Goldsby R E, Morgan J G, Egger M J, Feusner J
Department of Pediatrics, University of Utah, Salt Lake City, USA.
Med Pediatr Oncol. 1997 Aug;29(2):98-102. doi: 10.1002/(sici)1096-911x(199708)29:2<98::aid-mpo6>3.0.co;2-m.
The diagnostic criteria for meningeal relapse (MR) of acute lymphoblastic leukemia (ALL) are a cerebrospinal fluid (CSF) chamber count of more than five leukocytes per microliter and a cytomorphological evaluation revealing lymphoblasts. A dilemma arises when confronted with a patient with a low CSF white blood cell (WBC) chamber count and lymphoblasts. We utilized a scoring system to review lymphoblast morphology in 12 such patients. A cell was defined as a lymphoblast if it could not be easily categorized as a lymphocyte, monocyte. histiocyte, or granulocyte. Each lymphoblast was scored on four parameters: presence of nucleoli, homogeneous distribution of chromatin, nucleocytoplasmic ratio greater than 75%, and nuclear irregularity. Cells were scored without knowledge of the patients' out come. Seven patients eventually developed MR by current criteria and five patients never relapsed. The mean lymphoblast scores for patients that did and did not relapse were 2.35 and 1.53, respectively (P < .001). The percent of cells scored as lymphoblasts was also significantly higher in patients that relapsed, 36.9% vs. 19.4% (P = .01). Our study shows that careful cytomorphologic analysis can predict which patients with low chamber counts and "blasts" on cytocentrifuge examination will progress to meningeal relapse. We recommend reviewing the definition of MR and using a scoring system when confronted with blasts in a low chamber count cerebrospinal fluid specimen.
急性淋巴细胞白血病（ALL）脑膜复发（MR）的诊断标准是脑脊液（CSF）每微升腔室计数超过5个白细胞，且细胞形态学评估显示有原始淋巴细胞。当面对脑脊液白细胞（WBC）腔室计数低且有原始淋巴细胞的患者时，就会出现两难局面。我们使用一个评分系统对12例此类患者的原始淋巴细胞形态进行了评估。如果一个细胞不容易被归类为淋巴细胞、单核细胞、组织细胞或粒细胞，则将其定义为原始淋巴细胞。每个原始淋巴细胞根据四个参数进行评分：核仁的存在、染色质的均匀分布、核质比大于75%以及核不规则性。在不知道患者预后的情况下对细胞进行评分。按照当前标准，7例患者最终发生了MR，5例患者从未复发。复发和未复发患者的原始淋巴细胞平均评分分别为2.35和1.53（P<0.001）。复发患者中被评为原始淋巴细胞的细胞百分比也显著更高，分别为36.9%和19.4%（P=0.01）。我们的研究表明，仔细的细胞形态学分析可以预测哪些脑脊液腔室计数低且在细胞离心涂片检查中有“原始细胞”的患者会进展为脑膜复发。我们建议在面对脑脊液标本腔室计数低且有原始细胞的情况时，重新审视MR的定义并使用评分系统。
