Krause J R
South Med J. 1977 Sep;70(9):1072-4, 1079. doi: 10.1097/00007611-197709000-00019.
Amyloid involvement of the bone marrow is not commonly diagnosed before necropsy. Paraffin sections of the trephine bone biopsy specimen are superior to marrow aspiration cell smears for the antemortem diagnosis. Thirteen cases of amyloidosis were diagnosed from the bone biopsy specimen during a ten-year period. Amyloid was detected in only two of the corresponding aspirates. Three morphologic patterns of marrow involvement were found: vascular, focal extravascular/perivascular, and diffuse. Five (38%) of the cases were associated with multiple myeloma. An abnormal immunoglobulin was detected in the serum or urine or both in ten of 11 cases when determined. Although the bone marrow may not be the best site for the diagnosis of amyloidosis, it should not be neglected and marrow biopsies taken for other diagnostic reasons may "incidentally" reveal amyloid. Amyloidosis should be included in the list of non-primary hematologic conditions of the bone marrow in which the trephine biopsy may prove useful for diagnosis.
骨髓淀粉样变在尸检前通常难以诊断。对于生前诊断，环钻骨髓活检标本的石蜡切片优于骨髓穿刺涂片。在十年期间，从骨髓活检标本中诊断出13例淀粉样变。在相应的穿刺物中仅检测到两例淀粉样变。发现骨髓受累有三种形态学模式：血管型、局灶性血管外/血管周围型和弥漫型。5例（38%）与多发性骨髓瘤相关。在11例进行检测的病例中，10例在血清或尿液或两者中检测到异常免疫球蛋白。尽管骨髓可能不是诊断淀粉样变的最佳部位，但不应被忽视，因其他诊断原因进行的骨髓活检可能“偶然”发现淀粉样变。淀粉样变应列入骨髓非原发性血液系统疾病清单，其中环钻活检可能对诊断有用。
