26例骨髓转移癌在骨髓涂片上的形态学改变

２６例骨髓转移癌在骨髓涂片上的形态学改变李玲谭咏梅丁凌陆骨髓转移癌临床上并非少见。我院自１９８６年以来经骨髓涂片检查确诊共２６例，报告如下。１临床资料１．１一般资料本组男１６例，女１０例，年龄２２～７３岁，中位数年龄为５１岁。骨髓检查前已确诊原发癌者...     

100例骨髓转移癌骨髓组织病理学的观察

目的：观察100例骨髓转移癌患者骨髓组织病理学的改变,并与骨髓涂片结果进行比较。方法：100例骨髓转移癌患者骨髓检查,行一步法骨髓抽吸取材,石蜡或塑料包埋骨髓组织,切片2μm或3μm厚作HGF或MGG染色,切片5μm厚作Gomori染色,必要时作Masson三色染色,按三种方法各染色1张切片。骨髓涂片行瑞特染色。结果：活检切片的诊断阳性率及判断骨髓增生度等较涂片明显为优。胶原纤维Masson三色染色呈阴性,提示骨髓转移癌并发骨髓纤维化,绝大多数为网硬蛋白型。结论：骨髓活检可作为诊断骨髓转移癌的常规检测手段,能够提高诊断率及评估疗效和预后。     

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     

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。     

骨髓细胞学分类与骨髓活检相结合在全血减少疾病诊断中的意义

 目的 探讨骨髓穿刺涂片联合活检病理切片在全血细胞减少性血液疾病诊断中的临床应用 。方法 筛选同时进行骨髓穿刺涂片及活检的全血细胞减少性血液疾病患者328例,进行回顾性分析。结果 328例患者中男154例,女174例,年龄4-79岁。骨髓活检在再生障碍性贫血（AA）、骨髓增生异常综合症(MDS)、骨髓纤维化(MF)、等方面诊断符合率高于骨髓涂片,有统计学差异（P<0.05）,骨髓活检增生程度的判断优于骨髓涂片。 结论 骨髓穿刺涂片联合骨髓活检病理切片更能客观准确地反映骨髓的真实情况,特别是在恶性血液系统疾病所致全血细胞减少的诊断、鉴别诊断等方面的价值更优于涂片,二者联合检查可以进一步提高全血细胞减少性疾病诊断的准确性。 关键词 全血细胞减少 骨髓涂片 骨髓活检 病理     

骨髓活检在多发性骨髓瘤诊断中的价值

目的:探讨骨髓活检在多发性骨髓瘤(MM)诊断中的价值.方法:同步观察多发性骨髓瘤26例患者骨髓涂片和活检塑料包埋切片.观察骨髓增生程度、浆细胞增殖模式及浸润程度.结果:MM患者骨髓造血组织在切片中的增生度明显高于涂片,两者差异有统计学意义(P<0.05).MM切片中浆细胞以簇片-间质型、结节-间质型、结节型及塞实型浸润为主,以结节出现为阳性诊断标准,其敏感性25例(96.1%) 明显高于涂片中浆细胞>15%的指标(76.9%).结论:骨髓活检能准确反映骨髓组织的增生程度、浆细胞浸润情况及增殖模式,对MM的诊断有重要价值.     

骨髓转移癌24例临床分析

分析1974年10月～1989年9月经骨髓细胞检查确诊的骨髓转移癌24例。其中男性16例,女性8例,年龄34～75岁。10例在确诊后1～3个月死亡,14例病情无改善或恶化自动出院,以后失去联系。本组病例的主要症状为骨病、贫血、发热、出血及消瘦。部分患者周围血出现幼红和/或幼粒细胞。     

