Turner G E, Reid M M
Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne.
J Clin Pathol. 1993 Jan;46(1):61-3. doi: 10.1136/jcp.46.1.61.
To test the hypothesis that the abnormal fibrous stroma of bone marrow found after treatment of disseminated neuroblastoma represents traumatic scarring.
Twenty six restaging bone marrow biopsy specimens from 14 children with disseminated neuroblastoma were compared with 37 from 37 children with acute lymphoblastic leukaemia. They were assessed independently by two observers for the presence of abnormal fibrous stroma. All biopsies were performed 23 to 50 days after the initial diagnostic biopsy, and from the same iliac crest. A further nine restaging bone marrow biopsy specimens from previously unbiopsied iliac crests from four children with neuroblastoma were examined and the appearances of the diagnostic bone marrow specimens in those with neuroblastoma recorded. Between diagnostic and restaging biopsies, the children received combination chemotherapy regimens.
In neuroblastoma abnormal stromal material was observed in 17 of 26 rebiopsied iliac crests as opposed to only 9 of 37 of those with acute lymphoblastic leukaemia (p < 0.005). In addition, four of nine restaging biopsy specimens taken from previously unbiopsied crests in patients with neuroblastoma contained abnormal stroma. All 11 children with neuroblastoma whose restaging specimens contained abnormal stroma had similar abnormalities in one or more biopsy specimens at diagnosis.
Abnormal fibrous stromal material in restaging marrow biopsy specimens of previously biopsied iliac crests occurs much more frequently in neuroblastoma than in acute lymphoblastic leukaemia. We suggest that factors other than traumatic scarring are responsible. This is supported by finding similar abnormalities in previously unbiopsied iliac crests and in the diagnostic biopsy specimens of children with neuroblastoma.
验证以下假说，即播散性神经母细胞瘤治疗后骨髓中异常纤维性基质代表创伤性瘢痕形成。
将14例播散性神经母细胞瘤患儿的26份再分期骨髓活检标本与37例急性淋巴细胞白血病患儿的37份骨髓活检标本进行比较。由两名观察者独立评估是否存在异常纤维性基质。所有活检均在初次诊断性活检后23至50天进行，取材于同一髂嵴。另外检查了4例神经母细胞瘤患儿先前未活检过的髂嵴处的9份再分期骨髓活检标本，并记录了神经母细胞瘤患儿诊断性骨髓标本的表现。在诊断性活检和再分期活检之间，患儿接受联合化疗方案。
在神经母细胞瘤中，26份再次活检的髂嵴标本中有17份观察到异常基质物质，而急性淋巴细胞白血病患儿的37份标本中只有9份出现这种情况（p<0.005）。此外，4例神经母细胞瘤患儿先前未活检过的髂嵴处的9份再分期活检标本中有4份含有异常基质。所有11例再分期标本含有异常基质的神经母细胞瘤患儿在诊断时的一份或多份活检标本中都有类似异常。
在先前活检过的髂嵴的再分期骨髓活检标本中，异常纤维性基质物质在神经母细胞瘤中出现的频率远高于急性淋巴细胞白血病。我们认为创伤性瘢痕形成以外的因素起了作用。这一点得到了在先前未活检过的髂嵴以及神经母细胞瘤患儿诊断性活检标本中发现类似异常的支持。
