Department of Pathology, University of Health Sciences, Izmir Tepecik Research and Training Hospital, IZMIR, TURKEY.
Turk Patoloji Derg. 2022;38(2):99-105. doi: 10.5146/tjpath.2021.01556.
Neuroblastoma (NB) is the most common extracranial solid tumor in children and is responsible for 12% of cancer-related deaths. The status of metastatic disease in the bone marrow (BM) is a predictor of poor outcome. The purpose of this study was to investigate the predictive significance of histopathological examination of BM in NB.
The study included 61 cases with archival bone marrow biopsy tissues. The cases were evaluated regarding the percentage of metastatic tissue and its differentiation. Primary tumor slides were also reviewed to perform the Shimada classification based on the differentiation status and mitosis-karyorrhexis index. The patients' age, gender, NMYC amplification, clinical risk group, and disease outcome were also noted.
Of the 61 cases, 17 had BM involvement. Of those, eight cases (47.1%) were refractory NB showing disease relapse. Based on BM examination, five cases (29.4%) were categorized as complete response, seven (41.2%) as progressive disease, three (17.6%) as minimal disease, and two (11.8%) as stable disease. The progressive disease category was significantly related with refractory disease and NMYC amplification along with the high-risk category (p =0.002 and p= 0.003 respectively). Undifferentiated histology and presence of more than 20% of tumor tissue in the BM biopsy at diagnosis were significantly associated with the progressive disease category (p=0.01 and p < 0.001, respectively).
We conclude that evaluating the percentage of metastatic tumor tissue and tumor differentiation in BM biopsies is of clinical importance in the management of neuroblastoma patients.
神经母细胞瘤（NB）是儿童中最常见的颅外实体瘤，占癌症相关死亡人数的 12%。骨髓（BM）中转移性疾病的状态是预后不良的预测指标。本研究旨在探讨 BM 组织学检查对 NB 的预测意义。
本研究纳入了 61 例存档的骨髓活检组织病例。评估了转移性组织及其分化的百分比。还回顾了原发性肿瘤切片，根据分化状态和有丝分裂-核碎裂指数进行 Shimada 分类。记录了患者的年龄、性别、NMYC 扩增、临床风险组和疾病结局。
在 61 例病例中，有 17 例存在 BM 受累。其中 8 例（47.1%）为难治性 NB，表现为疾病复发。根据 BM 检查，5 例（29.4%）被归类为完全缓解，7 例（41.2%）为进展性疾病，3 例（17.6%）为微小疾病，2 例（11.8%）为稳定疾病。进展性疾病类别与难治性疾病和 NMYC 扩增以及高危类别显著相关（p=0.002 和 p=0.003）。未分化组织学和诊断时 BM 活检中肿瘤组织比例超过 20%与进展性疾病类别显著相关（p=0.01 和 p<0.001）。
我们得出结论，评估 BM 活检中转移性肿瘤组织和肿瘤分化的百分比在神经母细胞瘤患者的管理中具有临床重要性。