骨髓转移癌20例临床分析

为探讨骨髓转移癌瘤细胞形态学特征及患者血像、骨髓像的变化 ,我们回顾性分析我院 1995年 5月～ 2 0 0 3年 1月收治的 2 0例骨髓转移癌的临床资料 ,报告如下。1　材料与方法1.1　临床资料自 1995年 5月～ 2 0 0 3年 1月 ,大连医科大学附属第一医院血液科收治骨髓转移癌 (行骨髓穿刺涂片确诊 ) 2 0例。患者年龄 2 6～ 83岁 ,平均年龄 5 6岁。男性 15例 ,女性 5例。其中 4例 (3例乳腺癌 ,1例胃癌 )是在原发肿瘤得以确诊后发现的 ;其余 16例是在未明确原发性肿瘤前发现。 19例经病理、X线、CT、胃肠镜等检查证实原发肿瘤 :肺癌 8例 ,胃肠癌 …     

Molecular determinants of occult metastatic tumor cells in bone marrow

The success of mammographic screening for breast cancer is that it involves increasingly more patients with small primary tumors formerly thought to have an overall excellent prognosis. Yet, only approximately two thirds of these patients actually have this favorable prognosis, while the remaining third develops metastatic disease. Thus, there is emerging evidence that epithelial tumor cells can disseminate into secondary organs at an earlier stage of primary tumor development than appreciated by current risk classifications. Bone marrow is one of the most prominent secondary organs screened for the presence of disseminated tumor cells. The current data suggest that bone marrow micrometastases represent a selected population of dormant and heterogeneous cancer cells. The analysis of micrometastatic cells opens a new avenue by which to assess the molecular determinants of both early tumor cell dissemination and subsequent outgrowth into overt metastases. Moreover, identifying therapeutic target structures (e.g., HER2/neu), monitoring the elimination of bone marrow micrometastases, and assessing treatment-resistant tumor cell clones might help to understand the current limitations of adjuvant systemic therapy. This review summarizes the current knowledge of the biological characteristics of micrometastatic cancer cells in bone marrow of breast cancer patients.     

c-myc detection in bone marrow biopsies

In the past the fixation procedures employed in the immunohistostaining of paraffin-embedded tissues with anti-myc protein antibodies were unsatisfactory since they permitted the leakage of the protein from its normal nuclear localization in the cell. In the studies described here 3 different fixation methods were compared and it was shown that only one, the AMeX method, was suitable for studying c-myc expression in bone marrow biopsies.     

骨髓活检在诊断及鉴别诊断真性红细胞增多症中的价值

目的：探讨骨髓活检在真性红细胞增多症（PV）诊断与鉴别诊断中的价值.方法：同步观察真性红细胞增多症37例患者骨髓涂片和活检切片.并与继发性红细胞增多症20例患者作比较,以正常人20例作对照.观察骨髓增生程度、增生优势细胞系、网硬蛋白积分.结果：PV组患者骨髓造血组织在切片中的增生度明显高于涂片,两者差异有统计学意义（P〈0.05）;与继发性红细胞增多症及正常对照组比较差异亦有统计学意义（P〈0.05）.PV组切片中增生优势细胞系分为累及三系的增生,累及二系（红系和粒系、红系和巨核系）的增生,仅累及红系单系的增生;继发性红细胞增多症组仅显示红系相对增生.PV组网硬蛋白纤维积分为1＋及以上占83.8%,继发性红细胞增多症组及正常对照组均未见1＋或l＋以上,分别比较差异有统计学意义（均为P〈0.05）.结论：骨髓活检能准确反应骨髓组织的增生程度、增生优势细胞系、纤维增生程度,对PV的诊断及鉴别诊断有较高价值.     

骨髓活检在诊断及鉴别诊断真性红细胞增多症中的价值

目的:探讨骨髓活检在真性红细胞增多症(PV)诊断与鉴别诊断中的价值.方法:同步观察真性红细胞增多症37例患者骨髓涂片和活检切片.并与继发性红细胞增多症20例患者作比较,以正常人20例作对照.观察骨髓增生程度、增生优势细胞系、网硬蛋白积分.结果:PV组患者骨髓造血组织在切片中的增生度明显高于涂片,两者差异有统计学意义(P<0.05);与继发性红细胞增多症及正常对照组比较差异亦有统计学意义(P<0.05).PV组切片中增生优势细胞系分为累及三系的增生,累及二系(红系和粒系、红系和巨核系)的增生,仅累及红系单系的增生;继发性红细胞增多症组仅显示红系相对增生.PV组网硬蛋白纤维积分为1+及以上占83.8%,继发性红细胞增多症组及正常对照组均未见1+或l+以上,分别比较差异有统计学意义(均为P<0.05).结论:骨髓活检能准确反应骨髓组织的增生程度、增生优势细胞系、纤维增生程度,对PV的诊断及鉴别诊断有较高价值.     

