Maisel D, Lim J Y, Pollock W J, Yatani R, Liu P I
Department of Pathology, University of South Alabama Medical Center, Mobile 36617.
Ann Clin Lab Sci. 1988 Mar-Apr;18(2):109-15.
Bone marrow necrosis is a poorly understood and frequently an unrecognized finding in routine bone marrow biopsies. Previous reports indicate the incidence of bone marrow necrosis ranges from 0.5 percent (rare) to approximately one-third of all bone marrow biopsies examined. Our studies indicate that the presence of bone marrow necrosis depends on the clinical condition of the patient. Overall, our incidence of bone marrow necrosis was 37 percent of the bone marrow biopsies examined. Of these, 26.4 percent was mild. 7.5 percent moderate, and 3.1 percent severe necrosis. The mechanism in most cases had an identifiable underlying etiology such as a malignancy, or vascular or cytotoxic damage, with a small percentage being unexplained. Bone marrow necrosis is seen across a wide range of conditions, including sickle cell diseases, AIDS, leukemia, lymphoma, metastatic carcinoma, anemia, sepsis, and other systemic diseases. Patients at the extremes of age, less than 20 years and greater than 70 years, usually demonstrate only small foci of necrosis (Grade I). Moderate (Grade II) and severe (Grade III) bone marrow necrosis are often associated with life threatening illnesses, with most of these being hematologic malignancies or bone marrow metastases. The prognosis associated with bone marrow necrosis seems to be dependent on the underlying primary clinical condition regardless of the degree of necrosis observed.
骨髓坏死在常规骨髓活检中是一种了解甚少且常常未被识别的发现。既往报告显示，骨髓坏死的发生率在0.5%（罕见）至所有接受检查的骨髓活检病例的约三分之一之间。我们的研究表明，骨髓坏死的存在取决于患者的临床状况。总体而言，我们所检查的骨髓活检中骨髓坏死的发生率为37%。其中，26.4%为轻度坏死，7.5%为中度坏死，3.1%为重度坏死。大多数情况下，其机制有可识别的潜在病因，如恶性肿瘤、血管或细胞毒性损伤，少数情况病因不明。骨髓坏死可见于多种病症，包括镰状细胞病、艾滋病、白血病、淋巴瘤、转移性癌、贫血、败血症及其他全身性疾病。年龄极端的患者，即小于20岁和大于70岁者，通常仅表现为小灶性坏死（I级）。中度（II级）和重度（III级）骨髓坏死常与危及生命的疾病相关，其中大多数为血液系统恶性肿瘤或骨髓转移瘤。与骨髓坏死相关的预后似乎取决于潜在的原发性临床状况，而与观察到的坏死程度无关。
