Lymphoma].

作者信息

Jiang Xian-Yong, Shen Hao-Rui, Ge Chang-Wen, Li Jian, Zhou Dao-Bin

机构信息

Department of Hematology, Peking Union Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China.

Department of Hematology, Peking Union Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China,E-mail:

出版信息

Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2019 Apr;27(2):421-425. doi: 10.19746/j.cnki.issn.1009-2137.2019.02.018.

Abstract

OBJECTIVE

To determine the significance of morphology of bone marrow smear for diagnosis of bone marrow involvement in patients with diffuse large B-cell lymphoma (DLBCL), and to study the morphological characteristics of DLBCL cells involved in bone marrow.

METHODS

Four hundred and twenty cases of DLBCL diagnosed at Peking Union Hospital from 2006 to 2016 were analyzed and identified.

RESULTS

Blinded analysis of bone marrow smear and bone marrow biopsy data showed involvement in 42 cases on smears (S), in 47cases by biopsy (B) and the in 49 cases by (S+B). There was an excellent correlation between 2 methods diagnosing the bone marrow infiltration of DLBCL independently (κ=0.889). The morphological features of DLBCL cells involved in bone marrow were of medium sizes, round or irregular nuclear. The chromatin presented dark purple rea and coarse granular, and most of them had 1-5 nucleoli. The amount of cytoplasm was moderate with the color of dark blue or greyish blue. Vacuoles and pseudopodia were common.

CONCLUSION

The morphological examination of bone marrow cells has a certain role in the diagnosing bone marrow involvement in patients with DLBCL, and the atypical lymphoid cells making up ≥1% of the total nucleated cells highly suggests the bone marrow involvement in the patients with DLBCL.

摘要

目的

探讨骨髓涂片形态学检查对弥漫性大B细胞淋巴瘤(DLBCL)患者骨髓受累诊断的意义,并研究DLBCL骨髓受累细胞的形态学特征。

方法

分析并鉴定2006年至2016年在北京协和医院确诊的420例DLBCL患者。

结果

对骨髓涂片和骨髓活检数据进行盲法分析,结果显示涂片(S)诊断骨髓受累42例,活检(B)诊断47例,涂片+活检(S+B)诊断49例。两种方法独立诊断DLBCL骨髓浸润的相关性良好(κ=0.889)。DLBCL骨髓受累细胞的形态学特征为中等大小,核圆形或不规则,染色质呈深紫红色、粗糙颗粒状,多数有1~5个核仁,胞质中等量,呈深蓝色或灰蓝色,可见空泡及伪足。

结论

骨髓细胞形态学检查对DLBCL患者骨髓受累诊断有一定作用,骨髓涂片中异常淋巴细胞占全部有核细胞≥1%高度提示DLBCL患者骨髓受累。

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