骨髓活检在骨髓增生异常综合征诊断中的价值

近几年来,骨髓组织病理学检查日益普遍。在骨髓活检中,病理诊断为骨髓增生异常综合征(MDS)病例数不断增多。本文就骨髓活检对MDS诊断价值作一初步分析。材料与方法一、病人:共55例(男28、女27)均系我院住院病人。其中临床诊断为MDS48例;再生障碍性贫血(再障)3例;急性粒细胞缺乏症2例;病毒感染和浸润性肺结核各1例。各疾病的临床诊断均依其相应的全国诊断标准,由我院血液科医师和有关专科医师     

骨髓穿刺涂片与骨髓活检切片同步分析对诊断骨髓增生异常综合征的临床意义

目的:探讨骨髓穿刺涂片与骨髓活检切片同步观察对诊断骨髓增生异常综合征(MDS)的临床意义.方法:50例MDS病人采用骨髓抽吸、活检双标本一步法取材,同步观察其涂片和切片.结果:活检切片对骨髓增生程度的判断优于穿刺涂片.粒系、巨核系病态造血的检出率,活检切片高于穿刺涂片;红系病态造血的检出率,穿刺涂片高于活检切片.网状纤维增生的观察,活检切片优于穿刺涂片.结论:活检切片和穿刺涂片同步分析比常规穿刺涂片形态学观察更有利于提高MDS诊断的准确性.     

骨髓增生异常综合征诊断与分期的探讨：附116例临床分析

报告ＭＤＳ１６６例，其中ＲＡ１２２例（７３．５％），ＲＡＳ５例（３％），ＲＡＥＢ２５例（１５％），ＣＭＭＬ１例（０．６％），ＲＡＥＢ－Ｔ１３例（７．９％）。并对其诊断标准，分期和治疗等进行了讨论。Ｂｅｎｎｅｔｔ改良的ＦＡＢ诊断与分型标准已被广泛应用，本文虽按此标准进行统计，但本文认为：①ＦＡＢ的５个亚型不是独立的，而是同一疾病病程发展的不同阶段；②ＣＭＭＬ实际为白血病，不宜划入ＭＤＳ范畴；③ＲＡＳ     

骨髓增生异常综合征58例临床分析

骨髓增生异常综合征(myelodysplastic syndrome,MDS)是一种源于多能造血干细胞的恶性克隆性疾病,现将我院1994年6月-2000年4月收治的58例MDS分析报道如下.     

骨髓活检在预测MDS预后中的意义

报告２４例骨髓增生异常综合征骨髓活检结果与预后的关系，结果：骨髓活检与骨髓涂片所见大致相同，但前者对粒系、巨核细胞系病态造血诊断率更高，对ＡＬＩＰ及合并纤维化是唯一的诊断手段；活检时造血细胞中红系占优者预后好，粒系占优伴ＡＬＩＰ阳性者预后差，巨核细胞增生常伴骨髓纤维增生，预后亦差。     

WHO骨髓增生异常综合征的诊断

骨髓增生异常综合征(MDS)为一组克隆性造血干细胞疾病,特点为≥1系髓系细胞有病态和无效性以致外周血≥1系血细胞减少的疾病,昔称白血病前期、少原始细胞白血病和髓系生成异常综合征.     

骨髓增生异常综合征14例误诊分析

对我院 1 995年 1月 - 2 0 0 2年 1 1月首诊误诊的 1 4例骨髓增生异常综合征 (MDS)进行分析 ,以期提高对本病的认识 ,减少误诊误治。1　临床资料1 .1　一般资料本组 1 5例MDS为门诊及住院患者 ,其中首诊误诊 1 4例 ,误诊率为 93 33 %。 1 4例中男 9例 ,女 5例 ;年龄 42～ 73岁 ,平均 65岁。误诊时间最短 1个月 ,最长 6个月。第 1次骨髓检查确诊 4例 ,第 2次骨髓检查确诊 1 0例。确诊为难治性贫血(RA) 1 1例 ,难治性贫血伴原始细胞增多 (RAEB) 2例 ,难治性贫血伴原始细胞增多 -转变型 (RAEB T) 1例。所有患者均有不同程度贫血 ,其中轻…     

骨髓增生异常综合征14例误诊分析

对我院1995年1月—2002年11月首诊误诊的14例骨髓增生异常综合征(MDS)进行分析，以期提高对本病的认识，减少误诊误治。     

骨髓GMA塑料包埋切片在骨髓增生异常综合征诊断中的特殊价值

骨髓病理检查在骨髓异常增生综合征(MDS)诊断中的重要性正日益引起重视.塑料包埋切片由于能完好地保存骨髓造血细胞、间质细胞以及支架结构的形态,故而在判断红、粒、巨三系病态造血和间质异常反应等方面具有特殊的意义[1].我们对我院1994年6月-1999年6月收治的46例MDS的乙二醇甲基丙烯酸酯(GMA)塑包切片的研究结果作一总结与分析.     

