McKenna R W, Parkin J L, Foucar K, Brunning R D
Cancer. 1981 Aug 1;48(3):725-37. doi: 10.1002/1097-0142(19810801)48:3<725::aid-cncr2820480312>3.0.co;2-f.
Leukemic cells from 13 patients with therapy-related acute nonlymphocytic leukemia (ANLL) were studied by electron microscopy. All of the patients had radiotherapy, and/or alkylating agent chemotherapy for other neoplastic disease 25 to 182 months prior to the diagnosis of ANLL. All cases manifested ultrastructural evidence of a panmyelopathy. All marrow cell lines exhibited nuclear--cytoplasmic asynchrony and abnormalities of cell size. Developing granulocytes exhibited decreased primary and/or secondary granule formation and abnormal granules characterized by irregular shape, large size and internal membranous lamellae. Monocytes showed perinuclear bundles of microfilaments. In some cases, the predominant leukemic blasts showed evidence of early basophil granule development which was not appreciated in light microscopy. Abnormalities in erythroid cells included abundant intracristal mitochondrial iron, large vacuoles, infoldings of redundant membrane and membrane-bound nuclear blebs and intranuclear clefts. Megakaryocytes manifested decreased numbers of granules and demarcation membranes. Excessively large platelets with decreased or abnormal granules were identified; giant compound granules with irregular contour and variable electron density were present. Several of the changes in the developing hematopoietic cells were similar to those described in preleukemia and in certain nonneoplastic disorders. The consistent panmyelosis in therapy-related ANLL together with several uniform clinical features defines a specific clinicopathologic entity.
对13例治疗相关性急性非淋巴细胞白血病（ANLL）患者的白血病细胞进行了电子显微镜研究。所有患者在ANLL诊断前25至182个月曾因其他肿瘤性疾病接受过放疗和/或烷化剂化疗。所有病例均表现出全髓病的超微结构证据。所有骨髓细胞系均表现出核质不同步和细胞大小异常。发育中的粒细胞表现出初级和/或次级颗粒形成减少，以及颗粒异常，其特征为形状不规则、体积大且内部有膜性板层。单核细胞显示核周微丝束。在某些病例中，主要的白血病原始细胞显示出早期嗜碱性粒细胞颗粒发育的证据，这在光学显微镜下未被发现。红系细胞的异常包括线粒体内嵴丰富的铁、大空泡、多余膜的折叠以及膜结合的核泡和核内裂隙。巨核细胞表现出颗粒和分界膜数量减少。发现有颗粒减少或异常的过大血小板；存在轮廓不规则且电子密度可变的巨大复合颗粒。发育中的造血细胞的几种变化与白血病前期和某些非肿瘤性疾病中描述的变化相似。治疗相关性ANLL中一致的全髓病以及一些一致的临床特征定义了一种特定的临床病理实体。
