免疫组化联合基因重排检测对发热待查伴骨髓分类不明细胞的诊断价值

目的:探讨发热待查伴有骨髓中发现分类不明细胞免疫组化联合基因重排检测的诊断价值。方法:对23例长期发热并骨髓或外周血中有分类不明细胞浸润的患者分离骨髓或外周血的单个核细胞进行免疫组化染色和基因重排检测。结果:23例患者中,诊断为非霍奇金淋巴瘤12例,其中滤泡性淋巴瘤(FL)3例、套细胞淋巴瘤(MCL)1例、弥漫性大B细胞淋巴瘤(DLBCL)2例、间变性大细胞淋巴瘤-T(ALCL)3例、血管免疫母细胞性T细胞淋巴瘤(AITCL)1例,侵袭性NK细胞白血病/淋巴瘤(ANKCL)1例,恶性组织细胞病1例;2例结合脾脏病理学诊断SLE;诊断为骨髓转移癌5例;4例未能确诊。结论:联合运用免疫组化和基因重排技术对长期发热并骨髓分类不明细胞浸润患者有一定的诊断价值。

Value of Gene Rearrangement and Immunohistochemistry Assay on Diagnosing Fever Of Unknown Origin with unidentified Unknown Cell Infiltration in Bone Marrow

To study the significance of gene rearrangement and immunohistochemistry assay on diagnosing fever of unknown origin with unidentified cell infiltration in bone marrow. Methods: Bone marrow cells of 23 cases with fever of unknown origin with bone marrow infiltration by unidentified cell were studied by using polymerase chain reaction (PCR) to detect clonal IgH and TCR gene rearrangement and immunohistochemical staining. Results: Twelve were diagnosised as non-Hodgkin's lymphoma (NHL), including 3 follicular lymphoma, 1 mantle cell lymphoma, 2 diffuse large B-cell lymphoma, 3 anaplastic large cell lymphoma, 1 angioimmunoblastic T-cell lymphoma, 1 aggressive NK cell leukemia/lymphoma and 1 malignant histiocytosis. Two were diagnosised as systemic lupus erythematosus. Five were bone marrow metastatic tumors. Four were not achieved final diagnosis. Conclusion:It is concluded that combined use of gene rearrangement and immunohistochemistry technique may be of some diagnostic values for diagnosing fever of unknown origin with unidentified cell infiltration in bone marrow.