Choe J K, Hyun B H, Salazar G H, Ashton J K, Sung C Y
Am J Clin Pathol. 1984 Jan;81(1):19-24. doi: 10.1093/ajcp/81.1.19.
Ten cases of epithelioid granulomas in the bone marrow of patients with various non-Hodgkin's lymphoproliferative malignancies have been encountered. These included six with non-Hodgkin's lymphoma (three histiocytic and three poorly differentiated lymphocytic types), three with multiple myeloma, and one with acute lymphoblastic leukemia. The bone marrow was not involved by the primary disease in two of the six patients with lymphoma, whereas three with lymphoma showed both granulomatous and lymphomatous lesions in the same marrow specimens, and in one, these lesions were seen in the marrow at different times. The three myeloma patients showed evidence of both myeloma and granulomas in their marrow. In the case of acute lymphoblastic leukemia, the bone marrow showed only granulomas, the leukemic process being in complete remission. Although small numbers of similar cases have been reported before, the authors were unable to find a previous report of acute lymphoblastic leukemia associated with bone marrow granulomas. Although the pathogenesis and the clinical significance of the granulomatous lesion of the bone marrow in non-Hodgkin's lymphoproliferative malignancies are unknown, this lesion should be differentiated from infectious or lipid granulomas as well as from involvement by the primary disease.
我们遇到了10例患有各种非霍奇金淋巴瘤增殖性恶性肿瘤患者骨髓中的上皮样肉芽肿病例。其中包括6例非霍奇金淋巴瘤（3例组织细胞型和3例低分化淋巴细胞型）、3例多发性骨髓瘤和1例急性淋巴细胞白血病。6例淋巴瘤患者中有2例的骨髓未被原发性疾病累及，而3例淋巴瘤患者在同一骨髓标本中同时出现了肉芽肿性和淋巴瘤性病变，1例在不同时间的骨髓中发现了这些病变。3例骨髓瘤患者的骨髓中显示出骨髓瘤和肉芽肿的证据。在急性淋巴细胞白血病病例中，骨髓仅显示肉芽肿，白血病进程处于完全缓解状态。尽管之前已有少量类似病例的报道，但作者未能找到先前关于急性淋巴细胞白血病合并骨髓肉芽肿的报道。虽然非霍奇金淋巴瘤增殖性恶性肿瘤中骨髓肉芽肿性病变的发病机制和临床意义尚不清楚，但这种病变应与感染性或脂质肉芽肿以及原发性疾病的累及相鉴别。