133 例恶性淋巴瘤骨髓细胞学分析

目的：探讨恶性淋巴瘤骨髓浸润的临床特点。方法：回顾性分析133 例经病理确诊的恶性淋巴瘤病例,分析其骨髓浸润情况。结果：133 例恶性淋巴瘤患者中骨髓受累率为21.8%（29/133）;在骨髓受累的病例中,淋巴肉瘤性白血病、骨髓侵犯、淋巴瘤细胞比例未达5% 的病例分别占31.0%（9/29）、55.2%（16/29）和13.8%（4/29）。 在29例骨髓受累病例中,B 细胞淋巴瘤占55.2%（16/29）,T/NK细胞淋巴瘤占41.4%（12/29）,霍奇金病占3.4%（1/29）。 T/NK细胞淋巴瘤的骨髓受累率为37.5%（12/32）,比B 细胞淋巴瘤要高18.2%（16/88）,两组具有统计学差异。结论：恶性淋巴瘤骨髓浸润比例高,不同的病理学类型骨髓受累的风险不一,总体而言T 细胞淋巴瘤的骨髓浸润率更高,而且以淋巴肉瘤性白血病多见,骨髓细胞学检查对恶性淋巴瘤的正确分期、治疗方案的选择和预后判断有重要的意义。     

Acute Megakaryoblastic Leukemia: Importance of Bone Marrow Biopsy in Diagnosis

Five cases of megakaryoblastic leukemia, presenting as “de novo” acute leukemias are reported. They represented 7.2% of all cases of adult acute non-lymphoblastic leukemias (ANLL) seen in our Hematology Service during the past 30 months. These cases showed features of predominantly blast proliferation with a marked increase of reticulin fibres in the bone marrow. One case had features of acute leukemia with trilineage myelodysplasia and one had a more chronic evolution with splenomegaly initially resembling a myeloproliferative syndrome. In all cases, the definitive diagnosis was made on bone marrow histology as cytology was poor and the blast cells were positive for factor VIII with the immunoperoxidase technique. The importance of bone marrow histology is emphasized.     

Bone Marrow Biopsy Changes in the Iliac Bone Mimicking Multiple Colonic Polypi

Many different entities simulating colonic polyps on barium enema examination have been described. Of the extraluminal mimics, round bony structures such as vertebral pedicles are perhaps best known. We describe the cause of a previously undescribed artifact: bone marrow biopsy of the ilium.     

不同骨髓检查在淋巴瘤诊断中的价值

探讨3种骨髓检查方法（骨髓涂片、活检、流式细胞术分析）对淋巴瘤骨髓浸润的诊断及分期价值。方法：对74例患者进行3种方法的骨髓检查,评估不同方法的检出率、对分期的影响以及各亚型中骨髓浸润的风险。结果：骨髓涂片阳性者12例（16.2%）,骨髓活检阳性10例（13.5%）,流式细胞术分析阳性23例（31.1%）,流式细胞术分析的阳性率显著高于涂片和活检检查（P<0.05）;骨髓涂片、活检、流式细胞术分析可互相修正淋巴瘤患者的临床分期;弥漫大B细胞淋巴瘤亚型骨髓浸润比例最高;对于无淋巴结、肝脾肿大者,骨髓检查具有明确诊断的作用。结论：骨髓涂片、活检及流式细胞术分析对淋巴瘤有重要的诊断及分期价值,三者互为补充,不能相互替代。     

Myelodysplastic Syndrome Associated with Bone Marrow Fibrosis

Bone marrow biopsy (BMB) in myelodysplastic syndrome (MDS) frequently reveals a slight alteration in the reticulin stroma which does not have any clinical significance. However, in a minority of cases, full-blown bone marrow fibrosis (BMF) can be found.

Primary MDS patients with BMF show distinct clinico-pathological features and an unfavourable prognosis mainly attributable to complications deriving from pancytopenia and continuous transfusions, while leukemic transformation occurs only rarely. Since BMF may characterize other hematological disorders, primary MDS with BMF should be included in the differential diagnosis particularly with malignant myelofibrosis (MM) and idiopathic myelofibrosis (IMF).

Secondary MDS with BMF represent a variety of preleukemic conditions in subjects treated for previous neoplasias. Unlike the primary forms, they do not form a clearcut clinico-pathological entity.     

