1例前列腺胚胎性横纹肌肉瘤骨髓转移后细胞形态学分析并文献复习

目的：分析前列腺胚胎性横纹肌肉瘤（embryonal rhabdomyosarcoma,ERMS）骨髓转移后细胞形态学特点,探讨其作为辅助临床分期和治疗的潜在价值.方法：1例前列腺ERMS患者抽取骨髓,行细胞涂片,采用常规瑞氏染色、过氧化物酶染色、糖原染色,对骨髓中ERMS细胞形态学特征及细胞化学染色结果进行分析.并复习相关文献,结合其临床表现、病理学检查、治疗及国内外研究进展等方面进行讨论.结果：该患者骨髓象示粒、红、巨三系增生明显受抑,瘤细胞占66％,散在或成团分布；胞体大小不一,胞浆量丰富,色深蓝,易见较多空泡,边缘可见瘤状突起；胞核较大,双核及多核可见；核染色质粗糙疏网状,核仁大而明显.细胞化学染色示瘤细胞过氧化物酶染色阴性,糖原染色粗细不等颗粒状阳性.结论：前列腺ERMS通过对患者原发部位病理活检结合相关免疫组化结果可以确诊.当外周血出现至少一系减低或可见幼红、幼粒细胞时应考虑肿瘤骨髓转移的可能,及时行骨髓细胞学检查,细胞形态及化学染色结果符合ERMS细胞特征,从而为临床分期及治疗提供可靠依据.

Cell morphological analysis on a case of prostate embryonal rhabdomyosarcoma with bone marrow metastasis and review of the literature

Objective：To investigate the morphological features of bone marrow Rhabdomyosarcoma（RMS） cells in patients with embryonal rhabdomyosarcoma （ERMS） and bone marrow metastasis,and to investigate the potential value for clinical staging and treatment.Methods：To collect anterior superior iliac bone marrow from a prostate ERMS patient and made cell smear.To apply routine wright staining,peroxidase stain,and Periodic Acid-Schiff stain to anylaze the cell morphological and cytochemical staining features.Discussions were focused on the clinical manifestation,pathologic feature,treatment and research progress of the disease.Results：In this case,bone marrow image showed tablets,red and giant three-line proliferation was inhibited.66％ cells were neoplastic cells which scatteredly or agglomerately distributed in bone marrow smear.The size of the neoplastic cells body was different,cytoplasm was rich,color dark blue,more vacuoles were noticeable,cytoplasmic edge was easy to see tubercule,nucleus comparatively large,binucleated and multinucleated tumor cells were visible,nuclear chromatin were like sparse mesh coarse,nucleoli was big and clear.Cytochemical staining showed negative for peroxidase staining of tumor cells and coarse granular positively for Periodic Acid-Schiff staining.Conclusion：The diagnosis of ERMS was confirmed on the results combined with pathology biopsy at the primary site of tumor and related immunochemistry results.When the peripheral blood appear to reduce at least a series or found erythroblasts or immature granulocytes,should consider the possibility of bone marrow metastatic tumors,and bone marrow cytomorphology examination shoud be performed in time.If tumor cells can be seen were scattered or into a mass in bone marrow,combine the cell morphology and cytochemical staining features can confirm the diagnosis result,in order to provide a reliable basis for clinical staging and treatment.