全身弥散加权成像对肿瘤转移的诊断意义初探

背景与目的:随着临床上晚期肿瘤病例的增多,为了解治疗前、后全身转移瘤的大小及数量变化的实际情况,以往多采用分部位进行CT和(或)MR扫描,少部分有条件的患者采用PET检查,但这些方法可能存在过多地暴露于射线、检查时间过长及经济负担过重等问题.因此,我们探讨磁共振的全身弥散加权成像(whole body diffusion weighted imaging,WBDWI)方法对肿瘤及转移灶的检出准确性及其临床应用的可行性.方法:对68例临床已发现原发肿瘤及多个转移灶或发现多个肿瘤病灶,但原发灶不明确的患者进行WBDWI检查,其中男性49例;女性19例.平均年龄61岁.68例均与CT和(或)MRI的检查结果进行比较,其中17例与PET的检查结果相比较.对病灶的检出率,以病灶长径大小分为:<1 cm,≥1～<2 cm,≥2～<3 am及≥3cm以上4组进行计数分析,同时,对不同部位间的病灶检出情况进行分析.结果:WBDWI对4组病灶的检出率分别为30%、785、96%及100%.在各个部位的敏感性和准确性中以骨骼最高.对位于肺部小于1 cm的病灶和位于颈部、盆腔小于2 cm的淋巴结的诊断存在一定困难.结论:WBDWI对大范围的肿瘤病灶筛查是安全、简便、有效和经济的检查新方法.随着技术参数的进一步完善,WBDWI在发现和诊断全身多发肿瘤方面,具有良好的发展潜力.因此,本技术有望作为一种新的、效果好于PET的全身检查技术.     

Methodology of bone marrow imaging in diagnosis of skeletal metastatic involvement in cancer patients

The cost-effectiveness of visualization techniques for the entire hemopoietic bone marrow (BM) in diagnosis of tumor involvement of the skeleton was evaluated in 1,200 cancer patients. BM involvement was diagnosed in 199. Generalized involvement detectable by imaging any skeletal region was reported in 72 (31.6%) patients. Focal BM involvement was registered in 127 (68.4%): pelvis--51, femur--29, sternum--25, cervical or sternal region--25 and lumbar--15. When pelvis, sternum, femur and cervico-thoracic spine were imaged, tumors were detected in 90%, 3 regions--62.3-80.1%, 2--50.5-71.1% and 1--38.2-54.6%.     

New method to evaluate the distribution of metastatic tumor cells in bone marrow with bromodeoxyuridine labeling

Background The development of tumor micrometastases as an early event in the distribution of tumor cells to target organs, especially bone marrow, has been difficult to analyze due to a lack of suitably sensitive markers. The inability to discriminate small numbers of tumor cells from normal tissue cell populations has interfered with marker development. Methods To overcome this problem, human prostate cancer cell lines (PC-3) were labeled with bromodeoxyuridine (BrdU) and subsequently injected into athymic nude mice using the tail veins with or without compression of vena cava. Results Using a direct immunoperoxidase method with anti-BrdU monoclonal antibody, the BrdU-labeled tumor cells in the bone marrow stained intensely, while neighboring normal bone marrow cells were not stained. Staining of BrdU-labeled tumor cells is specific and extremely sensitive in detecting tumor cells in metastatic bone marrow. Conclusions These findings demonstrate the effectiveness and sensitivity of BrdU labeling as a maker in experimental studies for early metastatic events and that BrdU labeling provides a tool in virtually any tumor system for examining the distribution of tumor cells in target organs and their relationship to host organ microenvironments.