Application of Long-Term Bone Marrow Cultures for Studying the Leukemic Transformation of Myelodysplastic Syndromes

Myelodysplastic syndrome (MDS) has been thought to be an identifiable early stage in mul-tistep leukemogenesis. Considerable numbers of patients with MDS eventually develop acute myelogenous leukemia (AML), which is very much more difficult to manage than typical de-novo AML. There are several differences in both the clinical and biological behavior of AML with and without prior MDS. We have established an unique long-term bone marrow culture (LTBMC) system which allows abnormal cells to grow in preference to normal cells, based on the method originally described by Dexter et al. Leukemic transformations occur more frequently in MDS patients with abnormal karyotypes, and particularly those with multiple abnormalities. New cytogenetic abnormalities were occasionally observed at the time of transition to AML. We have applied this LTBMC system for cytogenetic and molecular studies on the leukemic transformation from MDS. Among the 32 patients with MDS studied thus far, novel abnormal karyotypes were detected during the LTBMCs in 15 patients. Furthermore, 6 out of 23 novel karyotypes detected during the in-vitro cultures emerged in vivo, one to 11 months later in 4 patients. In addition, point mutation of the N-ras proto-oncogene was observed in 3 of 18 cases. The signal of the dot-blot hybridization was increased in one examined case after 2 weeks in culture. Thus, this LTBMC system may provide some promising information with respect to understanding the multistep process from the preleukemic stage to the development of overt leukemia as well as its prognostic relevance.     

The Effect of Lavender Aroma on Anxiety of Patients Having Bone Marrow Biopsy

Introduction: Bone marrow biopsy is a common procedure for the diagnosis and treatment of hematologic diseases and tumors, which are associated with anxiety. The purpose of this study was to examine the effect of lavender aroma on anxiety of patients having bone marrow biopsy. Materials and Methods: This study was performed on 80 patients referred to Vali-e-Asr Hospital for bone marrow biopsy. Samples were selected by convenience method and were assigned into intervention and control groups using randomized blocks of 4. Random sequence was generated by RAS software. Several drops of distilled water on a cotton ball was used in the control group and same amount of lavender essential oil on a cotton ball was used in the intervention group. Then, participants in both groups were asked to smell the cotton ball for 15 minutes and then, their anxiety level was measured immediately. The results were analyzed by SPSS software version 25 using covariance analysis and rank regression. Results: The results showed that, the mean scores of anxiety in the control and intervention groups were 6.3 ± 1.92 and 3.75 ± 1.05, respectively. There was a significant difference (p <0.05) between the two groups in terms of anxiety score.The results showed that there was a significant difference in anxiety score between two groups in terms of variables such as age, gender, physician experience, biopsy history and biopsy site (P <0.05). The results also showed no significant difference between the (p >0.05). Conclusion: The results of this study showed that bone marrow biopsy is associated with anxiety, and smelling of lavender aroma is effective in reducing anxiety in patients undergoing this procedure. This fragrance can be used by treatment team in hematology and oncology clinics to reduce anxiety caused by bone marrow biopsy.     

Impact of Day 14 Bone Marrow Biopsy on Re-Induction Decisions and Prediction of a Complete Response in Acute Myeloid Leukemia Cases

Background: With acute myeloid leukemia (AML), there are limited data about the accuracy of day 14 bone marrow (BM) biopsies for predicting complete remission as compared to day 28 BM biopsy results. We here aimed to estimate the correlation between, and the diagnostic accuracy of, both approaches. Materials and Methods: We reviewed 84 patients with AML treated with standard induction chemotherapy to evaluate the remission rate and treatment decisions based on day 14 BM biopsy from 2000-2012. Results: Sixty five patients (77%) demonstrated remission (CR) with less than 5% blasts on their day 14 BM. Thirteen patients (16%) had residual disease (RD), and 6 (7%) were classified as indeterminate response (IR) i.e., blasts 5-20%. Two patients with RD on day 14 underwent re-induction. Out of the 17 remaining cases with RD+IR, 14 (all 6 with IR and 8 out of 11 with residual disease with no re-induction) demonstrated a morphologic complete remission (CR) on day 28 BM. The percentages for complete remissions on days 28 and 14 were significantly different [94% versus 79.3%, respectively; p=0.004, (OR= 0.143, 95% CI: 0.032-0.63)]. Day 14 BM had 82% sensitivity in predicting CR on Day 28; however, it had insufficient specificity (60%) in predicting failure of CR. Conclusions: Induction treatment response assessment based on day 14 BM does not accurately predict the response rate on day 28 and the use of day 14 BM as a sole marker of response to therapy might expose patients to unnecessary interventions.     

小细胞肺癌骨髓转移29例临床分析

目的探讨小细胞肺癌(SCLC)骨髓转移的临床特征、治疗方法及预后影响因素。方法回顾性分析29例SCLC骨髓转移病例的临床资料,应用SPSS10.0软件包分析其预后影响因素。结果29例SCLC患者中位年龄为52岁。诊断为局限期(LD)11例,广泛期(ED)18例。出现临床症状到确诊为SCLC的中位时间是2个月,诊断SCLC后到确诊骨髓转移的中位时间是20天。全组患者中位生存期为6个月(2～19个月),确诊骨髓转移后中位生存期为5个月(10天～18个月)。患者生存期与临床分期、发病部位、转移部位数目、含铂类化疗方案及骨髓缓解无关。采用含足叶乙甙(VP16)的化疗方案、联合放疗与患者生存期密切相关。结论SCLC骨髓转移后生存期短,治疗仍以化疗为主的综合治疗。采用含VP16的化疗方案、联合放疗对SCLC骨髓转移的预后较好。